Inspection on 17/02/09 for Glenkealey Residential Home

This inspection was carried out on 17th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Glenkealey Residential Home 11/12/07

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Glenkealey Residential Home Upper Hermosa Road Teignmouth Devon TQ14 9JW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Judy Hill     Date: 1 7 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Glenkealey Residential Home Upper Hermosa Road Teignmouth Devon TQ14 9JW 01626774214 01626774214 glenkealey@saffroncare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Saffron Care Ltd Name of registered manager (if applicable) Miss Stephanie Kent Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 15. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Glenkealey Residential Home is registered to provide accommodation and care for a maximum of fifteen people who are elderly. The current owners, Saffron Care Limited, brought the business as a going concern were registered in July 2007. The registered manager is Stephanie Kent. Information about the service is available in a Statement of Purpose and a Service Users Guide. Copies of previous inspection reports can be found on the CSCI Website. Care Homes for Older People Page 4 of 28 care home 15 Over 65 15 0 Brief description of the care home The home is situated in a residential area of Teignmouth, it is on a bus route and is less than a mile from the town centre, railway station and beach. The fees range from 360 to 465 pounds a week. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection ended with an unannounced site visit that was carried out by one inspector and an Expert by Experience on 17th February 2009. An Expert by Experience is a person who is not directly employed by the Commission for Social Care Inspection but commissioned through a voluntary organisation, in this case Help the Aged, because they have either experienced living in a care home or been close to someone who has. The Expert by Experience spent over three hours in the home talking to the people who live there. He made observations about the premises and about the way the staff work with people. Care Homes for Older People Page 6 of 28 The information contained in this report was gained from the Service Users Guide, the Expert by Experiences report, an Annual Quality Assurance Assessment that had been completed by the manager, surveys that had been completed and returned to the Commission by some of the people who use the service and some of the staff. Additional information was gained during the site visit by a tour of the premises and in conversation with one of the registered owners, the staff and the residents. Some of the homes records were inspected including residents care plans, reviews and risk assessments, and staff recruitment and training records. The medication administration records were seen and a meal was sampled. What the care home does well: What has improved since the last inspection? The manager had only just started working at the home at the time of the last key inspection. She is now registered and dealt with all of the requirements and recommendations contained in the previous inspection report. The Service Users Guide has been updated and provides a good description of the service provided. Pre-admission needs assessments are much more detailed and provide enough information to enable the service providers to make sure that they will be able to meet a new residents needs before admission. The people who use the service are directly involved in their care planning, reviews and risk assessments so they can influence the way their care is delivered. A quality monitoring/quality assurance programme is now in place and annual development reports are being produced. Care Homes for Older People Page 8 of 28 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –03000 616161. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their representatives have the information needed to choose a home that will meet their needs. Evidence: A copy of the Service Users Guide was made available to us on request and this document, which contains a summary of the Statement of Purpose, was found to be well written and informative. Some details about admission are included in the Service Users Guide including information on pre-admission assessments and a six weeks trial period that is in place following admission. Samples of pre-admission assessments were seen and these contained the information Care Homes for Older People Page 11 of 28 Evidence: needed to enable the service provider to give written confirmation to prospective residents about the ability of the home to meet their individual needs. Surveys completed and returned to the Commission by some of the people who use the service told us that they had been given good information about the service that would provided before they moved into the home. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are involved in decisions about their lives, and play an active role in planning the care and support they need. Evidence: The care plans show that the people who use the service are involved in every stage of their care planning, reviews and individual risk assessments. Good care planning enables the assistance provided by the staff to help people to maintain their personal hygiene, with as much or as little assistance from the staff that they need. Most people do need some assistance to take a bath or shower. People told us that they could have a bath or shower as often as they wanted to. Most of the residents are able to access the toilets independently but where help is needed this is given discretely and none of the obvious signs of incontinence were detected during the site visit. Care Homes for Older People Page 13 of 28 Evidence: The home is not registered to admit people with dementia but existing residents who may become confused can continue to live at the home until such time when their representatives or the service providers assess that the home can no longer meet their needs. Although the building is on multiple levels the people told us that they have no difficulty accessing all areas as they can make use of the passenger lift and stairs. A bath hoist, walk in showers, toilet frames and grab rails are provided to help people whose physical mobility may be restricted. Some of the residents would benefit from a ramp to the front door and the door to the garden although level access is provided through the kitchen. Peoples health care needs are monitored and access to primary and secondary health care services is arranged as and when requested by residents or assessed as necessary by the staff. This was demonstrated during the site visit when a resident told us that she had asked for a home visit to be arranged with her GP and he arrived during our conversation. The staff will accompany people to outside appointments if necessary. Several people have retained control of some or all of their medication. The medication that is administered by the staff is stored in a locked cupboard and trolley in the office. Suitable storage facilities are provided for controlled medication and for medicines that require refrigeration. Good information is provided in a folder that also contains the medication administration record sheets. This includes details of the medicines administered and possible side effects that the staff need to look out for. The use of homely remedies is suitably limited and signed and dated records are kept of their administration. The staff who handle the residents medication have received training to do so but further training is needed as a failure to monitor the supplies of one item of medication had left a person without an item of prescribed medication for several days. Although no other errors were detected, the clarity of the medication administration record sheets could be better. People told us that they are treated with dignity and respect by the management and staff. They told us that the staff usually respond to call bells within five minutes or less at any time of the day and night. The residents also told us that they are able to get up and go to bed when they choose to do so. The care plans seen showed that the registered manager had discussed the sensitive Care Homes for Older People Page 14 of 28 Evidence: subject of death and dying with the people and that their wishes had been recorded. Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their life style and to engage in a variety of activities if they choose to do so. Evidence: An activities calendar is displayed in the home to let people know about any activities that are planned. This shows that organised activities take place most weekdays and can include sing along sessions, arts and crafts, quizzes, exercise classes and games. Some of the activities are provided by professional entertainers and others by the staff. Many people said that they join in and enjoyed some, if not all of the activities. The services of the local library are used to ensure that people have a good supply of books to read and some people have newspapers delivered. There is a television and music centre in the communal lounge but people also have televisions and radios in their bedrooms. A telephone is available for people to use to make and receive calls in private, but some people have chosen to have private telephone lines. Care Homes for Older People Page 16 of 28 Evidence: Occasional group outings are arranged and one of the care staff told us that part of her duties include taking people out to town for shopping or to the beach. A minister visits the home weekly for Holy Communion. Birthdays are celebrated and the residents told us that they had each received a card, a chocolate and a flower to celebrate Valentines Day. People are able to invite their friends and families to visit them at any time and the Service Users Guide states that they may invite their visitors to stay for a meal at no extra cost. A visitor told us, If I had to go anywhere this is the place I would come. There is a four weekly menu plan with multiple choices for the teatime meal. People are offered a set meal at lunchtime but they said that if the set meal is not to their liking, an acceptable alternative is always found. Evidence was seen of this at lunchtime with one diner having beef as they did not want the planned meal, which was chicken casserole. Sweet corn, carrots, broccoli, swede and potatoes accompanied all meals. The dessert was a fruit sponge. A variety of fruit juices were also available. We were told that on Sundays a glass of sherry or wine is offered as an aperitif before the roast dinner. The residents spoke very well of the food saying, food is really good, food is marvellous, very satisfied with the food, food good and plenty of it, plenty of fruit, which I do like, anything you ask for they will get it, and they do quite a good lunch. Most of the residents spoken with told us that the were given a choice of where to have their meals. Several said that they liked to have their breakfast in their bedrooms. One resident said that she liked to have her breakfast in the kitchen with the staff because she enjoyed that chat across the table. One person told us that he always had his main meal of the day in the evening, because that was what he was used to. The staff confirmed that the lunchtime meal was kept for him to enjoy in the evening. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that any concern or complaints they may have will be taken seriously and dealt with appropriately by the manager. Evidence: People told us that they would know who to talk to if they had any concerns about the service provided and wished to make a complaint. The record of complaints was seen and showed that the registered manager had taken all the residents concerns and complaints very seriously and had taken appropriate action to put things right. Policies, procedures and codes of practice are in place to protect the residents from the threat of abuse and the staff told us that they had received training on the Protection of Vulnerable Adults. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, comfortably furnished and nicely presented home. However, the work identified in risk assessments does need to be carried out promptly as failure to do so could place the residents at risk. Evidence: Glenkealey is situated in a quiet residential area in the seaside town of Teignmouth. The home is about a half a mile from the town centre, which has a good range of shops and facilities including a railway station, bus services. A three storey extension was added to the original two storey house many years ago when Glenkealey was an hotel and this means that the accommodation is on several different levels. There is a passenger lift to the first floor and stair lifts have been fitted to the smaller flights of stairs to aid peoples mobility around their home. Steps lead up to the front door but level access is provided at the back of the house. A sun lounge, lounge and dining room are on the ground floor. These rooms are all spacious and comfortably furnished. The residents make good use of the elevated and pleasant sun lounge with its open aspect across the entrance to the grounds giving good views of the locality, visitors arriving and passers by. Care Homes for Older People Page 19 of 28 Evidence: The office is also on the ground floor and is accessible to the residents and visitors to the home. The kitchen is adequate for the needs of the home. The laundry is accessible either through the kitchen or via an outside door. There are plans to provide a corridor through the kitchen but until this is done, the outside entrance is used to transfer soiled laundry. The home is registered to accommodate a maximum of fifteen people who are elderly and although two of the bedrooms were originally registered as double rooms, these are currently being used as single rooms. All but two of the bedrooms have en-suite toilet facilities and the remaining two bedrooms have private toilet facilities next to them. Most of the people use their bedrooms as bed sitting rooms and had personalised their rooms to make them homely and comfortable. Call bells are available to all of the residents in their bedrooms to enable them to call for staff assistance whenever they need to. We were told that each person had been given a lockable box in which to store their money and other valuables. We observed that not all of the bedrooms had suitable locks, which would enable them to lock their doors for privacy both from within and outside their rooms. There is a shower room on the first floor, which is suitable for use by people who may have poor mobility. The bathroom on the ground floor has a fixed hoist to enable the staff to help people to get in and out of the bath safely. There is a garden to the front of the home that provides outside space for the people to use to relax or take exercise in. Risk assessments and maintenance checks are carried out of the premises on a regular basis. We saw a record book containing a list of work that needs to be carried out to ensure that the premises are safely maintained. Although many of the repairs and renovations had been dealt with some, including fitting safety chains to some of first floor windows, remained outstanding. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service hold the staff in high esteem. Evidence: The care staff are kept busy but people told us that they were always or usually available to provide the care and support people needed when they wanted it. We were told that staff usually respond to call-bells within five minutes or less during the day and night. Many positive comments were received about the staff during the site visit. People said, I get on fine with the staff, nothing is too much trouble for the staff, the staff are marvellous, I get on very well with the staff, the staff are all so jolly and helpful, they do oblige if they can, the staff could not be better, they do everything to please us and they succeed and very nice and kind indeed. Some of the staff have worked at the home for many years and they told us that they still enjoyed working at Glenkealey and had formed good working relationships with each other. Staff recruitment records show that safe practices are used to ensure that unsuitable staff are not employed at the home. Care Homes for Older People Page 21 of 28 Evidence: Only four of the fourteen permanent care workers had completed National Vocational Qualifications, although some of the staff do have many years experience in the provision of care. Staff training records showed us that Common Induction Standard, Skills for Care, training has been introduced for new staff. A training matrix is used to identify the staffs training needs and achievements. There were some gaps in the provision of health and safety related training and some of the staff told us that they would like to attend more specialist training to enable them to gain a better understanding of some of the conditions that people using the service have. Some of the senior staff said that they had been delegated responsibility for specific areas of care and that they found this to be rewarding work. Examples of their work in these areas were seen to be very good. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager and staff are committed to providing the best standard of care they can for the people who use the service. Evidence: The registered manager is Stephanie Kent. Stephanie has completed her National Vocational Qualification in Care at Level 4. Although she was not present at the time of the key inspection, which was unannounced, her records keeping told us that she has a very good understanding of the National Minimum Standards and Care Homes Regulations and this, coupled with positive feedback from registered providers, staff and residents tell us that she manages the service very well. Resident and staff meetings are held occasionally and minutes are kept of these. The residents are also directly involved in drawing up and reviewing their care plans which ensures that their opinions are taken into account. In addition to this a quality monitoring programme is in place and an annual report is produced from this to enable Care Homes for Older People Page 23 of 28 Evidence: the service providers to see what they are doing well and areas where improvements could be made. The home does not provide assistance to help the people who use the service to manage their financial affairs and this is recognised as good practice. People who need help receive it from friends, family or a legal representative. The manager does, however hold small amounts of personal spending money for some people for safekeeping purposes and signed records of income and outgoings are kept. People are given a lockable box in which to store their money and other valuables safely. Records of individual supervision and annual work appraisals were seen and showed that the registered manager is able to give both positive and negative feedback to her staff in a constructive manner. All of the required and recommended policies, procedures and codes of practice are kept at the home and accessible to the staff. The servicing of electrical, gas and fire safety equipment is up to date. Regular risk assessments are carried out of the premises, these were seen to be very comprehensive. Although maintenance work is being done to remove identified risks, the speed at which some of the work is being done is sometimes a little slow. There are a few gaps in the staff training on health and safety related issues that need to be filled (see Staffing). Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 12 The registered persons must 19/03/2009 ensure that the supplies of prescribed medication are checked regularly. This is to ensure that prescribed medication does not run out. 2 19 13 The registered person must 19/03/2009 ensure that any maintenance work that is identified as posing a potential risk to the people who live at the home, such as fitting window restrictors, is carried out without delay. This is to ensure that the home is safely maintained. Having established a very 19/03/2009 good system of identifying risks, the registered persons must to ensure that the maintenance work needed to deal with matters raised is carried out promptly. 3 38 13 Care Homes for Older People Page 26 of 28 This is to ensure that the home is a safe as possible for the residents. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 9 24 The clarity of the information recorded in the medication administration records could be better. Suitable locks, which have an override facility to enable the staff to gain access to a room in an emergency, should be fitted to all bedroom doors to enable people to lock their bedroom doors from the inside and from the outside if they choose to do so. More staff should be encouraged to gain National Vocational Qualifications. Any gaps in the provision of training in health and safety related areas, including Food Safety and Hygiene, Moving and Handling, Health and Safety, First Aid, the Protection of Vulnerable Adults and Infection Control should be filled and arrangements should be made to enable the staff to attend any other training courses that they and their manager feel may help them to help the people who use the service. 3 4 28 30 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - 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!