Inspection on 23/05/05 for Grange (The) & Walton Cottage

This inspection was carried out on 23rd May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Grange (The) & Walton Cottage 12/02/07

Grange (The) & Walton Cottage 03/11/05

Grange (The) & Walton Cottage 24/11/04

Grange (The) & Walton Cottage 29/06/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 The Grange & Walton Cottage 26-28 St Johns Road Woking Surrey GU21 1SA Lead Inspector Ms S Magnier Unannounced 23 May 2005 12.00 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 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. The Grange & Walton Cottage H58_s 13656_The Grange & Walton Cottage_v228053_130505_stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Grange & Walton Cottage Address 26-28 St Johns Road, Woking, Surrey, GU21 1SA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01483 730670 01483 730670 grangeandwaltoncottage@hotmail.com Grange & Walton Cottage Limited Miss Parveen Akram CRH Care Home 18 Category(ies) of LD Learning Disability, 18 registration, with number LD(E) Learning Disabililty, 1 of places MD Mental Disorder, 2 The Grange & Walton Cottage H58_s 13656_The Grange & Walton Cottage_v228053_130505_stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Grange: 10 Residents may be aged 20-65. 2. The Grange: 1 Resident may be aged over 65 years. 3. Walton Cottage: 8 Residents aged 18-40 years. 4. Walton Cottage: 1 Resident may be over the age of 40 years. 5. Two residents with a learning disability may also have a mental disorder. Date of last inspection 24 November 2004 Brief Description of the Service: The Grange and Walton Cottage are detached properties standing in adjoining grounds in a residential area close to the local amenities of St Johns and within access of public transport. They provide accomodation to 18 adults with learning disabilities. The Grange has ten single bedrooms, six on the ground floor and four on the first floor. Walton Cottage has undergone refurbishment and an extension to the exisiting property to provide eight single bedrooms two downstairs and six upstairs. A large spacious room has been built on the ground level at Walton Cottage to provide space for in house activities for residents if they choose and an activities room for snooker. Both houses have a lounge, dining room, kitchen and laundry facilities and staff room. Aditionally The Grange has a small quiet room and small office. There is off street parking and the rear gardens are attractive and easily accessible to residents all of whom are mobile. Each property is furnished to a high standard and offers a comfortable, clean and homely environment. The Grange & Walton Cottage H58_s 13656_The Grange & Walton Cottage_v228053_130505_stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was held at midday and lasted four and a half hours. Several residents were at home during the inspection and talked enthusiastically about their lifestyles, hobbies, aspirations and summer holidays. Written comments received from the residents have been included within the report. The inspector looked at individual care plans; risk assessments, staff records and health and safety records during the inspection. The home continues to have an active atmosphere with the residents leading full lives. During the tour of both homes the inspector noted that they were maintained to a high standard and the extension to Walton Cottage has been completed. The CSCI would like to thank the residents and staff for their hospitality throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better: The home is operating at a high standard. Through internal Quality Assurance the home could seek to improve on areas, which they identify. The Grange & Walton Cottage H58_s 13656_The Grange & Walton Cottage_v228053_130505_stage 4.doc Version 1.30 Page 6 The staff recruitment practice must also include the checking of the validity of referees detailed on staff application forms to ensure residents safety and protection. The home should ensure that the care records indicate that all guidelines in residents care plans are up to date and current, particularly where these were produced some years earlier. Records should also be maintained in respect of staff training in some specialist areas, such as the administration of insulin. The home’s complaint policy was in need of amendment to include the details of the Commission for Social Care Inspection. Action was required regarding the repair of a shower in the home and two health and safety matters required attention, including a trip hazard and the maintenance of fire safety equipment. 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. The Grange & Walton Cottage H58_s 13656_The Grange & Walton Cottage_v228053_130505_stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection The Grange & Walton Cottage H58_s 13656_The Grange & Walton Cottage_v228053_130505_stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,4 Very good information was available to enable prospective residents to make an informed choice about whether they wish to live in the home. Both homes have resident vacancies and the Manager is active in meeting and assessing prospective residents choosing to live in either home. EVIDENCE: The Registered Manager has recently updated the combined Statement of Purpose for both homes. Additionally the Manager has made a commendable effort to improve and update the service users guide. This now includes plain English in large print, attractive photographs and is also available on audiotape in order that residents can have a fuller understanding about the home and what it offers. The home offers trial periods of stay/visits to residents. One resident has had an assessment to move into the home and the Manager told the inspector that their friends and family had visited the home. The Grange & Walton Cottage H58_s 13656_The Grange & Walton Cottage_v228053_130505_stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,9. The philosophy of the home is based on residents having informed choice, opportunities for new interests and activities, maintaining daily living skills and being free to live their lives safely and with support where needed. At the time of the inspection there was evidence that this philosophy was being promoted and achieved. EVIDENCE: The home is to be commended on the thought and effort that has been made to develop and maintain the individual resident care plans and risk assessments. The care plans contain step by step guidelines, including photographs, to assist residents in achieving daily living skills and goals and each goal is reviewed monthly and signed by care staff. Each resident has also signed their care plan and has a named key worker. Each resident helps in the running of the home which includes helping to prepare meals, improving cooking skills, laying the tables and helping with washing up and making drinks with staff support where necessary. Several residents spoke with the inspector about their achievements and decisions they had made including plans for a holiday. One resident comment card stated ‘I think I have a care plan’ and ‘I go shopping for food’. The Grange & Walton Cottage H58_s 13656_The Grange & Walton Cottage_v228053_130505_stage 4.doc Version 1.30 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,15. The care plans; social activities, leisure pursuits and contacts with family and friends demonstrated that the residents lead active and full lifestyles. EVIDENCE: Both the homes have an active atmosphere and the resident’s lead full and varied lifestyles. Each resident has their own key to their rooms, where appropriate and one resident commented that they keep their ‘key in their pocket’. One resident told the inspector that they go and visit their parents often and that also includes staying with them. Several residents commented positively about their home stating ‘I like having my friends and talking’, I like the staff on e to one and the people in the house’. Residents commented that what was not so good was ‘watching T.V.’, ‘missing family’ ‘shouting’ and ‘when others get upset’. The home provides residents with the opportunity to learn new skills by having a ‘home and kitchen day.’ This involves residents being supported, where necessary, to help in the kitchen and in keeping their bedrooms clean and tidy. The Grange & Walton Cottage H58_s 13656_The Grange & Walton Cottage_v228053_130505_stage 4.doc Version 1.30 Page 11 Activities include visits to the local town, visiting friends and family, going to day services and attending further education colleges on a full or part time basis. Additional activities include going to the cinema, pub, day centres, employment, and visiting special places of interest and visiting friends and family. Each resident is encouraged by the staff to engage and enjoy their hobbies and interests and this was evident during conversations with the residents. The new extension at Walton Cottage includes a large and spacious room, which will act as an additional area/day centre for the residents. Activities will be individualised to include Pottery, arts and crafts, cookery, gardening fun and fitness and other out door leisure pursuits. Comments received from the residents stated ‘we have lots of food’, ‘I choose what I eat’. The Grange & Walton Cottage H58_s 13656_The Grange & Walton Cottage_v228053_130505_stage 4.doc Version 1.30 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20 The health and personal care needs of residents were being met. The residents receive support from other health care professionals as required. EVIDENCE: The preferences and support residents require are clearly documented in the individual care plans and include agreed working practices by staff in order to support residents in a consistent way. The care plans sampled by the inspector indicated that the residents have support from health care professionals which includes, district nurses, chiropodist, G.P. dietician and specialist consultants. A requirement has been made that all health care appointments for example dietician and district nurse are clearly documented in the care plans. Appointments should be dated and signed by the attending health care professional in order to give a clear audit of appointments attended. The inspector noted that in one residents care plan, the specialist guidelines were dated a few years ago. The Manager advised the inspector that although they were old the care and support remained the same. A recommendation has been made that the Manager detail this evidence in the care plan to ensure The Grange & Walton Cottage H58_s 13656_The Grange & Walton Cottage_v228053_130505_stage 4.doc Version 1.30 Page 13 that all persons having right of access to the care plan and support for the resident are aware that the guidelines are a current working document. The Manager advised the inspector that the district nurse had held a training session for specific staff to assist a resident with their insulin. No records of the training were available and a requirement has been made that documentation of competency must be held within the individual care plan and in the medication folder to ensure their safety and wellbeing of the resident and staff. The Grange & Walton Cottage H58_s 13656_The Grange & Walton Cottage_v228053_130505_stage 4.doc Version 1.30 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23. The home offers a transparent approach to complaints. Staff were trained in the area of adult protection and appropriate procedures were in place at the service. The complaint policy was in need of updating to reflect the change from the National Care Standards Commission to the Commission for Social Care Inspection. EVIDENCE: The residents spoken with during the inspection told the inspector that they would tell a member of staff if they were unhappy or scared about something. The inspector sampled several staff training records, which indicated that Protection of Vulnerable Adults training had been attended. The care plans contained risk assessments; behaviour assessment forms and staff agreed working guidelines to support residents who may be distressed. The inspector noted that the complaints procedure within the updated statement of purpose refers to the National Care Standards Commission and a requirement has been made that this is changed to CSCI details to ensure that all people who wish to make a complaint have the correct details. The Grange & Walton Cottage H58_s 13656_The Grange & Walton Cottage_v228053_130505_stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,30 The standard of cleanliness and maintenance of the home continues to be high offering residents a homely and comfortable environment. EVIDENCE: The Registered Persons have maintained a high standard of thought and consideration to the environment and lives of the residents in both homes. There are still some finishing touches being carried out to the extension at Walton Cottage and the Manager explained that these should be completed within the next several months. The resident’s bedrooms are individually personalised. Some residents were in their rooms, either on their own or with staff during the inspection. The inspector noted that the residents had a variety of comfortable furniture and fittings, personal belongings, ornaments of interest and leisure equipment. Several residents comment cards stated ‘I like my bedroom’ ‘I have a nice room’, ‘we have garden’. The Grange & Walton Cottage H58_s 13656_The Grange & Walton Cottage_v228053_130505_stage 4.doc Version 1.30 Page 16 The Manager explained that in the Grange there continues to be difficulties with a leak in the shower room on the ground floor. Although it was repaired previously this had not resolved the issue and further repair work to investigate the leak would be undertaken. A requirement has been made that this is attended within the timescales set in order to ensure that the residents have access to the shower if they choose. The bathrooms and toilets throughout the home are homely and decorated to a high standard. The communal areas of both homes are well maintained and offer alternative room for residents to move freely in their home. The inspector noted that several residents were using the enclosed and well-maintained rear gardens of both homes for leisure and also hanging out clothes on the washing line. The Grange & Walton Cottage H58_s 13656_The Grange & Walton Cottage_v228053_130505_stage 4.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,36 The staff on duty during the inspection demonstrated a sound knowledge and competency of their roles and responsibilities. EVIDENCE: The staff team at The Grange and Walton Cottage are well supported by the Managers and have meetings to discuss the ongoing care needs of the residents and the homes generally. One staff member had recently achieved their NVQ Level 3 Promoting Independence and several other staff were undertaking the same award. The inspector sampled several staff files that indicated that the Managers support staff and mange their performance through supervision and appraisals. On the day of the inspection all the staff team were involved in a Diabetes training workshop being facilitated by the district nurse. The home offers the Learning Disabilities Award Framework (LDAF) Induction and Foundation Training to all staff. The Inspector sampled one staff recruitment record and a requirement has been made that all information on staff application forms is validated to include whom the referees are in order to ensure the safety and well being of residents. The Grange & Walton Cottage H58_s 13656_The Grange & Walton Cottage_v228053_130505_stage 4.doc Version 1.30 Page 18 Several residents were heard by the inspector to ask and were interested to know which staff were coming into their home on a daily basis and the residents spoke highly of the staff ‘I like the staff’ and ‘I like living here’. The Grange & Walton Cottage H58_s 13656_The Grange & Walton Cottage_v228053_130505_stage 4.doc Version 1.30 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39,42. The Management of the home is efficient and effective. The Registered Persons and staff continue to offer a person centred service to the residents. In general, the health and safety arrangements were adequate with two areas identified as requiring action. EVIDENCE: The Registered Manager has achieved a Level 3 NVQ in Promoting Independence and has also achieved a Diploma in Advanced Management in care. She has nearly completed the NVQ Level 4 Registered Managers Award. There is a strong sense of leadership in the home and a Deputy Manager supports the Manager well. The inspector sampled the homes fire and health and safety records, which were current, indicated that a robust system for regular maintenance and health and safety awareness was conducted in both of the homes. The Grange & Walton Cottage H58_s 13656_The Grange & Walton Cottage_v228053_130505_stage 4.doc Version 1.30 Page 20 The inspector noted two issues regarding the health and safety of residents and requirements were made as follows: A fire extinguisher was found behind an armchair on the hallway landing in Walton Cottage. The Manager advised that the extinguisher might not have been in use. A requirement has been made that all fire fighting equipment within the home must be accessible to any person within the home and appropriately maintained. A trip hazard was identified on the raised patio area of the Grange and a requirement has been made that this is rendered safe. The Grange & Walton Cottage H58_s 13656_The Grange & Walton Cottage_v228053_130505_stage 4.doc Version 1.30 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 4 3 x 3 x Standard No 22 23 ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 4 3 x 4 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 2 3 N/A 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 x x Standard No 31 32 33 34 35 36 Score 3 3 3 2 x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Grange & Walton Cottage Score 3 2 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 x x 2 x H58_s 13656_The Grange & Walton Cottage_v228053_130505_stage 4.doc Version 1.30 Page 22 NO Are there any outstanding requirements from the last inspection? 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 19 Regulation 13.(1)(b) Requirement The Registered Persons must ensure that all health care appointments for example dietician and district nurse, are clearly documented in the care plans and appointments dated and signed by the attending health care professional in order to give a clear audit of appointments attended. The Registered Persons must ensure that documentation of staff competency regarding support with specfic medication for a resident must be held within their individual care plan and medication folder to ensure the safety and wellbeing of the resident and staff. The Registered Persons must remove reference to the NCSC in the complaints procedure and amend this to the CSCI to ensure that all people who wish to make a complaint have the correct information. The Registered Persons must ensure that the equipment provided in the care home for the use by residents is maintained in good working Timescale for action 23.6.05 2. 20 18(1)(a) 28.5.05 3. 22 22.(7)(b) 30.6.05 4. 27 23.(2)(j) 13.7.05 The Grange & Walton Cottage H58_s 13656_The Grange & Walton Cottage_v228053_130505_stage 4.doc Version 1.30 Page 23 5. 34 7,9,19 Schedule 2 .3 6. 42 23.(4)(a)( c)(iv) 7. 42 13.(4)(c 23.(2)(o) order and the shower in the Grange is rendered back in use. The Registered Persons must 23.6.05 ensure that all information on staff application forms is validated to include who the referees are in order to ensure the safety and well being of residents. The Registered Persons must 28.5.05 ensure that all fire fighting equipment within the home is maintained and accessible to any person within the home. The Registered Persons must 23.7.05 ensure that the raised patio area in The Grange garden, which was viewed as hazardous, be rendered safe to ensure that unnecesary risks to the health and safety of residents are identified and so far as possible eliminated. 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. Refer to Standard 19 Good Practice Recommendations A recommendation has been made that the Manager ensures that all persons having right of access to a residents care plan and support for the resident are aware that the guidelines are a current working document. The Grange & Walton Cottage H58_s 13656_The Grange & Walton Cottage_v228053_130505_stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 The Grange & Walton Cottage H58_s 13656_The Grange & Walton Cottage_v228053_130505_stage 4.doc Version 1.30 Page 25 - 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!