Inspection on 01/12/08 for Green Lane House

This inspection was carried out on 1st December 2008.

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

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

Green Lane House 27/11/07

Green Lane House 04/10/06

Green Lane House 02/03/06

Green Lane House 04/10/05

Green Lane House 14/03/05

Green Lane House 08/09/04

Green Lane House 12/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Green Lane House Green Hill Brampton Cumbria CA8 1SU     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: Diane Jinks     Date: 0 1 1 2 2 0 0 8 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. the things that people have said are important to them: They reflect 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 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (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.csci.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Green Lane House Green Hill Brampton Cumbria CA8 1SU 0169772345 Telephone number: Fax number: Email address: Provider web address: claire@greenlanehouse.com Name of registered provider(s): Name of registered manager (if applicable) Mrs Claire Pratt Type of registration: Number of places registered: Greenlane Care Homes Ltd care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The home is registered for a maximum of 28 service users to include: up to 28 service users in the category of OP (old age not falling within any other category) up to 5 service users in the category DE(E) (Dementia over 65 years of age) The home is registered from time to time to admit persons between the ages of 60 and 65 years of age. The service must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Two service users may share a bedroom of at least 16 sqm usable floor space only if they have made a positive choice to do so and when a shared space becomes vacant the remaining service user has the opportunity to choose not to share, by moving to a different room if necessary. When single rooms of less than 12 sqm usable floor space become available they must not be used to accommodate wheelchair users and where existing wheelchair users are in bedrooms of less than 12 sqm they must be given the opportunity to move to a Care Homes for Older People Page 4 of 25 Over 65 5 28 0 0 larger room when one becomes available. Date of last inspection Brief description of the care home Green Lane House is a period home, on the outskirts of Brampton, set in extensive well-maintained gardens with ample car parking. There are 25 bedrooms, 7 of which are en-suite, with additional communal facilities of three bathrooms and four separate toilets. There are three lounge areas, which open onto patios, and an additional smaller room, which is designated as a smoking area. The home has a passenger lift, ramps, handrails and has suitable furniture and equipment to met the needs of people using this service. The home produces a guide to the services and facilities it can provide. This is available on request from the manager. Care Homes for Older People Page 5 of 25 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: The assessment of this service took place over several weeks and included a visit to the home. As part of the assessment we sent questionnaires to some of the people that live and work at the home to obtain some of their views. We also spoke to a number of people at the home during our visit, including residents, staff and visiting professionals. The manager completed an annual quality assurance assessment (AQAA). This document provided us with further information about the home and the services it provides. It also tells us where the manager has made improvements and the areas she intends to make further improvements to over the next 12 months. Care Homes for Older People Page 6 of 25 What the care home does well: What has improved since the last inspection? 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 of 25 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 8 of 25 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 using this service have their health and social care needs assessed prior to moving into the home. This helps to make sure that the home will be able to meet their needs and expectations. Evidence: The home produces a Statement of Purpose and Service User Guide. These documents provide people who are considering moving into the home, with information about life at Green Lane and the type of services and support provided. The people who participated in the assessment of this service told us that they and/or their relative received enough information to help them make a decision about Green Lane House. They also told us that they have a contract, which helps to ensure people are aware of their terms of residency. One person said; our relative was shown pictures of the home and asked if she would like to be closer to the family. She was happy to go to this home and we discussed her needs with the manager to ensure that Care Homes for Older People Page 9 of 25 Evidence: they could fully meet them. People are able to visit the home to help them to make a decisions about moving there. They are able to live at the home for a trial period of one month to help them make sure that the home will be suitable. We looked at a sample of care records for some of the people that live at the home. They show that the manager obtains copies of care and support needs assessments from social workers or the health trust. The records also show that the manager undertakes her own assessment of the care and support needs of prospective residents. These assessments help to make sure that the service will be able to meet the needs and expectations of people wishing to use this service. Care Homes for Older People Page 10 of 25 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. People using this service have detailed and individualised plans of their care and support needs. These help to make sure they are supported appropriately and that their independence is encouraged and respected. Evidence: We looked at a sample of the care records of some of the people that live in the home. Plans have been developed to help meet every aspect of peoples health and social care needs. There is clear information of what those needs are and of the action that staff will take to make sure they are met appropriately. The plans are regularly reviewed and updated, with changes made where necessary. The information recorded in the care plans is mindful of peoples independence, privacy and dignity. Some of the people that live at Green Lane House told us that they feel their care and support needs are always met. They said that staff are always available when needed and that they are efficient, friendly and caring. One person told us, they are never hurried or short and always take time to attend to our needs. We spoke to some of the staff that work at the home. They told us that they always Care Homes for Older People Page 11 of 25 Evidence: have access to the care plans of the people that use this service. They are able to read them and are always told of any changes that may have occurred to people since they were last on duty. There is a staff handover session at the beginning of each shift and all staff are expected to attend this. The care plans include elements of nutritional assessments to help ensure that people are supported with their eating and drinking needs appropriately. Risk assessments form part of the care planning too and include information and strategies for staff to follow, particularly where people may have poor mobility, be at risk of falling or at risk of developing pressure sores for example. Daily records are kept with regard to the care and support given to people that live at Green Lane House. They show that people have access to other healthcare professionals such as doctors, dentists, district nurses, physiotherapists, occupational therapists and podiatrists. We spoke with one of the community nurses during our visit to the home. They told us that they have a very good relationship with the home. Staff contact them if needed and always in good time. If the nurse leaves instructions about a persons care, staff always follow them carefully. They said, the care and support is very good and I cannot fault it. Staff have good care practices and the people living here always look happy, clean and well cared for. There are medication policies and procedures in place at the home. These documents include information on the use of homely remedies (non-prescribed medicines such as paracetamol) and the involvement of the persons doctor and pharmacy. Medication is safely stored within the home and there are arrangements in place for the secure storage of some special medications. People using this service are able to manage their own medicines, but this is dependent on a risk assessment to ensure that they can undertake this task safely. There were no people responsible for their own medicines on the day of our visit to the home. We looked at a sample of the medication records. Medicines, including creams and ointments had been clearly recorded and signed for when administered. The records we looked at were accurately maintained. The medicine procedures at the home have changed significantly and staff told us that they feel safer and more confident when administering medication. Staff receive instruction on the policies and procedures relating to medicines and medication. Senior staff are responsible for the administration of medicines at the home. They have received training on this subject via a distance learning course through a local college and by the pharmacist that supplies the medication to the home. Care Homes for Older People Page 12 of 25 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. There are some gaps in the provision of stimulating social and leisure activities, particularly where people may have short term memory or dementia type illnesses. This means that some people may not always have their social needs met appropriately. Evidence: People using this service do have access to some social and leisure activities. Most people are able to make choices about how they spend their days. The home tries to support people to maintain and pursue their hobbies and interests. The home has links with the local community and some residents are able to attend church groups, tea dances and day centres locally. Ministers from the church visit the home regularly and people using this service are able to attend those gatherings if they wish. The manager produces a monthly calendar of planned events and during the month of December 2008, people can participate in a variety of craft sessions and entertainments both in the home and in the community. Some people living at the home told us that they sometimes join in games such as dominoes and cards and that entertainers have been to the home to play the piano. Some residents enjoyed dancing to this music. Care Homes for Older People Page 13 of 25 Evidence: On the day of our visit to the home some people were looking forward to attending a Christmas concert in Carlisle in the afternoon. One person has been able to bring their pet cat into the home with them and are able to continue going out into the community to access some day centre services. Assessments have been put in place to ensure that other people are safe with the cat. There are restrictions on the cat to ensure residents are protected from trips, falls, poor hygiene and any allergies that they may have. The manager and staff told us that residents meetings take place and that people are encouraged to express their wishes and make suggestions for additions to the menus and activities available at the home. This may not be the most appropriate way for some people to express their wishes, especially people that may be suffering from dementia illnesses. One person told us I had higher expectations in the way of activities and trips available. My relative is unable to make demands on staff because she has dementia. The staff always listen to what I say but I dont think there are any suitable activities provided to meet her needs. This is an area that the manager needs to consider making improvements to. The people we spoke to told us that the food is very good at the home. They said that they always have a choice regarding their meals and that there is always plenty of food available. We spoke to the chef who explained that the menus are on a four week rotation. They are reviewed and changed from time to time and people are able to make suggestions for dishes to be included. We were told that the owners of the home do not scrimp on the food, the chef can have whatever she or the residents want. She is told of any special dietary needs, allergies, likes and dislikes when a person moves into the home. We discussed pureed food - this is presented with each food item pureed individually and on a suitable plate. We observed the lunchtime meal being served. People were given good portion sizes and pureed meals were served as stated by the chef. Where people needed help with eating and drinking, staff provided this. The way in which this support is provided could be improved upon to make sure that people needing help are always treated as an individual. Staff should take time to ensure that they are sat down with the person they are helping and provide them with some social stimulation too. Care Homes for Older People Page 14 of 25 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. There are robust procedures and staff training programmes in place at the home to help ensure that people using this service are able to raise concerns. These help to make sure that people are listened to, taken seriously and will have their concerns addressed appropriately. Evidence: There is a complaint procedure in place at the home. This is made available to all residents and their families where applicable. The process is also displayed in various parts of the home. Most of the people participating in the assessment of this service told us that they know about the complaints process and that they know who to raise any concerns with. They indicated that they have never had the need to use this process. One person did tell us any small problems are dealt with efficiently and quietly. The manager told us that she has not received any complaints. Dealing with concerns and complaints is included in the staff induction training programme. This helps to make sure that staff know what to do if a concern is raised with them. Regular residents meetings are held at the home and this provides an additional forum for people living at the home to raise any issues or concerns they may have. There are procedures and staff training programmes in place at the home to help ensure that people using this service are safeguarded from harm or abuse. These include the guidelines issued by the local authority, who take a lead role in safeguarding matters and whistleblowing procedures to help staff report any concerns Care Homes for Older People Page 15 of 25 Evidence: that they may have too. Staff told us that they are aware of these processes and know who to report such concerns to. The home has procedures in place relating to restraint, including the use of equipment such as bed rails, which can sometimes be viewed as a restraint. The manager follows robust recruitment processes and ensures that all the necessary checks are made on prospective staff. This helps to make sure that only suitable people are recruited to work at the home. Care Homes for Older People Page 16 of 25 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. Green Lane House provides a clean, warm and safe environment for the people that live there. Evidence: The home provides a safe, warm and well maintained environment for the people that live there. We had a look around the home during our visit to the service. We found that the home is kept clean and tidy and that several areas have been re-decorated or had carpets and flooring replaced. The home is equipped with ramps, hand rails and a passenger lift to help support and promote the independence of people using this service. Where necessary, specialist advice and equipment is obtained from community nurses or occupational therapists to make sure people receive the right support, safely. The people we spoke to told us that the home is always clean. One person told us that there are never any smells and nowhere is untidy or sticky. It does not feel institutional but instead has a clean, homely feel. This is a well run happy place with a lovely atmosphere. We looked at some of the rooms occupied by people living at Green Lane House. They were warm and comfortably furnished. People are able to personalise their own rooms with ornaments, pictures and treasured possessions to help enhance the homely feel. All of these rooms have a wash basin and some also have en-suite toilet facilities. Care Homes for Older People Page 17 of 25 Evidence: There are a variety of communal areas in the home, including lounges/dining areas, a designated smoking room, bathrooms and toilets. The home has extensive gardens, which are also accessible to the people that live at the home, when the weather is suitable. There is a small laundry at the home. This is maintained in a clean and organised manner. Staff are provided with protective clothing such as gloves and aprons to help minimise any risk of infection. There are cleaning schedules in place and the home employs housekeepers. This helps to make sure that the home is always clean and hygienic and allows care staff to concentrate on the support and well-being of the people that live at Green Lane House. Over the last year, the manager has replaced one of the baths and parts of the bath hoist have been replaced. There is a maintenance plan in place at the home and the manager told us that there are further plans to upgrade the hallways, corridors, one of the sitting rooms and the staff room over the next twelve months. Care Homes for Older People Page 18 of 25 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 manager ensures that staff are recruited safely and trained to a good standard. This helps to make sure that people using this service are supported by competent and suitable care staff. Evidence: On the day of our visit to the home, there were enough staff on duty to meet the needs of the people living at Green Lane House. There is a staff rota in place and this shows that there are usually sufficient numbers of staff on duty at all times of the day. The manager employs housekeepers and kitchen staff to help ensure that care staff are not taken away from the people that need their support and assistance. Two thirds of the staff employed at the home have completed, or are in the process of undertaking, a National Vocational Qualification (NVQ) in care. We spoke to some of the staff that have completed this qualification. They told us that they have found this training very useful in their job and that they have learnt a lot whilst working towards the qualification. We looked at a sample of staff training records. They show that staff are provided with a variety of training to help them understand the needs of the people they work with and to help them work safely. New staff undertake induction training which includes instruction regarding personal care, health and safety, safeguarding adults and manual handling. Discussion with staff and the training records show that staff also have training in the administration of medication, infection Care Homes for Older People Page 19 of 25 Evidence: control, nutrition, first aid and dementia care. Staff told us that they would like to have some extra training in dementia care as more and more people seem to be suffering from a degree of this condition. They told us that the manager is trying to arrange this training for them. We looked at the way in which new staff are recruited to the home. There are good procedures in place and the manager ensures that prospective staff undergo robust checks. The checks include Criminal Records Bureau (CRB), Protection of Vulnerable Adults (POVA) and references from previous employers. This helps to ensure that the staff will be suitable to work with vulnerable people. Care Homes for Older People Page 20 of 25 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 home is run in the best interests of the people that live there and by a competent and qualified manager. Evidence: The home is run by a competent, qualified and experienced manager. Records show that the manager keeps her training and knowledge up to date. This helps to ensure that she is aware of and understands the changing needs of the people living at Green Lane House. The general records kept at the home are up to date and are readily available. At our last visit to this service we asked the manager to make some improvements and we made some requirements in particular areas. The manager gave us a plan of how these improvements would be made and when. We found at this visit that the manager has completed everything we asked her to do. People using this service are encouraged to remain as independent as possible. The home is not responsible for the management of any of the residents finances. We looked at a sample of the records kept at the home. The manager ensures that equipment is Care Homes for Older People Page 21 of 25 Evidence: regularly serviced and tested, including handling equipment, fire fighting and detection systems, electrical, gas and heating systems. Records show that staff are supervised and have their practice monitored frequently. This helps to make sure that they are providing good, safe and consistent support to people who use this service. There are risk assessments in place and these are reviewed and kept up to date. The manager ensures that staff are provided with safety training such as manual handling, infection control and first aid. There is an infection control policy in place at the home. Protective clothing is available for staff use and clinical waste bins have been placed in toilet areas. These measures help to reduce the risk of cross infection. The manager notifies us of any events which adversely affects the home or any person living there and each month the owner provides us with a report of life at the home, identifying any issues or improvements that have been made. Care Homes for Older People Page 22 of 25 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 23 of 25 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 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 12 It is recommended that the way in which people with dementia are consulted about their social and leisure activities be reviewed. The manager should consider developing a stimulating activities plan to include people who may have dementia illnesses. Staff assisting residents with eating and drinking should receive some further instruction and training to ensure that each person is treated consistently and as an individual. The manager should ensure that the complaint process on display in the home shows up to date and accurate information, particularly the addresses and contact details of other agencies that people may take their complaints to. 2 15 3 16 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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 25 of 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!