Inspection on 05/09/07 for Harlow Moor Drive (43)

This inspection was carried out on 5th September 2007.

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

Harlow Moor Drive (43) 02/12/09

Harlow Moor Drive (43) 11/01/06

Harlow Moor Drive (43) 27/06/05

Harlow Moor Drive (43) 01/03/05

Harlow Moor Drive (43) 29/11/04

Harlow Moor Drive (43) 18/02/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood House

Whitwood Hall

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

CARE HOME ADULTS 18-65 Harlow Moor Drive (43) 43 Harlow Moor Drive Harrogate North Yorkshire HG2 0JY Lead Inspector Pauline O`Rourke Unannounced Inspection 5th September 2007 09:30 Harlow Moor Drive (43) DS0000007879.V345531.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Harlow Moor Drive (43) DS0000007879.V345531.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Harlow Moor Drive (43) DS0000007879.V345531.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Harlow Moor Drive (43) Address 43 Harlow Moor Drive Harrogate North Yorkshire HG2 0JY 01423 502160 F/P01423 502160 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Northern Life Care Limited T/A U.B.U. ****Post Vacant**** Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (6) of places Harlow Moor Drive (43) DS0000007879.V345531.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th September 2006. Brief Description of the Service: 43 Harlow Moor Drive is registered to provide accommodation and personal care for six adults with learning disabilities. The home is situated in a residential area of Harrogate close to the town centre and overlooking the Valley Gardens. It is a large Victorian terrace house converted for its present use. 43 Harlow Moor Drive is owned by UBU formally known as Northern Life Care. The Statement of Purpose and Service User Guide are provided upon enquiry. The Cost of a placement at the home is dependent on individuals needs. On the 5th September 2007 the charges ranged between £679.42 to £1096.06 Harlow Moor Drive (43) DS0000007879.V345531.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key inspection has used information from different sources to provide evidence for this report. These sources include: • • • • Reviewing information that has been received about the home since the last inspection. Information provided by the registered person on a Annual Quality Assurance Assessment form. Comment cards returned from all 6 people living Harlow Moor Drive, and two relatives. A visit to the home carried out by one inspector that lasted for three and a half hours. During the visit to the home three people in the home, and two staff were spoken with. Care records relating to two people, two staff members and the management activities of the home were inspected. Care practices were observed, where appropriate, and time was also spent watching the general activity within the home. This enabled the inspector to gain an insight of what life is like at Harlow Moor drive for the people living there. What the service does well: All the people who use, or want to use the service at Harlow Moor Drive have to tell someone of the help they need. This information is used to make a care plan. The care plans used are detailed and tell the carers everything from how people like to get up, go to bed, what they like to do during the day and how it is best to communicate with them. These care plans are reviewed regularly. The people at Harlow Moor Drive are treated as individuals and each has their own diary of activities, including college courses, jobs, voluntary work, when and where they go to church and outings with the staff to the cinema, theatre or local pub. Several people in the home said ‘I like living here, I feel well cared for, staff treat me well and my privacy is respected. I help make decisions in the home, there are good activities, I like the food and I feel safe. I know who to speak to if I am unhappy’ and those people spoken with during the inspection said ‘the staff are nice’ and ‘I enjoy the food’ and ‘you can do your own thing in the home’. Feedback received from relatives said ‘we get enough information about the care home to help us make decisions. The home meets the needs of my relative and helps her keep in touch with us’ and ‘I feel the trained staff are excellent and go to a lot of trouble to ensure the client has a happy home and enable them to reach their potential’. Harlow Moor Drive (43) DS0000007879.V345531.R01.S.doc Version 5.2 Page 6 The staff are well trained and have been thoroughly checked before they started working for the UBU at Harlow Moor Drive. The staff have regular training to make sure they have the skills needed to ensure the needs of the people who live there are met. The service is well managed and the staff said that the manager listens to them and asks for their opinion. The manager makes sure that any work needed on the building is carried out and she makes sure it is a safe place to live and work. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Harlow Moor Drive (43) DS0000007879.V345531.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Harlow Moor Drive (43) DS0000007879.V345531.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People admitted to the home are involved in a comprehensive assessment of their needs to ensure the placement is appropriate and that they have information about the home before they are admitted. EVIDENCE: There have been no recent admissions to the home. In discussion with the staff on duty it was clear they had a good understanding of the admissions process. Information is gathered from the person looking to be admitted to Harlow Moor Drive as well as from their family, and any social and health care professionals involved in their care. Once this information has been assessed by the staff an initial decision about the suitability of the placement is made and if suitable introductory visits or overnight stays are arranged. The person looking to come in to the home dictates the pace of this process. The assessment information assists the staff in providing appropriate support and enables them to settle in the home. During these visits further assessments are made and the opinions of the current occupants are taken in to account when making a decision about a permanent admission. Usually a six week assessment period is planned although this can be longer if necessary before a Harlow Moor Drive (43) DS0000007879.V345531.R01.S.doc Version 5.2 Page 9 placement becomes permanent. The files of the people currently living in Harlow Moor Drive contained detailed assessment information. Information about the home is available in word and picture format and the people in the home contribute to the Statement of Purpose and Service User Guide so that it properly represents their home. Harlow Moor Drive (43) DS0000007879.V345531.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People who use the service experience excellent 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 are able to make decisions on a day-to-day basis about their lives and this allows them to remain as independent as possible. EVIDENCE: Three case files were seen and each of them contained a detailed care plan that outlined the current levels of support provided and a progression plan that looks to increase the individuals independence. The plans include information about how the person is helped to become more independent. Since the last inspection some of the language has been simplified to include ‘where I go what I do’ and ‘who is important to me’ so that these plans allow the people they are about to be actively involved in them. Staff also use picture prompts although these are limited and the manager is still looking at other tools to assist people in having a fuller understanding of their care plan. Everyone in the home has a key worker and people spoken with were aware of who their Harlow Moor Drive (43) DS0000007879.V345531.R01.S.doc Version 5.2 Page 11 key worker was. The case files contained review information of the care plans and they are reviewed at least twice a year. Each plan is maintained in hard copy with a back up kept on the computer. People are encouraged to keep a daily log on the computer and where they are not able to do this independently the staff supports them. Two people have pictorial diaries these are not kept on the computer. Each persons care plan and daily log is password protected so that they can only access their own logs. Staff can access all the logs. One person spoken with said that they preferred the staff to write their log although they told them what to say. During the visit people at home made their own decisions about what they wanted to do. One person watch a homemade video sent buy their parents, another listened to music and someone else spent time in their room. One person said ‘I can do what I want’ another one would only be distracted by staff if they wanted to be. Where someone was not able to make decisions for themselves the reasons for this were recorded, this information was then used in a progression plan so that people could become or remain as independent as possible. Interactions between staff and people in the home were seen to be respectful and in accordance with the care plan as some people had communication difficulties. Staff spoke with said that they receive thorough training through their induction and foundation courses in treating people with dignity and respect. The individual care plans seen contained pertinent risk assessments these documents do not restrict a persons activities but informs the staff about the best way to achieve the desired outcome with minimal risk to the person involved. Harlow Moor Drive (43) DS0000007879.V345531.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to make decisions about their daily life and staff provide appropriate support and encouragement for them to remain independent. EVIDENCE: The case files contained a personal timetable for each person in the home. These reflected activities inside and outside of the home. Currently one person is supported in paid employment, another is applying for work and someone else does voluntary work at their church. Other people in the home attend college. The individual progression plans identify areas for each person where staff could enable people to improve their independence skills either through paid/voluntary employment or through developing personal skills. People in the home access local facilities, during the inspection people went to the bank shopping and one person visited a chiropodist. People also enjoy Harlow Moor Drive (43) DS0000007879.V345531.R01.S.doc Version 5.2 Page 13 going to the pub, the cinema, on holiday, the theatre and local clubs such as Gateway. Staff support people in the home to maintain links with their families, two people have phones in their rooms so that they can contact their relatives when they want to. Feedback from relatives said ‘The home meets my brothers needs and help him to keep in touch with us’ and ‘The home meets the needs of my relative and helps her keep in touch with us’ and ‘He is able to phone me every week, which is a comfort to me and him’. People’s diaries also contain important family dates such as birthdays and anniversaries. Staff were observed entering bedrooms only with the permission of the occupant. People were addressed by the name they preferred and this was also identified in their case file. The routines of the house were dictated to by any appointments, college visits, going to work, otherwise people can choose how they spend their time. Any restriction on their movement is identified in their case file. The meals are planned on a weekly basis and the people in the home help to plan them. They also assist in the shopping and preparation of the meals. People spoken with said that they eat together in the evening but during the day they help themselves to breakfast and lunch. During the visit one person was observed getting her own lunch, two people in the home had lunch in town during the visit. Staff support these meal choices discreetly to make sure people are choosing a healthy diet. People said they discuss menus in house meetings and take it in turns to help with the supermarket shopping. They also said that they enjoy the food and feedback received from surveys also said ‘I like the food’ Staff are currently working with the people in the home to enable them to be more independent with the preparation and cooking of meals. Harlow Moor Drive (43) DS0000007879.V345531.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s health and personal care needs are met on an individual basis. The staff employ the principles of respect, dignity and privacy in all interactions with them EVIDENCE: The case files contained detailed information about the level of support required by the person they related to. Staff provide support and guidance where necessary and personal care tasks are identified in the progression plans. All the people in the home are independent with their bathing although they require some support in preparing a bath. The times for baths, getting up/going to bed are flexible and only guided by external appointments. The case files also contain details of GP and any specialist appointments. Evidence in the files showed that people do access medical services when necessary. One person has been to the well woman clinic and others access the local Learning Disability Team. This service offers physiotherapy, specialist medical support and support and advice to the staff. People also access Harlow Moor Drive (43) DS0000007879.V345531.R01.S.doc Version 5.2 Page 15 Chiropody, optician, dentist and aromatherapy and massage sessions these service compliment the support given by the local GP. None of the people in the home are self-medicating and information about this is in their case file. A nomad system is used and delivered to the home on a regular basis. The storage and administration of the medication was found to be appropriate. All the staff have received accredited training in the Safe Handling of Medicines. Harlow Moor Drive (43) DS0000007879.V345531.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in the home and their representatives are able to express their concerns through the complaints procedure and are protected from abuse, so their rights are protected. EVIDENCE: There is a clear complaints procedure in place and people in the home have access to a pictorial complaints procedure. There have been no formal complaints to the home or to the Commission of Social Care Inspection since the last inspection. One person has complained about another person in the home and the complaints procedure was followed. People in the home said they would speak to their key worker if they were unhappy. Feedback received from the surveys supported this assertion. There are regular house meetings and people are encouraged to raise any concerns at this forum as well. One person in the home has used the services of an advocate. Feedback from relatives said ‘We know who to complain to if we are unhappy and if I have they have always responded appropriately’. There is a comprehensive policy and procedure with regard to safe guarding adults and the procedure to take if there is a suspicion of abuse and staff have a good awareness of this. Staff receive training in adult protection issues during induction and foundation training and as part of NVQ level 2 and 3. Harlow Moor Drive (43) DS0000007879.V345531.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. People who use the 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 in the home live in a well-maintained, clean property that allows them to access all areas, promoting their independence. EVIDENCE: Harlow Moor Drive is a spacious property offering a large lounge separate dinning area and a fully equipped kitchen on the ground floor. The bedrooms are situated on the next two levels and were all found to be personalised by the occupant. One room had an ensuite facility, another had a fridge at the request of the occupant and several had their own phones installed. Whilst the communal areas have been recently decorated other areas of the home would improve for some updating. These include the bathrooms and several of the bedrooms. The member of staff available did say that the refurbishment had been identified and was in the planning process and she expected it to be completed in the near future. Health and safety checks are carried out weekly/monthly and annually to ensure the environment is safe and secure. Harlow Moor Drive (43) DS0000007879.V345531.R01.S.doc Version 5.2 Page 18 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Well-trained staff in sufficient numbers support the people who live in the home. They are seen as individuals and the care provided is pertinent to their needs. EVIDENCE: UBU has a rigorous employment policy where prospective staff complete an application form, and provide two references. A formal interview is held and the people in the home are involved in this process. One member of staff said that they had spent some time in the home with the people who live there and the manager made observations of this process. This information was included in the interview. All staff prior to the commencement of their employment have a Criminal Records Bureau disclosure check carried out. The staffing levels are appropriate and extra support is provided when necessary to assist people in the home with their social and independence skills. Staff have access to regular training both internal and external. The staff on duty had received training in first aid, challenging behaviour, epilepsy, manual handling, since the last inspection. Other training available to them included medication Harlow Moor Drive (43) DS0000007879.V345531.R01.S.doc Version 5.2 Page 19 refresher, complex behaviour, diabetes COSHH, and health and safety. All staff are encouraged to do their National Vocational Qualifications level two in care and the opportunity to the level 3 is also available. Each member of staff has regular supervision and they can identify areas of training they want to do, the training is linked to the individual progression plans of the people in the home. Harlow Moor Drive (43) DS0000007879.V345531.R01.S.doc Version 5.2 Page 20 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. People who use the 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 well managed home where the administration of the home is based on openness and respect. This allows them to retain their individuality and independence. EVIDENCE: The home has benefited from have the same manager in post for over twelve months. She is currently going through the registration process. Staff said that she was a good manger, who listens to the people in the home and staff. There is a quality assurance programme in place through UBU who carry out monthly management checks. This is supplemented by monthly house and staff meetings, staff supervisions and the reviews of the case files. This then feeds in to a development programme for the manager and staff. Harlow Moor Drive (43) DS0000007879.V345531.R01.S.doc Version 5.2 Page 21 All the working practices within the home are safe and staff keep accurate accident records, this information is used to inform the care plan and in requesting specialist input either through training or actual support. Staff have received training in the health and safety procedures and all the policies are read by the staff. The records relating to health and safety issues that were seen during the visit were up to date Harlow Moor Drive (43) DS0000007879.V345531.R01.S.doc Version 5.2 Page 22 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 Standard No Score 1 X 2 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 4 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 4 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 4 X 3 X 4 X X 4 X Harlow Moor Drive (43) DS0000007879.V345531.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Harlow Moor Drive (43) DS0000007879.V345531.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 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 © 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 Harlow Moor Drive (43) DS0000007879.V345531.R01.S.doc Version 5.2 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!