Inspection on 20/11/06 for Hartfield House

This inspection was carried out on 20th November 2006.

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

Hartfield House 06/12/07

Hartfield House 21/02/06

Hartfield House 16/08/05

Hartfield House 06/12/04

Hartfield House 09/07/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Hartfield House 5 Hartfield Road Eastbourne East Sussex BN21 2AP Lead Inspector Gwyneth Bryant Unannounced Inspection 20th November 2006 07:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hartfield House DS0000021127.V314942.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hartfield House DS0000021127.V314942.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hartfield House Address 5 Hartfield Road Eastbourne East Sussex BN21 2AP 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) 01323 731322 Mrs Cindy Nahoor Mrs Cindy Nahoor Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Hartfield House DS0000021127.V314942.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of residents to be accommodated is twenty one (21). Residents must be aged sixty - five (65) years or over on admission. Date of last inspection 21st February 2006 Brief Description of the Service: Hartfield House is registered to provide care and accommodation for up to twenty-one older people. The premises are situated opposite the park of Hartfield Square and within walking distance of the town centre of Eastbourne and the mainline railway station. A passenger lift provides access to all floors. The home has well maintained gardens to the rear of the property. Regular social activities are arranged within the home plus outings to places of interest. There are eighteen single rooms of which ten have en-suite facilities. The one double room also has en-suite facilities. There are six communal toilets and four bathrooms all of which are assisted. The service provides prospective residents with a copy of the homes brochure and an offer to visit in the first instance. The initial visit includes an offer to stay for coffee or a meal with existing residents. A care needs assessment is carried out at which time prospective residents are provided with an information pack which includes the homes statement of purpose and residents guide. Contracts are completed at the time of admission and a copy of the homes latest inspection report is held in the homes entrance hall. The range of fees charged as from 1 April 2006 is from £315 to £450 per week which includes in-house activities. Additional charges are made for hairdressing, toiletries, chiropody, newspapers and dry cleaning. Intermediate care is not provided. The homes email addresses are jackie@carehome.demon.co.uk and cindy@carehome.demon.co.uk. Currently the home does not have a website. The home is in the process of reducing its registered numbers from 20 to 19 as one room is now used as an office. Hartfield House DS0000021127.V314942.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulations`2001 uses the term ‘residents’ to describe those living in care home settings. For the purpose of this report, those living at Hartfield will be referred to as ’residents’ at their own request. This was an unannounced inspection and there were nineteen people in residence on the day. The inspection was undertaken over 8.5 hours and a number of documents and records were viewed; including personnel files, medication charts and care plans. A tour of the premises was carried out. Six residents, two relatives, two carers and the deputy manager were spoken with. Although the registered manager was on the premises the deputy manager was the person in charge on the day and she was the contact person during the site visit. Prior to the inspection a pre-inspection questionnaire was sent to the home to be completed with information required as part of the inspection process. This was returned and information detailed is used in this report. Nine service user surveys were returned and in the main comments were positive and included: ‘anyone wishing to enter a care home couldn’t do better than choose Hartfield House’. ‘I receive first class care and support always’. ‘ I would like to say how very happy and contented I am living at Hartfield House’. ‘The care that I receive at Hartfield House is just great’. What the service does well: What has improved since the last inspection? Hartfield House DS0000021127.V314942.R01.S.doc Version 5.2 Page 6 No requirements were made at the last inspection but recommendations were made in respect of the recording of complaints and the tracking of residents blood tests and pulse rates both of which had been addressed. 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. Hartfield House DS0000021127.V314942.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hartfield House DS0000021127.V314942.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Standard 6 is not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory pre-admission assessments are carried out prior to residents moving into the home that ensure that their needs are identified and can be planned for and they are provided with detailed information on services provided by the home. EVIDENCE: The home has a statement of purpose and residents guide which are included in the information pack given to prospective residents. Residents and relatives spoken with confirmed that they were given information at the time of admission and this was confirmed in the returned surveys. One survey included the comment’ I would have liked a second inspection of the home (prior to moving in)’. Pre-admission documentation was viewed for recent admissions and it is evident that these documents are used effectively to ensure the home is able to meet the needs of prospective residents. At the time of admission information is sought from social and healthcare professionals to ensure all needs are clearly identified and planned for. Hartfield House DS0000021127.V314942.R01.S.doc Version 5.2 Page 9 Two recently admitted residents appeared to be out of the homes registration category and this was discussed with the manager who agreed to address the matter. While there were records that showed their needs were met, a variation to the registration category needs to be sought from the CSCI to ensure the home does not breach the regulations. Intermediate care is not provided. Hartfield House DS0000021127.V314942.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All aspects of residents’ health, social and care must be identified and planned for, in order to clearly direct staff in the delivery of appropriate care EVIDENCE: Six care plans and daily records were viewed and it is evident that residents care needs are identified and that pre-admission assessments are used to inform the care planning process. While the plans were generally satisfactory, however some shortfalls were identified. In order to ensure staff are clearly directed in the delivery of care, the plans need to be more specific. The care plans had general comments such as ‘monitor for changes’ and this approach assumes all staff are sufficiently knowledgeable in identifying changes. On arrival it was noted that all nineteen residents were having breakfast in their bedrooms. This was discussed with the deputy manager who confirmed all residents chose to eat breakfast in their rooms but residents’ choices in respect of meal times was not recorded in their care plans. This needs to be addressed in order to provide evidence that residents are offered a choice. Hartfield House DS0000021127.V314942.R01.S.doc Version 5.2 Page 11 Care plans are reviewed but this process would be improved if the information from the daily notes were used to inform the process and that care plans were updated with the new information. Risk assessments need to be developed. It is required that where risks are identified, they are followed through with an assessment of the controls in place to minimise those risks. Risk assessments should be linked in with the support plans to ensure a member of staff can support residents in the safest and most appropriate way. The residents, the carers and deputy manager spoken with were unanimous in the belief that needs are identified and fully met but this is not reflected in the care planning documents. Records relating to care and residents daily lives need to be more detailed in order to accurately reflect the work carried out by staff and the positive outcomes for residents. The residents spoke positively about the care they receive and that they felt they could discuss any issues with staff or the manager, her deputy or staff. Relatives spoken with confirmed they are consulted on the care given and notified of any adverse events. Staff were seen to treat residents with care and respect throughout the site visit. Residents spoken with confirmed that staff are kind and caring and comments included: ‘staff are marvellous’ ‘I couldn’t wish for better’ ‘all the staff are wonderful’. The medication administration charts were viewed and it was found that some signatures had been overwritten which indicates that medication had been signed for prior to administration. In addition some signatures had been scribbled out and where code letters were used the reasons for the code were not recorded. If medication charts are inaccurate it is difficult to track whether or not medication was given or who had administered it. All staff need to be trained in the safe handling of medication to ensure they are confident to follow the homes policies and procedures on medication. Some residents self medicate and while risk assessments had been carried out they did not fully identify the risks nor how the risk is to be controlled and this needs to be addressed. Hartfield House DS0000021127.V314942.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are systems in place for residents to experience a lifestyle that matches their expectations, choice and preferences in respect of both leisure and meals. EVIDENCE: The home has a daily programme of activities and outings to local attractions or shopping are also arranged. Activities provided include music for health, exercises, quizzes, art and crafts and visiting entertainers. All residents and relatives spoken with confirmed there is a variety of activities arranged, in addition to outings and summer fairs and cream teas in the garden. The latter were singled out by four residents who said how much they had enjoyed these events. One resident said ‘there are lots of opportunities to go on outings’. Outing include visits to local events, parks, churches and to tea rooms. One resident regularly goes to the town and was seen to be going out on the day. Residents’ family and friends are welcome at all times and they are also invited to the summer fairs and other garden events. In addition the relatives spoken with said they are invited for meals and staff always offer refreshments and make them feel welcome. Residents are actively encouraged to visit the town to do their own shopping if they wish to do so. Hartfield House DS0000021127.V314942.R01.S.doc Version 5.2 Page 13 Returned surveys also confirmed that there were activities that they could participate in and equally the wishes of those residents who choose not to partake are also respected. Comments in surveys included: ‘ I don’t wish to partake but I am made aware of them’. ‘lovely trips out – they are most enjoyable’. ‘we have many activities which are most enjoyable’. ‘the food is very good’. ‘I always take part in activities which I really enjoy’. ‘some vegetables could do with more cooking’. Food was another area singled out for special mentioned by all residents spoken with. The menus were viewed and it is evident that balanced and nutritious meals are provided daily. Meal times are not flexible but if residents have an appointment or wish to go out then mealtimes will be adjusted for them. Hartfield House DS0000021127.V314942.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a satisfactory complaints system with evidence that residents felt confident their views would be listened to. Although there are policies and procedures on adult protection these are not followed in practice. EVIDENCE: The home has detailed policies and procedures on complaints and the complaints book showed that all complaints are investigated and responded to in line with the homes policies and procedures. All surveys returned indicated that residents know how to make a complaint and comments included: ‘I can speak to the owner, the deputy manager or a carer’. ‘I know they will listen to me’. ‘(name) is always ready to listen’. ‘they (staff) always listen and act on what I say’. The CSCI received an anonymous complaint in respect of there being just one member of staff on duty at night. The night notes were viewed and it appeared that staff were rarely needed during the night therefore it was concluded that one member of staff could manage the night duties. This was also discussed with the deputy manager who confirmed that there are three other members of staff who are ‘on-call’ at night. The home has detailed policies and procedures on adult protection, however the complaints book showed that there had been an allegation of abuse by a carer to a resident. The abusive incident was witnessed by two staff who Hartfield House DS0000021127.V314942.R01.S.doc Version 5.2 Page 15 notified the deputy manager. However, subsequent records were viewed and it was found that the homes’ policies and procedures were not followed, nor was the CSCI and local adult protection team informed. In order to ensure residents are protected the correct procedures in respect of adult protection must be followed whenever an allegation is made. Hartfield House DS0000021127.V314942.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of décor is good, providing residents with a safe, homely and attractive place in which to live. Laundry facilities are satisfactory and residents protected by effective infection control systems. EVIDENCE: A tour of the premises was carried out and all parts of the home are well maintained, including the gardens and décor is also good. All repairs and maintenance is carried out promptly and satisfactorily. Laundry facilities are clean and hygienic. Systems are in place for the control of infection and all staff have been trained in this area and were observed to be working in ways that minimised the risk of infection, by wearing gloves and aprons when required. Hartfield House DS0000021127.V314942.R01.S.doc Version 5.2 Page 17 Surveys returned indicated that the home is kept clean and tidy and one comment was ‘the home is kept very clean indeed’. Hartfield House DS0000021127.V314942.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The number of staff and the skill mix is such that residents’ needs are met and consistent care is provided but improvements need to be made to staff induction. The recruitment practice is robust and provides sufficient safeguards for the protection of residents. EVIDENCE: Staff rotas were viewed and demonstrated that there are sufficient staff deployed at all times to ensure residents needs are met. Residents spoken with said they felt well cared for and confirmed that staff answer call bells promptly. Either the manager or her deputy are on duty six days a week and they also provide on-call duties at night. The anonymous complaint received in respect of only one night waking staff has been addressed under Standard 16. The pre-inspection information included information on staff training and indicated that seven staff currently hold National Vocational Qualifications (NVQ) in Care at level 2 or above and that three are in the process of gaining this qualification. Recruitment records for the last three staff recruited were viewed and it was found that they had provided the required documentation prior to appointment and all necessary checks had been undertaken including Criminal Record Bureau checks and Protection of Vulnerable Adults First Checks. One carer spoken with confirmed she had an induction period and has achieved NVQ level Hartfield House DS0000021127.V314942.R01.S.doc Version 5.2 Page 19 2 in care. This carer also said she really enjoys working at the home and that staff work as a team. She was knowledgeable about individual residents needs and she had a good understanding of adult protection issues. The induction records for two staff were viewed and it was found that induction had been carried out over two days. The care skills sector guidance states that the induction period should cover six weeks to ensure new staff have an indepth knowledge of the home and its policies and procedures. Information in the pre-inspection questionnaire indicated that staff are also trained in safe handling of medication, Protection of Vulnerable Adults, infection control, moving and handling, fire safety and first aid. However, not all staff had received all this training and in light of the shortfalls found during the site visit some staff need updated training. Hartfield House DS0000021127.V314942.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff and residents benefit from clear leadership and direction and all aspects of residents’ health, safety and welfare are protected and promoted. EVIDENCE: The manager and her deputy are both experienced in the care industry and both have relevant qualifications in care. A residents’ questionnaire has been carried out as part of the quality assurance system and this needs to be further developed to encompass all parts of the service. This will enable the provider to objectively evaluate the service and ensure it is run in residents’ best interests. Residents are responsible for their own finances if appropriate; relatives and solicitors support others. The home holds small amounts of money for Hartfield House DS0000021127.V314942.R01.S.doc Version 5.2 Page 21 residents and receipts are provided for all purchases and appropriate records are maintained for all transactions. Staff records showed that regular supervision is provided and the carer spoken with confirmed they had received supervision and that they found it useful. Information in the pre-inspection document confirmed that safety checks are carried out on all electrical and gas systems and appliances and that they are serviced annually. In addition documents relating to safe working practices and Health and Safety are available and regularly reviewed. Accident records were viewed and it was found that they are not maintained in accordance with health and safety guidance and this needs to be addressed. Hartfield House DS0000021127.V314942.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 Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 2 2 Hartfield House DS0000021127.V314942.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. 1 Standard OP7 Regulation 15 (1) and 13 (4) ) (a-c) (5) Requirement That care plans and risk assessments include direction to staff in meeting service users needs, including manual handling. Care plans need to be updated in line with the monthly reviews. All staff who administer medication must receive satisfactory training and that all medication administered is appropriately recorded. That all staff be trained in adult protection. That induction is carried out in accordance with the Care Skills Sector guidance. That quality monitoring and quality assurance systems be expanded. That all accidents are appropriately recorded as required under Regulation 17 Schedule 3 and 4. That systems be devised to notify the CSCI of all adverse events including allegations of abuse. Timescale for action 20/01/07 2 OP9 13(2)18 (1)(ac)(i) (ii) 13(3) (6)(7)(8) 18(1ac) (i)(ii) 24 (1ab) (2)(3) 17 (1a) (2) 37 (1) (a-g) (2) 20/01/07 3 4 5 6 OP18 OP30 OP33 OP38 20/01/07 20/01/07 20/01/07 20/12/06 7 OP18 OP37 20/12/06 Hartfield House DS0000021127.V314942.R01.S.doc Version 5.2 Page 24 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 Hartfield House DS0000021127.V314942.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 Hartfield House DS0000021127.V314942.R01.S.doc Version 5.2 Page 26 - 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!