Inspection on 29/08/07 for Hazel Garth

This inspection was carried out on 29th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Hazel Garth 12/09/06

Hazel Garth 28/02/06

Hazel Garth 24/08/05

Hazel Garth 21/03/05

Hazel Garth 09/08/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hazel Garth Hazel Road Warwick Estate Knottingley WF11 0LG Lead Inspector Gillian Walsh Key Unannounced Inspection 29 August 2007 10:00 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 Hazel Garth DS0000034421.V338431.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. Hazel Garth DS0000034421.V338431.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hazel Garth Address Hazel Road Warwick Estate Knottingley WF11 0LG 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) 01977 722405 01977 722408 jlinwood@wakefield.gov.uk www.wakefield.gov.uk Wakefield MDC Miss Janet Linwood Care Home 24 Category(ies) of Dementia - over 65 years of age (24) registration, with number of places Hazel Garth DS0000034421.V338431.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Can provide accommodation and care for four named service users in OP category. 12th September 2006 Date of last inspection Brief Description of the Service: Hazel Garth is a care home registered to provide care for 24 older people who are living with dementia. It is owned by Wakefield MDC (Metropolitan District Council) a Local Authority offering a wide range of services to vulnerable people. The home is situated on a residential estate on the outskirts of Knottingley, a small town adjacent to the A1 & M62 motorways and local buses stop very near the entrance to the home. The home was purpose built and was extensively refurbished in 2000 with a further programme of refurbishment taking place as part of the change of registration to dementia care in 2005/6. It is a two-storey building with both personal and communal accommodation based on four potentially selfcontained wings. All the bedrooms are single and there is a passenger lift. There are large gardens to the side and rear of the premises. The person in charge said on 29/08/07 that the current charges for living at the home are £90.02 - £494. 54 per week. Extra charges are made for hairdressing, newspapers/periodicals and private chiropody. Information about the home is available within the Statement of Purpose and the Service User Guide. Information about the Commission for Social Care Inspection is included in the Service User Guide. Hazel Garth DS0000034421.V338431.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit to the home which took place from 10.30am to 5.00 pm on 29 August 2007 and was made as part of a full inspection of the service. During the visit time was spent speaking with people who live at the home and staff working there. Unfortunately the home manager was not in the home due to annual leave but a senior member of staff ably assisted with the inspection process. Time was also spent looking around the home and examining documentation. As part of this inspection the views of people who live at the home, their relatives, healthcare professionals, including General Practitioners and district nurses, were sought by way of surveys sent out by the Commission prior to the visit to the home. The outcome of this was as follows: Of the 10 surveys sent to people living at the home, 7 were returned. All of the people completing the forms had needed assistance to do so due to the nature of their illness and some had not been able to offer their views at all. Only 1 of 14 the surveys sent to relatives had been returned at the time of writing this report. The person completing this survey was very satisfied with the care their relative receives at the home. 1 survey from the 2 sent to district nurses who visit the home was returned. This person was very confident in the abilities of the staff to deliver the care needed by people living at the home commenting that they “are able to network well with all agencies” The nurse also said that the feedback about the home from the GP is “excellent”. In writing this report, information and evidence was not only obtained by way of visiting the home but also from notifications and information sent to CSCI and from previous CSCI inspection reports. The inspector would like to thank the people living at the home, their relatives and staff for their time and assistance during this inspection. Hazel Garth DS0000034421.V338431.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Care plans must be developed for all of the people living at the home, which detail their needs and inform staff how to meet these needs. This should include care plans relating to the care people need for managing aspects of their dementia and their social and recreational needs. Assessments must be undertaken as part of the care planning process, this is particularly important for people’s moving and handling needs. Current practice has the potential to put people at risk. In order to protect people, staff need to be aware of safeguarding procedures and when and how to refer under local safeguarding policies. Hazel Garth DS0000034421.V338431.R01.S.doc Version 5.2 Page 7 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. Hazel Garth DS0000034421.V338431.R01.S.doc Version 5.2 Page 8 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 Hazel Garth DS0000034421.V338431.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People do not move in without an assessment being completed to confirm that their needs can be met at the home. EVIDENCE: The person in charge on the day of the visit said that before any new person comes to live at the home, they are visited and assessed by either the manager or one of the senior carers from the home. Whenever possible, people are also invited to come to the home for a look around and a meal before moving in. One person who lives at the home confirmed this by commenting in a survey that they “went for a visit and lunch before moving” Completed pre admission assessment forms were seen during the visit but these are not kept within the care plan files. Discussion took place with the Hazel Garth DS0000034421.V338431.R01.S.doc Version 5.2 Page 10 person in charge about the benefits of staff having access to these assessments in order to assist them to develop an initial care plan. The Home provides respite care but does not provide intermediate care. Hazel Garth DS0000034421.V338431.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Good standards of care are maintained at the home. However this is not supported by good care planning or assessment processes and this, particularly in relation to moving and handling, could put people at risk. EVIDENCE: During the visit four peoples care plan files were looked at in detail. Generally care plan files contain “Life Diaries” which are developed to give detail of peoples life histories, a brief outline of their current needs and some detail of the persons likes, dislikes, hobbies and lifestyle choices. The quality of the information contained within the Life Diaries varies with some giving good information about the person and others giving very scant detail. The format for care planning is very good, concentrating on people’s strengths and abilities with a column for detailing the support a person needs to meet their needs in each area. Again the quality of the information varied from very Hazel Garth DS0000034421.V338431.R01.S.doc Version 5.2 Page 12 good, detailed care plans which included information about the individuals strengths, needs, likes, dislikes, personal preferences and lifestyle choices to one for a person on their second period of respite care in the home, where no care plans had been developed at all. All of the files seen contained nutritional, waterlow and moving and handling assessments but several of these assessments had not been completed at all and others had not been reviewed to give up to date information. Concerns were expressed particularly about the lack of, or out of date moving and handling assessments. Daily notes for one person who had not had a moving and handling assessment said that the person was now “very difficult to transfer, may need to use the hoist in future” with later entries confirming that the hoist was now being used. Another persons care plan said that the individual used a Zimmer frame for mobilising with a wheelchair for long distances. This person was observed being moved using a handling belt and, when asked about this, staff said that they used the handling belt when they knew that the person would weight bear but at other times used the hoist and sling. No moving and handling assessment had been completed for this person and use of a handling belt or hoist and sling were not included in the care plan. Entries in the same file indicated that the person had not been eating well and had lost over a stone in weight in a three-month period. This had been appropriately referred to the GP who had requested tests but the care plan had not been reviewed to reflect these changing needs. Whilst this home specialises in caring for people living with dementia, none of the files seen included care plans detailing the support and care people need for managing aspects of their dementia. Several references were made in the files about agitated or aggressive behaviour, poor short-term memory and confusion but no care plans had been developed in relation to these needs. Neither had care plans been developed in relation to people’s social and recreational needs. One person’s file included an entry on a sheet headed “Behaviour file” about the person hitting another person in the stomach and shouting. No care plan had been developed to inform staff how to manage this behaviour and daily records had not been made relating to this incident in either of the people involved files. It was also noted that this incident had not been referred under local safeguarding procedures. Records indicate that people’s health care needs are being referred appropriately to health care professionals. One health care professional said in a survey that staff from the home seeks advice when required. The person also said that the staff “Provide excellent care (holistic) meeting individuals needs” Hazel Garth DS0000034421.V338431.R01.S.doc Version 5.2 Page 13 and that they refer appropriately and are “able to network well with all agencies” Systems for storing and administering medications in the home were examined and were found to be well managed. Observations made on the day and feedback from surveys confirmed that staff are understanding of peoples needs and treat them with respect whilst maintaining their dignity. Staff spoken with said that training in dementia care had really helped them to develop a better understanding of the care needs of the people living at the home. Hazel Garth DS0000034421.V338431.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People enjoy their lifestyles and are supported to make choices. EVIDENCE: The person in charge said that dedicated activities staff are not employed at the home but that care staff engage people in activities on a daily basis. In addition to this activities staff employed by the local authority visit the home two or three times a month. Comments in surveys indicated that people particularly enjoy getting together for a sing- song and a dance. Staff confirmed that this is the activity that most engages people and they express all sorts of emotion when singing and listening to familiar songs. Other activities include games, bingo and short outings for small groups. Staff said that people particularly enjoy going to the local supermarket café for a drink and a snack. Hazel Garth DS0000034421.V338431.R01.S.doc Version 5.2 Page 15 Recently digi-boxes have been purchased to give people a wider choice of television viewing. One person spoken with has particularly benefited from this as they can now enjoy watching much more sport on television. No visitors were in the home to speak with during the visit, but one person said how much they enjoy seeing their family and friends and staff confirmed that visitors are made welcome. The development of care plans relating to people’s social and recreational needs would help staff to be aware of and recognise individual’s preferences in relation to their lifestyles. All of the people spoken with said that they enjoyed the food at the home. People eat in either the main dining area next to the kitchen or in one of the four smaller dining rooms. The lunchtime meal on the day of the visit looked very appetising and people were seen enjoying their meals. The choices on the day were, chicken goujons and chips, corned beef hash with Yorkshire pudding or baked potato with cheese. It was also good to see that condiments were available on the table and people were offered bread and butter with their meal. A choice of puddings was also available. Staff were seen to be supporting those who needed it with discretion and sensitivity. Hazel Garth DS0000034421.V338431.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People who use this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. A lack of staff understanding of safeguarding has resulted in people not being fully protected. EVIDENCE: People who completed surveys indicated that they would know who to speak to if they were unhappy or needed to make a complaint about the care at the home. Since the last inspection one complaint has been recorded as received in the home’s complaints book. Documentation shows that this complaint was dealt with timely and appropriately. During the visit it was noticed that an entry had been made within the care plan file on a sheet headed “Behaviour File” that they had been “hitting” another person in the stomach and shouting. This incident was not recorded in either of the people involved daily record and the person in charge said that it had not been referred under Wakefield Metropolitan District Council’s safeguarding procedures. The person in charge also said that they did not recognise this as an incident of abuse, which should be reported. Other staff at the home, when asked by the person in charge, also said that they would not report this as an incident of abuse. Hazel Garth DS0000034421.V338431.R01.S.doc Version 5.2 Page 17 Although staff have received training in protection of vulnerable adults, it is recommended that further training is undertaken to make sure that all incidents of suspected or actual abuse are reported appropriately. The person in charge was informed during the visit that a requirement would be made that all suspicion of, or actual abuse, must be reported appropriately, from the day of the visit. Hazel Garth DS0000034421.V338431.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People live in a clean, comfortable and safe environment. EVIDENCE: During the visit all of the communal areas and a number of bedrooms were seen. Everywhere was very clean and tidy but retained a comfortable and homely feel. Surveys received indicated that the home is always clean and well maintained. Work is underway to develop a sensory garden, which will enable people to sit in and walk around the large garden safely. Hazel Garth DS0000034421.V338431.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Staff are available as needed by people who live at the home. Although training is ongoing, this needs to be reviewed to ensure that staff know how to keep people safe. EVIDENCE: People who responded to the Commissions surveys generally felt that there is usually sufficient staff available to meet people’s needs. Observations during the visit were that this was the case most of the time but the registered person should keep the situation under review particularly during busy periods such as mealtimes when people need attention in different areas of the home. The person in charge said that common induction standards are now completed by all new staff. Information supplied to the Commission prior to the visit, indicated that almost all staff have achieved or are studying for National Vocational Qualifications in care at level 2 or above. Recruitment records are kept electronically and a number were seen during the visit. Recruitment procedures appear to be safe although the registered person should ensure that staff who have transferred from other local authority homes Hazel Garth DS0000034421.V338431.R01.S.doc Version 5.2 Page 20 have their records transferred appropriately so that they can be accessed by the management of the home they are now working in. Staff training is ongoing and a matrix is available which indicates that staff are up to date with mandatory training. However concerns were raised with the person in charge about poor systems relating to moving and handling and safeguarding despite staff having had recent training in both areas. People spoken with were complimentary of the staff and observations during the visit were that staff treated people with kindness and respect. Hazel Garth DS0000034421.V338431.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, and 38. People who use this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Generally the management of the home is of a good standard. However the poor moving and handling procedures and none referral of safeguarding could put people at risk and has therefore particularly affected the judgement of this section of the report. EVIDENCE: The registered manager is a registered nurse who has many years’ experience of managing a care home and has completed the registered managers award. Records show that she undertakes regular training updates and along with other staff has completed further training in caring for people living with dementia. Hazel Garth DS0000034421.V338431.R01.S.doc Version 5.2 Page 22 A quality monitoring system is in place at the home whereby people who live at the home and their families are given questionnaires about the quality of care provision at the home. Surveys have also recently been developed for people who have received respite care at the home and their families. A selection of these were seen during the visit and all give very positive feedback. Small amounts of personal allowances are kept, at the individuals’ request, in the home’s safe. Documentation relating to this was checked and found to be appropriate. All of the balances checked could be reconciled with the documentation made. Practices relating to health and safety and maintenance within the home are managed between the home’s manager, maintenance staff and the estates personnel from WMDC. Monthly Regulation 26 visit reports are received from the home, within which matters relating to quality and health and safety are recorded. Although there are many good practices in the home, which promote people’s safety, there is the potential that people could be put at risk due to a lack of assessment and guidance for staff in relation to moving and handling. Hazel Garth DS0000034421.V338431.R01.S.doc Version 5.2 Page 23 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 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 1 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 1 Hazel Garth DS0000034421.V338431.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1)(2) Requirement To inform staff of the support they need to give and to ensure that people’s needs are met, the registered person must ensure that care plans are developed, based on assessment, for all people living at the home. Timescale for action 30/11/07 2 OP7 OP38 13 (5) The registered person shall make 31/10/07 suitable arrangements to provide a safe system for moving and handling people. Detailed moving and handling risk assessments must be in place for each individual, clearly explaining what equipment, method, and staff should be involved in the transfer. The manager must ensure that training in this area is appropriate and is at all times adhered to. All suspicion of or incidents of actual abuse must be reported immediately under local safeguarding procedures to ensure that people are protected. DS0000034421.V338431.R01.S.doc 3 OP18 13(6) 29/08/07 Hazel Garth Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 2. Refer to Standard OP7 Good Practice Recommendations Care plans should Give clear details of residents’ needs, abilities and the support they need to meet their needs. Be signed by the person who has written it and, where possible, the resident or their representative. Be reviewed on a monthly basis and as needs change. Be used as a working document. Daily records should give clear details of how residents have spent their day and of any care or treatment the person has received. Staff should receive updates in recognition of abuse and how and when to report under local safeguarding procedures. The manager should keep staffing under review to ensure that staff are available in sufficient number to meet resident needs. 6. OP18 7. OP27 Hazel Garth DS0000034421.V338431.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND 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 Hazel Garth DS0000034421.V338431.R01.S.doc Version 5.2 Page 27 - 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!