Inspection on 01/05/08 for Heatherdene

This inspection was carried out on 1st May 2008.

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

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

Other inspections for this house

Heatherdene 24/03/09

Heatherdene 18/05/06

Similar services:

Ashcroft Hollow Nursing Home

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Heatherdene 3 Upper Brook Street Oswestry Shropshire SY11 2TB Lead Inspector Pat Scott Key Unannounced Inspection 1st May 2008 09:45 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 Heatherdene DS0000065628.V363249.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. Heatherdene DS0000065628.V363249.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heatherdene Address 3 Upper Brook Street Oswestry Shropshire SY11 2TB 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) 01691 670268 01691 662073 www.heatherdene.net Primecare Homes Britannia Limited Post vacant Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Heatherdene DS0000065628.V363249.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th May 2006 Brief Description of the Service: Heatherdene is a care home for older people situated in the centre of Oswestry, close to all amenities. The home is registered to provide care for a maximum of 18 service users. The home offers respite and permanent care to male and females over the age of sixty-five. It is a large adapted family house and the first floor is accessed by a shaft lift. The front door to this home is kept locked. The home is owned by Primecare Homes Britannia Limited. The home makes their services known to prospective service users in: The Statement of Purpose, Brochure, Welcome pack and web site which also contain their contact e mail address. The inspection report is mentioned in the statement of purpose and is given out on request. Fees are reviewed annually and range from £331-360. The only additional charges to service users are for toiletries, hairdressing, newspapers and escorting to hospital for routine appointments. This is clearly laid out in the terms and conditions. Heatherdene DS0000065628.V363249.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is *ONE star adequate service. This means the people who use this service experience adequate quality outcomes. We, the commission, used a range of evidence to make judgements about this service. This includes: information from the manager in the annual quality assurance assessment (AQAA), staff records kept in the home, medication records, survey results from people who use the service, surveys from the staff team, discussion with the acting manager, tour of the premises, previous inspection reports, quality assurance processes, Fire Authority reports, Environmental Health Office reports, observation of care experienced by people using the service. What the service does well: What has improved since the last inspection? A new acting manager is in post with relevant experience and qualifications. People are consulted more about their choice and views, e.g. decoration of the home and meal provision. Some areas of the premises have been redecorated and re carpeted. A new chef is in post to improve the delivery and service of meals. The kitchen has been refurbished. A treatment room has been provided which improves privacy for visiting professionals and for medication storage. Heatherdene DS0000065628.V363249.R01.S.doc Version 5.2 Page 6 What they could do better: The care home provider must make a monthly, unannounced visit to the home, and write a report of the visit. The presentation of the information documents such as the statement of purpose and service user guide should be reviewed. The acting manager feels that these can be made better with the addition of pictures and alternative formats. The service needs to ensure that partners, relatives or significant others are involved in health care decisions when it is the wish of the person using the service. Staff should indicate this as a record in the care plans. Care plans should be completed fully and consistently. After consulting people individually and collectively about their preferences for leisure activities the service could develop a social plan of care. Activity hours can then be allocated on a more planned basis to meet the residents’ assessed needs. Residents’ surveys state that staff do chat with them about what they are going to do on any day. The service has decorated and re carpeted areas of the home. The home has many worn out pieces of furniture in bedrooms and some rooms do not have a bedside light. There is lack of handwashing facilities in the laundry, bedrooms and treatment room. These need to be provided. The provider should develop a process of supervision for the acting manager which will fit the service’s statement of purpose and maintain and improve standards of care for people who use the service and the overall conduct of the home. Frequencies of supervision should be agreed so that the supervision of the acting manager can incorporate reviews of her role and responsibilities and progress to meet the business plan of the service. The provider needs to develop and implement systems that monitor the quality of the service and measure compliance with the policies and procedures of the home. The home is generally able to provide the aids and equipment recommended, but more attention could be given to the changing needs of residents i.e provision of a hoist. Heatherdene DS0000065628.V363249.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. Heatherdene DS0000065628.V363249.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 Heatherdene DS0000065628.V363249.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): Key Standard 3. 6 not applicable to this service. National Minimum Standard 1 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can be more confident that the care home can support them. This is because there is now a complete assessment of their needs that they, or people close to them, have been involved in. People will be able to feel that they will be able to live the life they choose in the home. This is because the assessment is now more person centred and shows an understanding and respect for their diversity. Prospective residents and their representatives are provided with most of the information needed for them to choose a home which will meet their needs. EVIDENCE: Heatherdene DS0000065628.V363249.R01.S.doc Version 5.2 Page 10 The service has developed a statement of purpose, which sets out the aims and objectives of the home and includes a service user guide, which provides information about the service that the care home offers. They do not fully comply with the Care Homes Regulations 2001 regarding information required to be given to people who use the service, nor are they easily readable as the print is so small. Advice given to the service regarding these documents on 29.1.08 has not been acted upon. An admission assessment was read of a recently admitted person. It shows the service is now taking into account the individual physical care needs of a service user in a person centred way. Previous assessments read demonstrate that the admissions process was more process driven and not particularly personalised with little extra consideration of individual social history or risk element. The acting manager states she consults the assessment information to see if the home can meet the person’s needs before they make the decision to accept the application for admission and offer a placement. Heatherdene DS0000065628.V363249.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): Key Standards 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service has a plan of care but does not demonstrate that the person, or someone close to them, has been involved in making it. This does not show the people’s needs and goals are met nor that they are able to make decisions about their life with support if they need it. People receive personal support from staff, to be as well as they can be, but it is not clear if it is in a way they prefer and want. Their physical and emotional needs may not be met because the care plan recording procedure is not followed by staff. People who can manage their own medicine are able to do so as the service can support them with it in a safe way. The acting manager understands the need to comply with safe medication systems and has improved these so that residents’ health matters can be safely addressed. Heatherdene DS0000065628.V363249.R01.S.doc Version 5.2 Page 12 EVIDENCE: The service’s contract states that ‘a service user plan of care will be drawn up with the full involvement of the service user and reviewed at regular intervals’. The service user guides states: ‘the individual residents agreed plan of care provides the basis on which Heatherdenes’ care service is delivered’. Care plans reviewed do not comply with this statement. Care plans are developed, the records of which give no indication of consultation with the individual concerned or their supporter. People who have been in the home some time do not have up to date plans and do not have a record of regular review. Assessments for risk such as pressure areas and manual handling have not been completed. The manager states that these will be introduced. One resident has bed rails attached to the bed. There is no assessment either by the home or the district nursing service for the use of bed rails as a restraint and that refers to the mental capacity of the individual. The acting manager acknowledges the need to conduct one in line with relevant advice. She states that none of the staff have received training on the use of bed rails and agreed that this should be addressed. A care plan written by the acting manager does contain a plan of care that is carried on from the assessment and has been reviewed at a timely date. The review page has not been signed/dated. The acting manager states that a new format is in progress and all residents’ details will be transferred to this. Staff have received training twice to improve their care plan writing skills but more work needs to be done in this area. Staff can provide a verbal update of care for people who use the service. The new plans, if used, will show that long term and short term health needs are monitored and appropriate action and intervention taken. The service is not able to manage people’s needs if their mobility deteriorates, as they do not have a hoist. This is not explained in the statement of purpose. The acting manager stated that the management of medicines has been under review with assistance from a new supplying pharmacy. The service’s statement of purpose claims the home can assist people to manage their own medication. The home provides individuals with lockable facilities within their bedrooms. Heatherdene DS0000065628.V363249.R01.S.doc Version 5.2 Page 13 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): Key Standards 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff support people to keep in touch with family, friends and representatives so that they have appropriate relationships. People state they are as independent as they can be, and the service demonstrates that they lead their life in a more chosen way so that they have the opportunity to make the most of their abilities and interests. The food in the home is of satisfactory quality so that the dietary needs of people are met. EVIDENCE: Staff know that they need to support residents socially and emotionally. The service consults and listens to people regarding the choice of daily activity through bi-monthly resident meetings. Staff provide activities as part of their role. The service does not employ an activity co-ordinator. The AQAA states in their improvement plan for the next 12 months that it is the intention to Heatherdene DS0000065628.V363249.R01.S.doc Version 5.2 Page 14 employ one. The service’s statement of purpose describes the activities provided. Activities carried out are recorded within an album. Residents look happy and relaxed. Families are at ease when they visit. Staff have a good interaction with the people they look after. The service reports it has no outstanding items to address from the recent Environmental Health officer visit. The kitchen has undergone refurbishment. Menus are not displayed within the dining area. The acting manager stated that the presentation of food has been revised i.e. food is now served on heated plates and that changes to the menu had been discussed at the resident meetings. Care plans lack reference to nutritional assessment and monitoring. Weights are recorded. The acting manager described her stated intention of introducing a nutritional risk assessment and care plan to accompany the new care plan records. Heatherdene DS0000065628.V363249.R01.S.doc Version 5.2 Page 15 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): Key Standards 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure that is up to date and accessible so that anyone associated with the service can complain or make suggestions for improvement. EVIDENCE: The service has a complaints procedure that meets the national minimum standards and regulations. The complaints procedure is not very visible within the home but it is within the service user guide. Two concerns received since the last inspection have been dealt with according to the home’s procedure and resolved. The acting manager is clear when incidents need external input and who to refer the incident to. Links with external agencies are satisfactory and include the commission, police and adult protection teams. An adult protection issue regarding financial abuse has been swiftly dealt with. Staff action in reporting this demonstrates an awareness of the content of the policy and what immediate action to take. People who use the service and their supporters state within surveys that they are satisfied with the service provision, and feel safe and supported. Staff are provided with regular updates in adult protection. Heatherdene DS0000065628.V363249.R01.S.doc Version 5.2 Page 16 Heatherdene DS0000065628.V363249.R01.S.doc Version 5.2 Page 17 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): Key Standards 19,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People feel they live in a comfortable, clean home but renewal and improvement is slow. There is a formal plan for identified changes so that residents are assured that the owner will provide a dignified or safe environment in the longer term for them. EVIDENCE: Residents tell us they like their environment and individual bedrooms. Although the home is comfortable and clean, there are areas which require improvement. Bedroom furniture is in a poor state with scrapes and knocks. Not every bedroom has bedside lighting. Bedrooms have soap dispensers but no paper towel dispensers or pedal bins. The treatment room does not have any hand soap/paper towels or a pedal bin. The laundry does not have a designated hand wash area, staff being expected to wash their hands after Heatherdene DS0000065628.V363249.R01.S.doc Version 5.2 Page 18 dealing with dirty laundry in the janitory sink or the staff toilet on their way back through the home. There has been some relaying of carpets and decoration in the lounge. The home has no garden but a courtyard area which needs some attention to make it an accessible and pleasant place to sit. The AQAA identified the programme of renewal of the fabric of the home. The service intends to employ a maintenance person. Previously decorated residents’ rooms do not look professionally attended to. Heatherdene DS0000065628.V363249.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): Key Standards 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff get access to training, supervision and support they need from the manager so that residents’ basic care need are met. Staff in the home are trained, but do not recognise the importance of care planning so that peoples’ changing needs may not be identified and acted upon. EVIDENCE: There are NVQ qualified and experienced staff employed to provide care to people at the home. The acting manager recognises the importance of training, and is trying to organise a programme that will meet mandatory requirements for 2008. Care plans show that there is limited understanding of the person centred way of delivering care and support and this is not through lack of training. The acting manager reports that the new leadership is aiming to address this. People using the service tell us that staff working with them provide safe and appropriate support. Heatherdene DS0000065628.V363249.R01.S.doc Version 5.2 Page 20 Three staff personnel files were selected for inspection, all the necessary identity checks have been carried out but with some discrepancy in start dates and references returns. The acting manager stated that files need to be more organised. Heatherdene DS0000065628.V363249.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): Key Standards 31,33,35,38 National Minimum Standard 32,37 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the home is based on openness and respect. The service has quality assurance surveys in place so that service users are assured that the overall conduct of the home is taking into account their views. People’s opinions are more central to how the home develops and reviews it’s practice, and the service is developing appropriate ways of making sure they get things right. So, people have confidence in the care home because it is run and managed better. EVIDENCE: Heatherdene DS0000065628.V363249.R01.S.doc Version 5.2 Page 22 The service user guide and the website refer to the acting manager as the ‘registered manager’ which is misleading. The service does not currently have a manager, registered with the commission, in post. The acting manager has management experience and knowledge of the National Minimum Standards and regulatory framework within which she must operate. The acting manager states that the care home provider visits the home but does not produce the required monthly report of the visit. Reports are not available in the home for inspection to evidence the monitoring of the running of the home by the provider. Through discussion, the acting manager is aware of the need to plan the business activity of the home but does not, at present, hold responsibility to manage finances and resources to deliver the service. The acting manager is improving and developing systems that monitor practice and compliance with the plans, policies and procedures of the home The acting manager was open in her wishes and ideas for improvement to the service. An initial audit of medication has resulted in changes to the procedures. There are no formal audits to check whether policies and procedures are being adhered to and that systems are working to achieve good outcomes for service users on an on going basis. Shortfalls to meet the National Minimum Standards have been identified by the service through the AQAA. There are plans to address these over the next 12 months. Plans for improvement are to be implemented by the acting manager with no administrative support. The acting manager understands person centred planning and thinking. She is having difficulty in encouraging staff to translate this theory into practice to make a difference to the outcomes for residents using the service. Quality assurance takes place with collated results from surveys to demonstrate how service users and their supporters are consulted about life in the home. Service users confirmed they are being asked their point of view. The acting manager arranges for staff to have mandatory training consistently and equally so that they are knowledgeable to care for people who use the service. Heatherdene DS0000065628.V363249.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 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 X X 3 Heatherdene DS0000065628.V363249.R01.S.doc Version 5.2 Page 24 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 OP37 Regulation 26(4)(5) Requirement The provider must make a monthly unannounced visit to the service and write a report of the visit. The reports must be kept at least until the next key inspection of the service. This must be done so that the provider can demonstrate effective and efficient conduct of the business. Timescale for action 30/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The quality of the presentation of the statement of purpose and service user guide should be reviewed. They should reflect full compliance with the National Minimum Standards and Care Homes Regulations 2001. The recording of entries within care plans should improve demonstrating discussion between all members of the inter-professional team and the resident. DS0000065628.V363249.R01.S.doc Version 5.2 Page 25 2 OP7 Heatherdene 3 OP12 Dedicated activity hours should be allocated for staff to provided opportunities for stimulation through leisure and recreational activities in and outside the home which suits residents’ needs, preferences and capacities. Dilapidated furniture should be replaced. Bedside lighting should be provided in all bedrooms. The laundry needs a separate handwash facility for staff to use after dealing with dirty laundry to control cross infection. Paper towels in dispensers and pedal bins should be provided in each resident’s bedroom for hygiene and infection control. The provider should provide supervision for the manager, at agreed frequencies. The provider must ensure that a risk assessment is completed for the use of bed rails with regard to the requirements of the Mental Capacity Act. This must be done so that the health, safety and welfare of people who use the service are promoted and protected. 4 5 6 7 OP19 OP26 OP26 OP31 8 OP38 Heatherdene DS0000065628.V363249.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Heatherdene DS0000065628.V363249.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!