CARE HOMES FOR OLDER PEOPLE
Hollin Bank House Blackburn Road Oswaldtwistle Lancashire BB5 4PE Lead Inspector
Mrs Susan Hargreaves Key Unannounced Inspection 10:00 21st August 2006 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 Hollin Bank House DS0000009433.V289136.R01.S.doc Version 5.1 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. Hollin Bank House DS0000009433.V289136.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Hollin Bank House Address Blackburn Road Oswaldtwistle Lancashire BB5 4PE 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) 01254 236841 Mr Raymond John Pullinger Mrs Sylvia Pullinger Care Home 14 Category(ies) of Dementia - over 65 years of age (1), Mental registration, with number disorder, excluding learning disability or of places dementia (1), Mental Disorder, excluding learning disability or dementia - over 65 years of age (1), Old age, not falling within any other category (11) Hollin Bank House DS0000009433.V289136.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. In annexe 2 the number of service users in each category is 11 OP, 1 MD(E) 1 MD and 1 DE(E) 9th March 2006 Date of last inspection Brief Description of the Service: Hollin Bank House offers 24-hour personal care for up to 14 people. The service has been registered as a care home, providing care for over 20 years, by the same registered owners. The home is a detached property set in a residential area approximately one quarter of a mile from Oswaldtwistle town centre. The home is close to a main road that is serviced by public transport. Accommodation is provided in single or twin-bedded rooms. A stair lift facilitates access to all areas of the home. Communal lounges and dining room are located on the ground floor. The current fees charged at Hollin Bank House are £352.50 to £373 per week. Additional charges are payable for hairdressing dry-cleaning and personal items. A copy of the statement of purpose and service user guide would be photocopied for prospective service users and their relatives on request. Hollin Bank House DS0000009433.V289136.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key unannounced inspection took place over seven and a half hours. At the time of this inspection twelve residents were living at the home. No additional visits have been made since the last inspection. A tour of the premises took place and staff files and care records were inspected. Members of staff on duty, residents and a visitor were spoken to. Discussions also took place with the manager and deputy manager regarding issues raised during the inspection. What the service does well: What has improved since the last inspection? What they could do better:
A detailed pre-admission assessment must be carried out for each resident prior to admission. Following this assessment the prospective resident or their relatives must be informed in writing that their care needs can be met at the home. Urgent action must be taken to ensure that care planning is improved. Care plans must provide clear guidance for staff to follow to ensure the needs of each resident are met. Where a risk e.g. of developing pressure sores has
Hollin Bank House DS0000009433.V289136.R01.S.doc Version 5.1 Page 6 been identified a care plan, which provides information about how the risk is managed must be in place. All care plans and risk assessments must be reviewed monthly and up dated when the needs of the resident change. The resident, if possible, or their relatives must be involved in planning their care. It is of serious concern that poor practice was observed in the administration of medication. Staff must not leave medication unattended for the resident to take with or after a meal. This increases the risk of error and puts other residents at risk if they mistakenly take this medication. To promote the safe handling of medication all hand written instructions on the medicines administration records should be signed and witnessed. To avoid the deterioration of medication the temperature of the storage area should be checked and recorded daily to ensure this does not exceed 25 degrees Celsius. To ensure residents understand how to express their concerns or make a complaint they should each be supplied with an up to date copy of the complaints procedure. It is important to provide suitable hand washing facilities for residents and staff in order to prevent the spread of infection. The broken soap dispenser in the ground floor toilet must be repaired or replaced and all soap dispensers must be refilled when empty. Failure to comply with the requirements issued on three previous occasions relating to recruitment practices is of serious concern. A POVA/CRB check and two written references must be obtained before a new member of staff starts working at the home. A record of all visitors to the home must be kept. A requirement issued following the last three inspections has not been addressed. Information relating to individual residents should be recorded in their individual care plan. Accidents should be recorded on a separate document for each resident and kept in their care plan. Action must be taken to promote the health and safety of residents and staff. All members of staff must receive training in fire prevention. A fire risk assessment should be carried out. Staff attendance records at fire drills should be kept. To prevent injury to residents and staff it is essential that correct moving and handling techniques are always used. Wheelchairs without footplates must not be used. Where residents do not wish to use footplates, this must be subject to a risk assessment and recorded in individual care plans. 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. Hollin Bank House DS0000009433.V289136.R01.S.doc Version 5.1 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 Hollin Bank House DS0000009433.V289136.R01.S.doc Version 5.1 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): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Admission procedures were not thorough. A pre-admission assessment was not completed for all residents prior to admission. EVIDENCE: The individual records of two residents were inspected. A pre-admission assessment had been completed for only one of these residents. The other resident had been able to visit the home prior to admission. Although some information had been obtained from relatives a detailed pre-admission assessment had not been carried out. There was no evidence to suggest that residents received written confirmation that their care needs could be met at the home prior to admission. Standard 6 is not applicable to this service. Hollin Bank House DS0000009433.V289136.R01.S.doc Version 5.1 Page 9 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. Privacy and dignity was promoted for all residents. Care plans did not contain detailed information relating to all aspects of care. Some procedures relating to medication were not managed correctly. EVIDENCE: The individual care plans of two residents were inspected. Although these records plans identified the care needs of each resident they did not provide clear guidance for staff to follow to ensure these needs were met. Appropriate risk assessments were in place. However, where a risk e.g. of developing pressure sores or falls had been identified a care plan about the action being taken to address the risk was not in place. Not all care plans were signed or dated. One of the care plans had not been reviewed since February. There was no evidence to suggest that residents or their relatives were involved in care planning. A written report about the care given to individual residents was completed during each shift. Residents were registered with a GP and had access to other healthcare professionals.
Hollin Bank House DS0000009433.V289136.R01.S.doc Version 5.1 Page 10 Records for the management of medication were in place. However, hand written instructions on the medication administration records were not signed or witnessed. Members of staff responsible for the administration of medication had received training. Medication was stored in a locked cupboard in the kitchen. The manager was advised to check and record the temperature of this area daily in order to prevent the deterioration of medication should the temperature exceed 25 degrees Celsius. Poor practice was observed at lunchtime on the day of the inspection when medication was left on the dining table for a resident. This practice increases the risk of error and must cease. Personal care was carried out in private. Members of staff were observed attending to residents in a friendly and professional manner. Two members of staff explained in detail how they promoted privacy and dignity for all residents. One resident said, “The staff are lovely.” Hollin Bank House DS0000009433.V289136.R01.S.doc Version 5.1 Page 11 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. Leisure activities were organised. Visitors were welcomed into the home at anytime. The daily routine was flexible in order to meet the needs and preferences of residents. Meals were wholesome and appetising. EVIDENCE: Residents were encouraged to pursue their own interests and hobbies. A number of residents enjoyed knitting and others liked reading and doing puzzles. Two residents regularly attended an evening social club. Activities organised at the home included; dominoes, videos, listening to music, manicures and trips out including Blackpool illuminations. One resident explained how she had enjoyed a recent trip to Malham. An outside entertainer regularly visited the home. Visitors were welcomed into the home at anytime and offered refreshments. A priest regularly visited one of the residents. Residents were encouraged to make decisions about their lifestyle and daily routine. One resident said, “You can do anything you want.” A member of staff explained that an appropriate routine and diet would be provided if a resident from a minority group were admitted to the home. Residents were encouraged to personalise their rooms with photographs, ornaments etc.
Hollin Bank House DS0000009433.V289136.R01.S.doc Version 5.1 Page 12 The meal served at lunchtime on the day of the inspection was wholesome and appetising. Although a choice of meal was not offered alternatives were readily available. The mealtime was unhurried allowing residents time to chat and enjoy their meal. All the residents asked said the meals were good. Hollin Bank House DS0000009433.V289136.R01.S.doc Version 5.1 Page 13 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 good. This judgement has been made using available evidence including a visit to this service. Complaints would be taken seriously and investigated. Appropriate procedures and training were in place to ensure the protection of residents at the home. EVIDENCE: A copy of the complaints procedure was displayed in the home. However, the copy of this procedure in the statement of purpose was not changed following the last inspection to state complaints would be dealt with within 28 days. The manager amended this copy at the time of the inspection and was advised to ensure all other copies were amended and an accurate one supplied to all residents. Policies and procedures relating to the protection of vulnerable adults were in place. The procedure explaining the action to be taken if allegations of abuse are made was amended at the time of the inspection to state that a referral will be made to social services. Training in the protection of vulnerable adults was included in the induction programme for new employees. This issue was discussed with two members of staff. They were aware of the procedure and said they would report any concerns immediately. Hollin Bank House DS0000009433.V289136.R01.S.doc Version 5.1 Page 14 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 home was clean and comfortable and provided a homely environment for the residents. Laundry facilities were appropriate for the size of the home. EVIDENCE: At the time of the inspection the home was clean, tidy, free from offensive odour and well maintained. This provided a safe and comfortable environment for the residents. The grounds and gardens were well kept. Laundry facilities were appropriate for the size of the home. Laundry bags, which disintegrate when put into the washing machine, were available for soiled linen. An infection control policy was in place. However, the soap dispenser in a toilet on the ground floor was broken and several other soap dispensers were empty. Hollin Bank House DS0000009433.V289136.R01.S.doc Version 5.1 Page 15 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 adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels were appropriate to meet the assessed needs of the residents. Recruitment procedures were not thorough. Training, including NVQ’s was encouraged for all members of staff. EVIDENCE: Examination of the duty rota confirmed that a sufficient number of staff were on duty for all shifts to meet the assessed needs of the residents. The files of two members of staff appointed since the last inspection were examined. One of these indicated that all the required pre-employment checks to ensure protection of the residents had been completed prior to appointment. It was evident from the other file that this member of staff had started working before a CRB or POVA check and two written references had been obtained. It was evident from discussions with the manager and members of staff that training was encouraged. This included induction training for new members of staff, first aid, basic food hygiene and moving and handling. One member of staff had an NVQ level 2, five had level 3 and one had level 4. In addition to this a further four care assistants were working towards NVQ level 2. The deputy manager had also achieved the NVQ ‘Registered Manager’s Award’. Hollin Bank House DS0000009433.V289136.R01.S.doc Version 5.1 Page 16 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, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has an experienced manager. Residents were encouraged to express their views about the care and services provided at the home. Records for individual residents were not managed efficiently. Procedures to safeguard the health, safety and welfare of residents require further development including staff training. EVIDENCE: The manager was a registered nurse with management experience. He maintained an up to date knowledge of current practice by attending relevant seminars and reading articles in various care publications. Members of staff said the manager was helpful and supportive. The home had achieved the nationally accredited Investors in People award. Residents were encouraged to give feedback about the care and services provided at anytime. Satisfaction questionnaires had recently been given to
Hollin Bank House DS0000009433.V289136.R01.S.doc Version 5.1 Page 17 residents. Although only three had been completed all the comments were positive. The manager explained that residents meetings took place. However, minutes of these meetings were not available. An annual business plan to help monitor the quality of the service and further improve outcomes for residents was in place. Policies and procedures were updated when necessary. Records of transactions involving resident’s money were seen to up to date A visitor’s book was kept in the dining room but used infrequently. The manager was advised to be proactive in asking all visitors to the home to sign this book on arrival and departure. Records were stored securely and available only to authorised personal. However, a ‘communications book’, bath/shower list and accident book included information about more than one resident on each page. This information is therefore not confidential to each individual resident and clearly in breach of the data protection act. Fire drills took place monthly but staff attendance records were not kept. Fire alarms and emergency lighting were tested monthly. However, records to support the testing of emergency lighting in recent months were not available. A fire risk assessment had not been carried out. Not all members of staff had received up to date training in fire safety. Records of the testing of small electrical appliances and up to date gas safety and electrical installation certificates were seen. During the inspection members of staff were observed using an incorrect moving and handling technique. Wheelchairs without footplates were also in use. Where service users do not wish to use footplates, this must be subject to a risk assessment and recorded in individual care plans. Hollin Bank House DS0000009433.V289136.R01.S.doc Version 5.1 Page 18 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 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 2 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 2 Hollin Bank House DS0000009433.V289136.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? YES 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 OP3 Regulation 14(1)(a) (b)(c)(d) Requirement Timescale for action 21/08/06 2. OP7 15(1) The registered person shall not provide accommodation to a service user unless, so far as it shall have been practicable to do so (a) the needs of the service user have been assessed by a suitably qualified or suitably trained person; (b) the registered person has obtained a copy of the assessment; (c) there has been appropriate consultation regarding the assessment with the service user; (d) the registered person has confirmed in writing to the service user having regard to the assessment the care home is suitable for the purpose of meeting the service user’s needs in respect of his health and welfare. Unless it is impracticable to carry 29/09/06 out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. Care plans must provide detailed
DS0000009433.V289136.R01.S.doc Version 5.1 Hollin Bank House Page 20 information about how all needs are to be met. Timescale of 28/04/06 not met. Residents or their relatives must be involved in care planning. The registered person shall - (b) keep the service user’s plan under review. All care plans and risk assessments must be reviewed monthly. The registered person shall ensure that the care home is conducted so as (a) to promote and make proper provision for the health and welfare of service users; (b) to make proper provision for the care and, where appropriate, treatment, education and supervision of service users. A care plan must be in place to address each identified risk Timescale of 28/04/06 not met. The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Staff must ensure that all medication is given to the resident and not left on the dining table. The registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. The broken soap dispenser must be repaired or replaced. Soap dispensers must be refilled when empty. The registered person shall not employ a person to work at the care home unless (b) he has obtained in respect of that
DS0000009433.V289136.R01.S.doc 3. OP7 15(2)(b) 29/09/06 4. OP8 12(1)(a) (b) 29/09/06 5. OP9 13(2) 21/08/06 6. OP26 13(3) 29/09/06 7. OP29 19(1)(b) Schedule 2 21/08/06 Hollin Bank House Version 5.1 Page 21 8. OP37 17(2) Schedule 4 9. OP38 23(4)(d) (e) 10. OP38 13(5) person the information and documents specified in (i) paragraphs 1 to 7 of schedule 2 Two written references and a satisfactory POVA/CRB check must be obtained before a person starts work. Timescale of 1/4/05, 03/11/05 and 17/03/06 not met. The registered person shall 21/08/06 maintain in the care home the records specified in Schedule 4. A record of all visitors to the care home including the names of visitors. Timescale of 1/4/05 and 3/11/05 not met. The registered person shall after 29/09/06 consultation with the fire authority - (d) make arrangements for persons working at the care home to receive suitable training in fire prevention. The registered person shall make 21/08/06 suitable arrangements to provide a safe system for moving and handling residents. Footplates must be used for all residents unless a risk assessment states otherwise. Timescale of 28/04/06 not met Correct moving and handling techniques must always be used 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. 2. Refer to Standard OP7 OP9 Good Practice Recommendations All care plans should be signed and dated. Hand written instructions on the medicines administration records should be signed and witnessed.
DS0000009433.V289136.R01.S.doc Version 5.1 Page 22 Hollin Bank House 3. 4. OP9 OP16 5. OP37 6. 7. 8. OP38 OP38 OP38 The temperature in the room where medication is stored should be checked and recorded daily. All copied of the complaints procedure should be amended to include a twenty-eight day timescale for dealing with complaints. All residents should be supplied with an amended copy of this procedure. Information relating to individual residents should be recorded in their individual care plan. Accident reports should be recorded on a separate sheet for each resident and stored in the individuals care plan. To ensure all members of staff have regular fire drills attendance records should be kept. Records of the testing of emergency lighting should be kept. A fire risk assessment should be carried out. Hollin Bank House DS0000009433.V289136.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB 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 Hollin Bank House DS0000009433.V289136.R01.S.doc Version 5.1 Page 24 - 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!
