Inspection on 12/09/07 for Holmhurst Care Home

This inspection was carried out on 12th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Holmhurst Care Home 21/04/06

Holmhurst Care Home 18/10/05

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

CARE HOME ADULTS 18-65 Holmhurst Care Home 28 Gordon Avenue Portswood Southampton Hampshire SO14 6WD Lead Inspector Michael Gough Unannounced Inspection 12th September 2007 10:45 Holmhurst Care Home DS0000062744.V344423.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Holmhurst Care Home DS0000062744.V344423.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Holmhurst Care Home DS0000062744.V344423.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holmhurst Care Home Address 28 Gordon Avenue Portswood Southampton Hampshire SO14 6WD 023 8034 8403 F/P 023 8034 8403 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) Mrs Susan Boyes Mrs Susan Boyes Care Home 20 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (20) of places Holmhurst Care Home DS0000062744.V344423.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users are not to be accommodated below the age of 30 years Date of last inspection 13th February 2007 Brief Description of the Service: Holmhurst Care Home is a large family home, extended to provide accommodation for 20 service users. Accommodation is provided in a range of single and shared rooms on the ground and first floors. Communal space comprises a lounge and small dining room. The home is located in a quiet side street a few minutes walk from the centre of Portswood and is close to local amenities and public transport. Fees at the home range from £327 - £600 per week. Service users are responsible for paying for their own chiropody, toiletries and items of a personal or luxury nature. Holmhurst Care Home DS0000062744.V344423.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report details the evaluation of the quality of the service provided at Holmhurst and takes into account the accumulated evidence of the activity at the home since the last key inspection April 2006. The inspection took into account the homes Annual Quality Assurance Assessment; and evidence for this report was obtained from reading and inspecting records, touring the home and during the visit the inspector was able to speak with 6 people who use the service, 3 members of staff and to observe the interaction between staff and service users. Surveys were sent out to gain the views of interested parties about the service provided by the home and responses were received from 9 people who use the service, 4 relatives, 3 care managers and 2 health care professionals. The homes provider who is also the manager was available throughout. The home is registered to provide accommodation and support for up to 20 service users who have mental health needs. What the service does well: What has improved since the last inspection? Since the last visit to the home, care plans have been reviewed and are now more person centred. Holmhurst Care Home DS0000062744.V344423.R01.S.doc Version 5.2 Page 6 Recruitment procedures have been improved to ensure that all relevant checks are carried out and to ensure that CRB and POVA checks are completed before staff start work at the home. An annual improvement plan has been developed for ongoing improvements to the home, this has resulted in the decoration of the hall and stairways, some individual bedrooms have been decorated and new furniture and fittings have been provided. Some of the double rooms in the home have been reduced to single occupancy and a bathroom has been refurbished and another bathroom is being made into a “wet room” Also a new smoking room has been provided for residents which meets the new government regulations. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Holmhurst Care Home DS0000062744.V344423.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Holmhurst Care Home DS0000062744.V344423.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective users of the service can be confidents that their needs would be fully assessed before they move into the home EVIDENCE: The homes AQAA stated that the home had a policy and procedure for any admissions to the home and that admissions would only be made after a full assessment of needs. The inspector looked at assessments for 3 people who use the service and one of these had recently moved into the home in April 2007. There were assessments undertaken by a CPN as well as the homes in house assessments, which were carried out by the manager. Comments received from care managers said that there is an effective assessment process. Holmhurst Care Home DS0000062744.V344423.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessed needs and personal goals of individuals are reflected in a plan of care and residents are supported to make decision about their lives with assistance given by staff. Residents are supported to take responsible risks and this allows them to live an independent lifestyle as much as possible EVIDENCE: Care and support plans were seen for 3 residents and these were clear and easy to follow and gave clear information on individual abilities, problems and needs, aim of care and the method of care delivery, plans had been improved and were person centred and gave staff the information they needed and informed they how individuals liked to be supported and when this support should be given. AQAA stated that care plans were agreed with residents and were reviewed and updated monthly, this was confirmed by recording in the care plans. There was evidence of monthly reviews by care staff and six monthly CPA reviews and residents, relatives and support workers are invited to attend. Comments received from care managers and relatives were also Holmhurst Care Home DS0000062744.V344423.R01.S.doc Version 5.2 Page 10 able to confirm this. The home had a daily diary were staff commented on what support had been given and how the resident had been, these were completed at the end of each shift. Residents are supported to make decisions about their day to day lives and staff were observed interacting with residents and taking their views into account, there was evidence in care plans of individual preferences for when they would like to get up and go to bed and on the day of the visit some residents chose to stay in bed while others were out individually and some were at home. There was information in care notes, which showed that residents had been offered choices and also detailed the choices made. Residents spoken to said that staff always asked them what they wanted to do and said that they could make their own decisions and staff would support them. Care plans looked at contained risk assessments and these gave details of the assumed risk, details of the risk, likelihood of event happening and control measures to minimise the risk and the support required. Risk assessments were also seen for generic risks around the home and risk assessments were reviewed monthly as part of the care plan review. Holmhurst Care Home DS0000062744.V344423.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to take part in appropriate activities and they access the local community on a regular basis. The homes visiting policy supports residents to maintain family links and friendships both inside and outside the home and their rights are respected. Residents are offered a healthy and varied diet and they enjoy their meals at the home. EVIDENCE: Residents are able to participate in appropriate activities and 3 of the residents attend a special purpose workshop and they make small items such as bird tables, this is voluntary work with no payment. 2 of the residents receive recreational earnings from a local skills workshop and 1 resident is a volunteer at a local charity shop. 2 residents attend pottery classes and 1 resident is currently having key skills assessment through a national organisation. Holmhurst Care Home DS0000062744.V344423.R01.S.doc Version 5.2 Page 12 The majority of residents are able to access the local community independently and they regularly go out to shopping and visit cafes in the local area. Staff support is available for those residents who do not have the confidence to go out on their own. The home has a clear visiting policy and visitors are always welcome, the visitors policy was on display in the entrance hall to the home and the inspector was informed that staff would respect service users wishes on who they wish or do not wish to see. Daily routines in the home promote independence as much as possible and residents are encouraged to participate in day to day routines. During the visit staff were observed interacting with residents and they appeared to get on well together, staff were seen knocking on residents doors before entering and seeking permission for them and the inspector to visit their rooms. Staff used residents preferred form of address and those residents who spoke with the inspector made it clear that they was very happy at the home and said that routines in the home were relaxed and they could be involved as much or as little as they want. Mail is given to residents unopened and staff support is available if required. All residents are able to have a key to the home if they wish and they have access to all areas of the home and there were no restrictions Menus at the home are made up using a four-week rolling menu, which is changed seasonally. The likes and dislikes of residents are taken into account as is their nutritional needs. Residents are supported to make their own breakfast and the main meal of the day is normally at lunchtime with a snack type meal in the evenings. Residents are able to make their own drinks and snacks and encouraged to help with the main meal with staff support. The home does not keep a written record of food provided and therefore there was no clear evidence that residents were offered a choice at meal times however those spoken with said that they could eat what they liked and said that the food was plentiful and good. After discussions with the manager the need for clear records was explained and she confirmed that in future a record would be kept. Residents are encouraged to eat their meals at the dining tables, however they can eat elsewhere if they wish. Holmhurst Care Home DS0000062744.V344423.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health, personal and social care needs of residents are set out in an individual plan of care and resident’s users have access to all relevant health care professionals and their health care needs are met. Medications systems in the home are generally well managed, however a protocol for monitoring blood glucose levels need to be developed. EVIDENCE: Care plans had information on the personal care needs of individuals and this was mainly verbal prompting. Residents spoken to said that their care needs were met by the home and that they could see health care professionals in private. The 3 care managers who completed survey said that they were happy that the manager and staff provide appropriate support and prompting with personal and health care and the manager and staff are very aware of the service users health and emotional care needs and know the service users very well. They were also happy that service users have access to health services as needed. Residents are all registered at a local GP surgery and district nurse’s and other healthcare professionals are available through GP referral. Dental treatment is provided through a local NHS dentist and a visiting optician calls at the home. Holmhurst Care Home DS0000062744.V344423.R01.S.doc Version 5.2 Page 14 The home uses a monitored dose system provided by a local pharmacist and all staff that administers medication has received appropriate training. Medication administration record sheets were inspected and there were no gaps in recording. None of the residents at the home administer their own medication and no controlled drugs were kept at the home. One resident requires insulin injections twice a day to control diabetes and this is carried out by care staff at the home using a pen injection system. Staff who administer insulin have received training from the district nurse to administer these injections and there was documentary evidence to confirm this. The home also monitors the service users blood glucose levels however, there was no protocol for this and no information for staff on how often this should be done, what readings could be expected or what action to take once the readings were known Holmhurst Care Home DS0000062744.V344423.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a clear and accessible complaints procedure, which includes timescales for the process and service users can be confident that their views would be listened to and acted upon, any complaints are logged and responded to appropriately. The homes policies and procedures help to protect service users from any form of abuse. EVIDENCE: The home has a clear and accessible complaints procedure and there have been no complaints made to the home since the last key inspection. Residents spoken to were aware that the home had a complaints procedure and said they would address any complaints to a member of staff or to the manager, staff members spoken to were also aware of the complaints procedure. Since the last key inspection there has been one referral to social service regarding an adult protection and the CSCI had been informed and records seen by the inspector confirmed that the correct procedures had been followed. The home has a copy of the Hampshire Adult Protection procedure and has a whistle blowing policy and a copy of the department of health guideline “No Secrets” staff also receive training with regard to adult protection and POVA as part of their induction. Staff members spoken to confirmed that they had received training and were aware of their responsibilities in this area. Holmhurst Care Home DS0000062744.V344423.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Generally people who use the service live in a homely and comfortable environment, which is clean, hygienic and free from offensive odours. However certain areas of the home would benefit from repair and redecoration EVIDENCE: A tour of the building was undertaken by the inspector who was accompanied by the manager and the home was clean throughout with no unpleasant odours. Furniture in the home was in a satisfactory state of repair, however in some areas of the home the décor was showing signs of age and would benefit from decoration. The inspector was informed that resident’s bedrooms were decorated as people move on and it was seen that some rooms had been redecorated and some of the bathrooms had been refurbished and a new wet room/WC was in the process of being completed. Communal areas were generally well lit and residents spoken to said that they were happy with the facilities available and the inspector observed residents using the communal lounge in the home. Routine maintenance is carried out and the inspector Holmhurst Care Home DS0000062744.V344423.R01.S.doc Version 5.2 Page 17 viewed the maintenance book were defects were recorded and the maintenance man signed these off as the jobs were completed. The home has an improvement plan in place for the repair, refurbishment and decoration of the home and this is being implemented, however the manager said that financial constraints dictate the speed at which improvements can be made. The laundry at the home has an industrial washing machine that can wash clothing at suitable temperatures and also an industrial tumble drier. The walls and floor were tiled for easy cleaning, however the floor of the laundry room was in need of repair and the manager said that this was noted in the defect book and should be repaired shortly. Some of the residents at the home are supported to do their own laundry, while staff at the home carry out laundry duties for others. Suitable protective clothing is provided for staff and any soiled laundry is brought down in yellow bags so that it is clearly identified. The home has infection control policies and procedures and the inspector was informed that all staff at the home have received training with regard to infection control and those staff members spoken to were able to confirm this. Holmhurst Care Home DS0000062744.V344423.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Competent, qualified and appropriately trained staff supports service users and meet their needs. The homes recruitment policy and practice protect service users. EVIDENCE: There is a good staff mix at the home and all staff are encouraged and supported to undertake National Vocational Training. Currently all of the 15 members of staff at the home have either completed or are in the process of obtaining National Vocational Qualifications. Recruitment records were seen for 3 staff members and all staff files seen contained all the required information and confirmed what the AQAA said about staff recruitment. Staff spoken to said the recruitment procedure was thorough and that they had to wait for the CRB/POVA check to be back before they started work. The home uses a training organisation who provide training for staff employed at the homes. Staff undertake induction training, which is linked to NVQ, and mandatory training is carried out in; moving and handling, fire safety, Holmhurst Care Home DS0000062744.V344423.R01.S.doc Version 5.2 Page 19 medication, first aid, health and safety, food hygiene, infection control and adult protection. Additional training is also carried out for: managing challenging behaviour, mental health issues, care practices, diabetes awareness, risk assessment, reporting and recording and NVQ training. A list of forthcoming training events was displayed on the staff notice board and staff members had indicated dates that they would like to attend the training. Staff members spoken with confirmed that they had received a good induction and said that there were regular training sessions at the home. Holmhurst Care Home DS0000062744.V344423.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well run home and the views of service users and other interested parties are being sought on how the home is meeting service users needs. The health, safety and welfare of residents and staff are protected EVIDENCE: The homes registered provider is also the registered manager and she has just completed NVQ level 4 in care and is nearing the completion of the registered manager award. The inspector spoke to staff and residents about the management of the home and also received comments from relatives and care managers. All comments received provided evidence that the manager is liked and respected and her positive and flexible approach to managing the home has benefits for both Holmhurst Care Home DS0000062744.V344423.R01.S.doc Version 5.2 Page 21 residents and staff. The manager is aware that the home environment could still be improved and has long term plans to achieve this. The manager is in the process of developing a quality assurance system based on regular questionnaires, to residents, relatives and other interested professionals, she intends to hold residents meetings to provide an opportunity for them to express their views about the service. A suggestion/comments box is going to be situated in the entrance hall of the home and staff views will be sought through regular supervision and staff meetings. The manager and her deputy are responsible for health and safety within the home and a sample of service certificates were seen evidencing that equipment and services are maintained promoting the safety of all at the home. The fire log book was inspected and all required testing had been carried out, lifting equipment was tested in August 2007 and the gas safety certificate was issued in August 2007, the fixed electrical wiring and private electrical equipment is due to be tested in September 2007. Holmhurst Care Home DS0000062744.V344423.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 X 3 X X 3 X Holmhurst Care Home DS0000062744.V344423.R01.S.doc Version 5.2 Page 23 No 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 OP9 Regulation 12(1)(a) Requirement The home must ensure that there is clear guidance for staff who monitors the blood glucose levels of a resident to promote and make proper provision for the health and welfare of service users. Timescale for action 12/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Holmhurst Care Home DS0000062744.V344423.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Holmhurst Care Home DS0000062744.V344423.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!