Inspection on 02/07/07 for Hurlfield View

This inspection was carried out on 2nd July 2007.

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

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

Other inspections for this house

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

CARE HOMES FOR OLDER PEOPLE Hurlfield View 203 Gleadless Common Sheffield S12 2UU Lead Inspector Chris Taylor Key Unannounced Inspection 09:45 2nd July 2007 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 Hurlfield View DS0000067343.V321101.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. Hurlfield View DS0000067343.V321101.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hurlfield View Address 203 Gleadless Common Sheffield S12 2UU 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) 0114 2399633 0114 2391573 Sheffield Care Trust Vacant Care Home 16 Category(ies) of Dementia - over 65 years of age (16) registration, with number of places Hurlfield View DS0000067343.V321101.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Minimum staffing levels providing direct care to service users must be maintained as described in the Supplement to the Handbook of Guidance on Registration, Inspection and Management of Residential Care Homes in Yorkshire and Humberside dated 13/09/1991. 2. Where additional services are provided eg day care, outreach, escort duty, staffing for the home must be over and above that required by the care home. This is the first inspection since the home Date of last inspection changed ownership form Sheffield Social Services to Sheffield Health Care Trust. Brief Description of the Service: Hurlfield View is purpose built single story building which provides 14 flexi beds and 2 permanent beds for older people who have dementia and two step-down beds, which are linked with the hospital. The home also has a 20 place day centre. The home is operated by Sheffield Health Care Trust. There are sixteen bedrooms none of which are en suite. There are sufficient bathrooms and toilets. There are three communal lounges, a dining room and accessible garden. The weekly charges are means tested and as of 2nd July 2007 range from £121.75 to £359 and do not include costs for hairdressing and chiropody. Service users/relatives and other interested parties are able to have access to inspection reports by requesting them from the home. 1. Hurlfield View DS0000067343.V321101.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is what was used to write this report. • • • Information about the home kept by the Commission for Social Care Inspection. Information asked for before the inspection, this is called a Pre Inspection Questionnaire. Information from surveys that were sent out. Five were sent to people who stay at the home, five to health care professionals and five to staff. Four surveys were received completed by relatives on behalf of people who stay at the home, three from staff and three from health care professionals. A visit to the home which was unannounced. This lasted six hours and included talking to staff and the manager about their jobs and the training they have completed. Also spending time with people staying at the home and checking some of the records polices and procedures the home has to keep. Looking at four peoples’ files in detail. • • What the service does well: People who stay at the home stay in a clean comfortable home. Staff are kind and helpful and make every effort to provide the support in the way that the person wants. The information kept about people is good, there is a care plan for everyone who stays at the home which includes details of the help and support people need and how this should be provided. This helps staff care for people properly all of the time. A good choice of food and drinks are available. This ensures that people receive a varied and nutritious diet. One service person spoken to said “The food is excellent.” There is enough staff on duty and they get the support they need to be able to provide proper care to people. Staff have completed comprehensive training to improve their knowledge and skills this means staff will have good skills and understanding about how to care for people, particularly for people with dementia. Hurlfield View DS0000067343.V321101.R01.S.doc Version 5.2 Page 6 The home is managed in such a way that puts people who stay at the home first. It concentrates on the needs, wishes and views of the people who use the service. What has improved since the last inspection? 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. Hurlfield View DS0000067343.V321101.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hurlfield View DS0000067343.V321101.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3. People who use this service experience good quality outcomes in this area. Peoples’ needs are assessed prior to staying at the home this helps make sure that staff know they will be able to meet peoples’ needs before they stay at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People are referred to Hurlfield view via social services or the community mental health team. The person’s social worker will complete an assessment which is sent to the home for consideration. If the home feels they can offer a period of respite and the person meets the home’s criteria then this is arranged. In addition to the social work assessment the home completes its own assessment which includes risk assessments and an assessment of capacity to consent. The assessment could include more detail about peoples’ social history and their routines and interests. The Statement of Purpose and Hurlfield View DS0000067343.V321101.R01.S.doc Version 5.2 Page 9 service user guide are given to people before they arrive and a copy is kept in each bedroom. A key worker is appointed who helps the person settle in and if further stays are arranged, co ordinates this and takes responsibility for up dating information. All of the surveys received said that people were provided with sufficient information about the home before they had a respite stay. Four service users’ files were looked at which confirmed that pre admission assessments had been undertaken. Hurlfield View DS0000067343.V321101.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. People who use this service experience good quality outcomes in this area. Peoples’ health and personal care needs are assessed and are met promoting independence, choice and respect for individuals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four peoples’ case records were looked at in order to check that a plan had been formulated which helped staff provide support to people according to their needs and wishes. There were forms completed which contained information about the person such as date of birth, GP, next of kin. This was followed with specific documents to record information about all aspects of the person’s life and what support is needed. The care plan format also records information about areas of risk, specifically with regard to moving and handling and falls; nutritional assessments, where a person may need a specific diet due to weight gain or Hurlfield View DS0000067343.V321101.R01.S.doc Version 5.2 Page 11 loss. People’s files contained a lot of relevant information but it was sometimes difficult to locate what was most up to date and most relevant. An example of this was important information about how someone needed to have his or her drinks prepared and given. This was written on a white label on the front of the daily records, the assumption being that it was placed there because the author felt this was where staff wouldn’t miss it. The care plan document although contained lots of relevant information was less descriptive than the review document and this document gave a much broader picture of the person particularly about aspects of personal care routines, interests, likes and dislikes. Throughout the day it was clear that staff held a wealth of knowledge about people particular their social histories and interests and this knowledge was used positively with people to reassure and support but this was kind of information was not recorded fully anywhere within the file. It is important that staff have this information to hand particularly when people only stay at the home for short periods; and for agency staff who may not work with great frequency in the home. This kind of information is particularly useful when supporting people with dementia as it helps settle and reassure people and helps staff understand peoples’ behaviours and routines. This was discussed with the manager and she agreed to review how peoples’ files are arranged and how best to gather social history information about people. Daily records provided a good picture of how people spend their day and would provide essential information to track any changes people may experience, with ill health or involvement in social activities. Arrangements for people to receive their prescribed medication is quite complicated because people only stay at Hurlfield for short periods. Sometimes people arrive with their medication in a monitored dosage system arranged by their local pharmacist but frequently medication arrives in original bottles and packets or sometimes without proper labels or directions for dose etc. All medication is checked and new prescriptions ordered if needed. Because medication is so variable there are more stringent monitoring systems in place to ensure people receive the correct medication. Medication is kept in a locked trolley or fridge in a locked room. Staff who administer medication have received accredited training which has recently been updated. Lunchtime medication administration was observed and this was carried out safely and in a way that ensured peoples’ dignity was maintained. People usually retain their own GP when they come for a short stay but if a GP is needed then the local GP practice is very happy to register people on a temporary basis. Relationships with local district nurses and other health professionals were reported as being very positive and supportive. One survey received from a health care professional stated that something they felt the service does well is the “ communication between all professionals involved in service users needs” Hurlfield View DS0000067343.V321101.R01.S.doc Version 5.2 Page 12 A key-worker scheme operates in the home which means specific staff are allocated people to make sure they have everything they need and are helped to settle in. The key worker liaises with family members and other professionals. The delivery of personal care is individual and flexible. This was evident from observations of staff supporting people. Staff were kind, respectful and discreet in assisting people throughout the day. One service user said that “staff were nice and very helpful.” People looked well cared for. Hurlfield View DS0000067343.V321101.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): Standards 12, 13, 14 and 15. People who use this service experience good quality outcomes in this area. Service users can choose how they spend their day and have the opportunity to pursue their own interests. Meals provided are nutritious, are of good quality and freshly prepared. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People choose their own daily routines and are encouraged to remain independent and have as much control over their lives as is possible. People can sit in communal lounges or spend time in their rooms and can rise and retire as they wish. Some people need more assistance and direction as others dependent on the stage of their illness and this was seen recorded in peoples’ care plans, particularly where a risk to person’s safety is concerned. There are activities on offer and this changes according to who is staying at the home. Every day a task sheet is completed which is used to discuss and organise activities for the day. All of the surveys received indicated satisfaction Hurlfield View DS0000067343.V321101.R01.S.doc Version 5.2 Page 14 with activities on offer. Staff are currently asking relatives to gather information, pictures and memorabilia relating to individuals to help staff support people and provide more individualised activities. The home has resources to use such as DVDs and photographs used for reminiscence. Wherever possible people are supported by staff to retain community contacts and routines whilst they are staying at Hurlfield View but due to distance and staffing this is not always possible. There are three main meals per day and a choice is provided at each meal. Special dietary needs such as low sugar diets are catered for and special requests can usually be met. On the day of the inspection a Halal meal was being prepared for one person. Where appropriate nutritional assessments are carried out and these were seen in case records. One person said that the meals were lovely and all the surveys received commented positively about the quality of meals provided; people clearly enjoyed their lunch. Staff supported those people who needed assistance respectfully and discreetly. Menus were looked at and these were varied. Staff make sure hot and cold drinks are available throughout the day with a hot drink and snack provided prior to bed. Hurlfield View DS0000067343.V321101.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): Standards 16 and 18. People who use this service experience excellent quality outcomes in this area. People can be confident that concerns are listened to and appropriate action is taken. There are sufficient effective systems in place to safe guard people from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A complaints procedure is provided to people and is included in the Statement of Purpose and service user guide. All the surveys returned stated that the complaints procedure is known and that any complaints would be dealt with properly. The manager views complaints positively and believes that bringing any concerns to the attention of the manger and staff can only improve the service provided and is part of the home’s quality assurance systems. The manager deals with general day to day complaints and anything more serious is allocated to another manager within the organisation to investigate. There have been two complaints made since the last inspection. These have been investigated thoroughly with the complainants satisfied with the outcome of the investigation. No formal complaints have been made directly to The Commission for Social Care Inspection. Hurlfield View DS0000067343.V321101.R01.S.doc Version 5.2 Page 16 There is a comprehensive policy and procedure with regard to adult protection and staff have a good awareness of this. The manager reported that there was good support with regard to adult protection issues from partner agencies; that they were always available to listen to any concerns and offer advice. Staff receive training in adult protection issues during induction and foundation training and as part of NVQ (National Vocational Qualification) level 2 and 3 in care. Appropriate recruitment procedures are followed, with references and Criminal Records Bureau (CRB) checks made to reduce the risk of undesirable people working in the home. Hurlfield View DS0000067343.V321101.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): Standards 19 and 26. People who use this service experience good outcomes in this area. People stay in a clean, comfortable and safe home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Hurlfield View was purpose built a number of years ago and has had some adaptations in order for it to meet the needs of the people who stay there. The building is shared with a day centre and office space for staff. There are keypad entry systems throughout the building which help keep people safe but allow them space to move about freely. None of the bedrooms are en suite but there are sufficient bathrooms and toilets located close to communal and bedroom areas. Although most people do not stay for long periods at Hurlfield people are still encouraged to bring their own possessions with them to personalise their bedroom. When a person Hurlfield View DS0000067343.V321101.R01.S.doc Version 5.2 Page 18 comes to stay their name is written on a small white board on their bedroom door. The names did not stand out sufficiently enough to help people find their bedrooms. Discussion about the use of photographs or other items that would help with orientation was discussed. There are secure grounds with safe pathways and seating areas. Information from surveys confirmed that people always find the home ‘clean and tidy’, ‘fresh and clean’. Repairs are carried out promptly and there is housekeeper employed who is responsible for coordinating repairs. The manager ensures compliance with the local fire service and environmental health department so that people are kept safe. The home is kept spotlessly clean so that the risk of people becoming ill from poor hygiene is unlikely. The home was free from offensive smells for the duration of the inspection and made the environment pleasant. Hand wash scrub, gloves and aprons are available throughout the home so as to minimise the risk of cross infection from one person to another. Hurlfield View DS0000067343.V321101.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): Standards 27, 28, 29 and 30. People who use this service experience excellent outcomes in this area. Staff are properly vetted and trained to ensure people receive the care and support they need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Prospective staff complete an application form and if short listed attend a formal interview. Written references and POVA (Protection of Vulnerable adults) first checks are made and staff are not permitted to work in the home until they have a CRB (Criminal Records Bureau) check. Records of the recruitment process were checked; all had completed an application form, had CRB check and two written references. Staff complete induction provided by social services and a home specific induction. There is probationary period during which further statutory training and NVQ (National Vocational Qualification) training is undertaken. Records confirmed staff training completed and included a rolling programme to ensure staff complete mandatory health and safety training. Staff said that training opportunities were good and training includes course relating to Hurlfield View DS0000067343.V321101.R01.S.doc Version 5.2 Page 20 dementia, anti discriminatory practice and sexual health in later life. The home has 26 of staff qualified to NVQ level 2 and above. The rota indicates that there are enough staff hours provided and more staff are on duty at key times during the day. The manager has the authority to increase staffing if the dependency levels of people staying at the home are high and more support is needed for people. The manager and senior staff work alongside staff and as such monitors their practice. At every shift change there is a handover where specific issues relating to people staying at the home are discussed. Polices and procedure are discussed at regular staff meetings. Staff receive formal recorded supervision and an annual appraisal. Hurlfield View DS0000067343.V321101.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): Standards 31, 33, 35 and 38. People who use this service experience excellent outcomes in this area. The home is managed in such a way that promotes the best interests of people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the home is organised, competent and runs the home to meet the needs of the people who stay there. People who use the service, staff and families know who to go to if there is a problem and are very happy with the way in which the home is run. The manager keeps up to date with her own training and is knowledgeable about current ways of working. This provides Hurlfield View DS0000067343.V321101.R01.S.doc Version 5.2 Page 22 staff with a broader insight and improves the care and up to date practice people receive. There is always a team leader on duty to take responsibility for the smooth, safe running of the shift. Tasks are appropriately delegated so that the safety of people and the safe running of the home is shared out among the staff. There is a quality assurance system in place and people who use the service, their relatives and other professional are sent surveys and asked to rate specific aspects of the service provided. These results an analysed, published and an action plan produced. The home also operates a system of “Team Governance” with representation from staff, relatives and other professionals. This group meets quarterly and produces and monitors an annual development plan. One of the aims for the home is to develop a satisfaction survey to be completed at the end of each person’s stay. Regular, internal audits make sure that all the necessary health and safety checks are being carried out. Monthly monitoring visits are made as a requirement of the care Homes Regulations and this process includes time for people to talk about their satisfaction with the service. The home does not managed peoples’ finances but there is a system for people to leave small amounts of money for safekeeping. This is kept in the home’s safe with individual records maintained. Records were seen which confirmed that equipment is maintained; electricity supplies in the home are safe and serviced appropriately. Fire detection and fire fighting equipment is tested and maintained regularly. Staff receive training with regard to all health and safety matters. Hurlfield View DS0000067343.V321101.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 4 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 x 18 4 3 x x x x x x 3 STAFFING Standard No Score 27 4 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 4 x 4 x x 4 Hurlfield View DS0000067343.V321101.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. Standard Regulation Requirement Timescale for action 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 OP3 OP7 Good Practice Recommendations More information should be gathered relating to peoples’ social and life histories and their daily and weekly routines as this would help staff understand peoples’ behaviours, routines and help staff provide reassurance more effectively and consistently. The way in which bedroom doors should be reviewed in order that people can identify their bedroom with more independence. 50 of staff should been qualified to NVQ Level 2. 2 3. OP14 OP28 Hurlfield View DS0000067343.V321101.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 Hurlfield View DS0000067343.V321101.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!