Inspection on 16/09/08 for Juniper House

This inspection was carried out on 16th September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Juniper House 25/07/07

Juniper House 06/03/07

Juniper House 19/01/06

Juniper House 14/07/05

Juniper House 11/02/05

Juniper House 20/07/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 23/11/2008.

CARE HOME ADULTS 18-65 Juniper House 159 Strathmore Avenue Luton LU1 3QR Lead Inspector Angela Dalton Key Unannounced Inspection 16th September 2008 12.40p Juniper House DS0000015013.V371855.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 Juniper House DS0000015013.V371855.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. Juniper House DS0000015013.V371855.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Juniper House Address 159 Strathmore Avenue Luton LU1 3QR 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) 01582 419923 albute.3@ntlworld.com Mrs Audrey Greer Mrs Audrey Greer Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Juniper House DS0000015013.V371855.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 25th July 2007 Brief Description of the Service: Juniper House is a small home for three service users with learning disabilities. The home was owned and managed by Mrs Audrey Greer. A small staff team are employed and work closely with service users. The home is situated in a residential of Luton, close to shops and other amenities. The building is a detached house with four single bedrooms, one of which is used by staff as an office and sleep – in room. The ground floor has a lounge, dining room and the kitchen with washing machine. An enclosed garden with a patio is accessible from the kitchen. The home charges between £600 and £700 per week for the care, depending upon the individual needs of the service user. Juniper House DS0000015013.V371855.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. One inspector conducted this unannounced site visit on 16th September 2008 between 12.40pm and 6.10pm. As this is a small service all three people were case tracked. The inspector followed the care of people who use the service to ensure the care they receive is reflected in the care plan and meets their individual requirements. The case tracking process cross-references all the information gathered to confirm that what Inspectors are being told is actually happening and reflects the Statement of Purpose, which contains the aims and objectives for the service. It included discussion with service users, staff and the manager. People who use the service are well cared for and staff focus upon individual needs and ensure that people develop their skills and independence. What the service does well: What has improved since the last inspection? Requirements made at the previous inspection have been met. Care plans are available to staff and it was evident that staff were meeting people who use the service’s needs. Risk assessments have been completed to ensure the safety of people who use the service both inside and outside. The manager has made the decision not to add an additional bedroom and has maintained adequate communal space. This enables people who use the service to have privacy without retiring to their bedroom. Training has been ongoing ensuring that staff are kept up to date with developments and enables them to provide good quality of care. Juniper House DS0000015013.V371855.R01.S.doc Version 5.2 Page 6 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. Juniper House DS0000015013.V371855.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 Juniper House DS0000015013.V371855.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 & 5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Prospective service users are able to visit the home and have the information needed to help them make an informed choice about moving into the home EVIDENCE: The home had a statement of purpose and a service user guide. This is reviewed annually and the manager plans to incorporate findings of the quality assurance review to reflect what the service is doing well. The manager is also exploring transferring information into a more user friendly format. All the people using the service had contracts and these were in picture format. Information on fees charged by the home was recorded in their files. No new admissions had occurred since the previous inspection in July 2007. When someone moves into the service the manager undertakes an assessment and where possible an advocate is involved in the process. The manager has previously visited people in their own placement to gather information and to discuss information about Juniper House. The manager stated that she would not admit any person to the home unless she and the staff felt that they would be able to meet their needs. It was also emphasised that they would not admit any one to the home unless they were able to get on well with the other people living in home. Evidence showed that the three people in the home were observed to be getting on well together. Juniper House DS0000015013.V371855.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 adequate. This judgement has been made using available evidence including a visit to this service. People who use the service are the focus of the service and individual choices are actively encouraged and implemented. Some development is needed to fully illustrate how risks are monitored and managed. EVIDENCE: All three people who use the service had care plans: they had been reviewed but did not clearly illustrate what changes had occurred in the previous year. The annual review contained an overview of what had improved or deteriorated in the past twelve months but this did not relate to the care plan. The manager is planning to develop the main parts of the care plans into a more user friendly format. All staff have an excellent knowledge of people who use the service’s needs but care plans did not always reflect this. Missing person forms were in each care plan but not completed. Staff would have no difficulty in providing this information if needed but a completed form would assist in finding a missing person. Juniper House DS0000015013.V371855.R01.S.doc Version 5.2 Page 10 Staff have comprehensive knowledge that ensures people’s well being is maintained and that they are content. An example being that one person prefers to wear a specific style of clothing but because this is achieved it does not form part of the current care plan. This prevents the person from becoming upset and illustrates that a high standard of care is delivered but is not seen as a current issue. Risk assessments were in place for road safety and kitchen safety but it was unclear what was meant by a person requiring ‘supervision’. The kitchen is kept locked at night to ensure that specific needs can be met for one person who uses the service. An informal agreement is in place but this is not written into any individual plan of care. Individuals are encouraged to take risks and experience new activities. Health needs are met but some development is needed. Two people who use the service have diabetes but only one has a care plan in place to manage their condition. This does not reflect the high standard of care that staff deliver. All the people living in the home had annual reviews by their funding authorities including a review of daycare. The reviews reflected that professionals were pleased with the level of care people were receiving and that their quality of life continues to improve. The manager has been involved in person centred planning with day centres and transferred information into individuals’ files where appropriate. Staff have attended person centred planning training and this is to be incorporated into the service’s care plans. The manager and staff regularly talk to people who use the service to ensure that they are happy with the care that they receive. This is a natural part of daily life in the service as there is a homely atmosphere and a family environment. People who use the service meet as a group and on an individual basis. Outcomes of the meetings are recorded and incorporated into care plans. People who use the service use their meetings to make decisions about where to go on holiday, what to eat and are involved in any changes to their home. Staff’s knowledge of people who use the service ensures that they do not wholly rely upon verbal communication to ensure that individual wishes are met. Juniper House DS0000015013.V371855.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. Daily living activities are tailored to the individual requirements of people who use the service. EVIDENCE: On the day of the inspection the people who use the service were all out at day care but the inspector met with them on their return. As stated earlier the service achieves a homely atmosphere: people who use the service return home and are able to relax before eating their evening meal. There is no regimented approach and the staff team and manager have successfully achieved a sense of belonging for people who use the service. People who use the service had recently enjoyed a holiday. The manager ensures that local health services are available as daily medical intervention is required for two people who use the service. This entails a lot of work but the Juniper House DS0000015013.V371855.R01.S.doc Version 5.2 Page 12 manager successfully ensures an annual holiday takes place despite the challenges that are in place. Mealtimes are an opportunity for people who use the service to meet up with each other and staff to discuss their day and make plans for the week. Even if staff are not eating with people who use the service they will sit down together which reinforces mealtimes as a social occasion. The menu is changed regularly and people who use the service ensure that their preferences are reflected. Two of the people using the service attend day care five days a week incorporating attendance at a day centre and college. One person attends day care two days a week and spends the rest of the week developing daily living skills with staff. All of the people who use the service have one to one time with staff and are able to pursue activities that they enjoy. One person informed the inspector that they enjoyed shopping, bowling and going to the cinema. Staff also ensure that people who use the service are able to attend events that their peers are going to such as discos and club and pub nights. People who use the service attend the Mencap disco if they wish. The home welcomes friends and families of the people living in the home. The manager has previously used an advocacy service when family have not been involved. Juniper House DS0000015013.V371855.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 & 21 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who use the service are assured of individualised care. The medication recording system requires attention. EVIDENCE: Staff have an excellent knowledge of people who use the service’s needs. There are occasions when toiletries may be excessively used or toilet paper is blocking the toilet but staff are creative in ensuring that toiletries are available and appropriately used so that dignity is observed and people do not have to go without. Staff are sensitive to the individual needs of people who use the service. They assist individuals to express their sexuality and personality through dress: this may be challenging for staff but the manager ensures that staff are skilled to deal with meeting personal preferences. The service only employs female staff and has legal exemption to ensure that this can continue. Staff accompany people who use the service to church should they wish to attend. This service reflects the diverse needs of people who use the service and is able to cater for a wealth of requirements: gender identity, race, religion and disability are all needs that staff facilitate. Juniper House DS0000015013.V371855.R01.S.doc Version 5.2 Page 14 As stated earlier health needs are met, but a care plan is not in place for one person who uses the service who has diabetes whereas another person has one in place. The manager ensures that medical needs do not prevent people form enjoying holidays and ensures daily medical attention is in place when people who use the service are away on holiday. The recording of medication administration requires attention: Medication Administration Record Sheets (MAR) are handwritten. They do not reflect who wrote the MAR sheet, what the route of medication prescribed is (e.g. oral) and what amount is to be given at each time is e.g. one required which does not state whether it is one tablet or one dose. No copies of prescriptions are kept in the home so the manager cannot refer to what the doctor has prescribed. A medication fridge has been purchased and the manager is awaiting a lock to be fitted. The manager has a protocol to follow in the sad event of a person who uses the service dying but no individual wishes have been recorded. Juniper House DS0000015013.V371855.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 adequate. This judgement has been made using available evidence including a visit to this service. A recording system for complaints is not in place. EVIDENCE: Although the home has a complaints policy there is nowhere to record complaints, concerns or compliments and the action that has been taken. This would assist staff to deal with any concerns that are identified and prevent them form escalating into complaints. The service has not received any complaints. The manager has not yet completed a complaints policy in a user friendly format but plans to have implemented one by the end of the year. As stated earlier, the size of the service facilitates ongoing communication between people who use the service and staff. Minutes are recorded of monthly meetings and examples of positive outcomes are stated earlier in the report. Staff are aware of the local safeguarding policy and the manager will be attending a local authority update on September 24th. Financial records were checked during the inspection and found to be in good order. Juniper House DS0000015013.V371855.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 good This judgement has been made using available evidence including a visit to this service. The service provides a homely environment, which meets the needs of people who use the service. EVIDENCE: The manager has reviewed their decision to extend the home, which was discussed at the previous inspection. This ensures that people who use the service have access to private areas within the home other than their bedroom. Each bedroom reflects the personality and needs of people who use the service. The manager has plans to replace bedroom carpets with domestic style flooring to better meet individual needs and to refurbish the bathroom. The bath will be replaced by a shower to enable easier access. There are also plans to investigate the purchase of a computer for people who use the service to use. The kitchen is locked at night to ensure that the complex needs of one person who uses the service are met. This agreement is in place informally with the professionals who support people who use the service but needs to be put in Juniper House DS0000015013.V371855.R01.S.doc Version 5.2 Page 17 place as a formal arrangement. Alternative arrangements are in place to provide food or drink at night should they be required. All people who use the service take a jug of drink to bed with them to ensure that they will not be thirsty. The home was clean and tidy on the day of inspection. Juniper House DS0000015013.V371855.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. Staff effectively meet the needs of people who use the service and are trained to be competent in the delivery of care. EVIDENCE: The staff team and manager attend frequent training that is offered by social services and health trust. The staff team know people who use the service well and work hard to maximise individuals’ independence. All staff receive a rolling programme of mandatory training. Additional support and training is provided by members of the multi disciplinary team who support people who use the service. Staff have received training to ensure they are able to meet individual needs e.g. diabetic training from the district nurse. Staff are encouraged to obtain their National Vocational Qualification (NVQ) and complete the induction and foundation components of the Learning Disability Award Frame work accredited training (LDAF). Staff receive supervision every two months and records demonstrated this. The service currently has staff vacancies of a senior support worker and a part time support worker. This results in the manager working additional hours. The home positively discriminates and employs only female members of staff. Only Juniper House DS0000015013.V371855.R01.S.doc Version 5.2 Page 19 one new member of staff had been appointed since the previous inspection and their documentation was in place. The application form does not ask for a full employment history and the dates that staff were employed. The manager plans to devise an application form to ensure that a full employment history can be sought. Juniper House DS0000015013.V371855.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 adequate. This judgement has been made using available evidence including a visit to this service. The needs of people who use the service are fulfilled but no formal system is in place to measure that the aims and objectives of the service are successfully met. EVIDENCE: The manager clearly has a passion for caring for people. The emphasis is upon providing a home for people with a family atmosphere and this has been achieved. Staff confirmed that the manager was highly supportive and available and stated they ‘were able to talk to her and she’s always there.’ The views of people who use the service are formally and informally sought. An advocacy service has previously been involved in using user friendly documentation to conduct formal quality assurance surveys. There is no formalised system currently in place to canvas people who use the service’s opinions on an annual basis. Views are sought at ‘resident’’ meetings’ but a Juniper House DS0000015013.V371855.R01.S.doc Version 5.2 Page 21 formal quality assurance system would demonstrate that the service was successful in meeting the needs of the people who use the service. The manager plans to implement a formal system to feedback in a user friendly format. They are also exploring the possibility of incorporating the outcome of the quality assurance report within the statement of purpose. The manager was in the process of completing the Annual Quality Assurance Assessment (AQAA) which is a document sent by the Commission for Social Care Inspection (CSCI) which requests for the manager t demonstrate what has improved within the last twelve months. Health and safety risk assessments are in place for environmental risks within the home. The manager is planning to expand the fire plan by utilising the local fire service’s assessment. Juniper House DS0000015013.V371855.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 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 X 33 3 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 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 2 2 2 3 X 2 X X 3 X Juniper House DS0000015013.V371855.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. 2. 3. Standard YA6 YA9 YA18 Regulation 15(2)(b) 14(b) 16(2)(i) Requirement Reviews must demonstrate any developments or changes to the care plan. Risk assessments must provide more detail how risks are managed and monitored. Records must reflect that professionals have been involved in the decision to lock the kitchen at night. All people who use the service with a diagnosis of diabetes must have a care plan to reflect how their condition is monitored and managed. Medication records must reflect who has written instructions. Administration details must be clear and specify the dose and route. Where medication is been omitted or refused the reason must be recorded. Timescale for action 30/11/08 31/10/08 31/10/08 4. YA19 12(1)(a) 31/10/08 5. YA20 13(2) 31/10/08 Juniper House DS0000015013.V371855.R01.S.doc Version 5.2 Page 24 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. 3. 4. Refer to Standard YA9 YA21 YA22 YA27 Good Practice Recommendations Missing person forms should be completed. All people who use the service should have their individual funeral wishes recorded. A recording system for complaints should be devised and the complaints procedure should be in a format that the people living in the home can understand. The bathroom and toilet should be modernised. Bedroom carpet should be replaced to better meet the needs of people who use the service. A questionnaire in a user friendly format should be undertaken to get their views of how the home is meeting the needs of people who use the service. 5. YA39 Juniper House DS0000015013.V371855.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Juniper House DS0000015013.V371855.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!