Inspection on 14/07/05 for Keer Sands Residential Home

This inspection was carried out on 14th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Keer Sands Residential Home 06/06/07

Keer Sands Residential Home 24/03/06

Keer Sands Residential Home 14/10/04

Keer Sands Residential Home 22/04/04

Similar services:

Chirnside House

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Belvidere Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Keer Sands Residential Home Shore Road Crag Bank Carnforth, Lancashire LA5 9HY Lead Inspector Jenny Dunkeld Announced 14 July 2005 10:00 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 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. Keer Sands Residential Home F57 F09 S9869 Keer Sands Residential Home V227384 140705 Stage 41.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Keer Sands Residential Home Address Shore Road, Crag Bank, Carnforth, Lancashire. LA5 9HY Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01524 732060 Mrs katherine Anne Plevey and Mr Stephen Plevey CRH Care Home 10 Category(ies) of OP Old Age 10 registration, with number of places Keer Sands Residential Home F57 F09 S9869 Keer Sands Residential Home V227384 140705 Stage 41.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th October 2004 Brief Description of the Service: Keer Sands is registered with the Commission for Social Care Inspection to provide care and accommodation for up to ten older people.The home is situated in a rural area of Carnforth but only a short drive from the many facilities and amenities available in Lancaster and Morecambe.The majority of accommodation at the home is offered on a single room basis and there is one shared room. There are toilet and bathroom facilities on both floors and a variety of communal areas including a lounge, dining room and conservatory.Prior to their admission, assessments are carried out of service users’ daily care needs to ensure the home can offer an appropriate level of care. Information gathered at the time of the assessment is used to form a care plan which is regularly reviewed throughout the service user’s stay at the home.Care is provided on a 24 hour basis including waking watch cover throughout the night. Several of the carers employed at Keer Sands have NVQ qualifications in care at level 2 or above.Service users’ health care needs are addressed in conjunction with visiting health care professionals such as district nurses and general practitioners.There are a variety of social activities offered at the home including home based activities and trips and outings.The registered provider of the home is Mrs Anne Plevey. Mrs Plevey works in the home on a full time basis. Keer Sands Residential Home F57 F09 S9869 Keer Sands Residential Home V227384 140705 Stage 41.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This home has been inspected against the National Minimum Standards for older people introduced in April 2002. This year, all registered Care Homes are to be inspected at least twice this year and both visits can be unannounced. However as this was the inspector’s first visit to the home she chose to carry out an announced inspection. This inspection was over a 4-hour period during the day on 12/7/05 and looked at various aspects of care. In the report there are references to the “tracking process”, this is a method whereby the inspector focuses on a small group of residents. All records relating to these individuals are examined, along with the rooms they occupy in the home. Residents are invited to discuss their experiences of the home with the inspector; this is not to the exclusion of the other residents who contributed in many ways. This inspection included discussion with residents, staff and the manager in addition to viewing the home’s required written information such as policies and procedures about various issues for instance ‘Health and Safety’. The residents written plans of care were also viewed for 3 people. The plan of care is a document outlining the needs of the individual resident and how these are to be met. The plans of care cover all aspects of the individual’s life including health, personal care and social activities. Thereby ensuring people are content in the care they receive. The residents the inspectors spoke with were happy with life at Keer Sands. The staff enjoyed their work at Keer Sands and spoke to the inspector in a professional manner about the residents. They were also full of praise for Ann the homeowner and manager. What the service does well: Keer Sands is a small family run business, which has a very homely atmosphere. The people who live at Keer Sands are full of praise about the care they receive. Keer Sands Residential Home F57 F09 S9869 Keer Sands Residential Home V227384 140705 Stage 41.doc Version 1.40 Page 6 The Commission for Social Care Inspection sent written questionnaires to residents, their relatives and health care professionals who regularly visit the home. A very good response was received from the written survey. In total 20 responses were received and the feedback from them was, without exception, very positive. In the responses received from the residents or their representatives; • • • • • • All respondents said that they were satisfied with the overall care provided all of the time. All respondents said that they liked living at the home all of the time. All respondents said that they felt well cared for all of the time. All the respondents said that their privacy was respected all of the time. All the respondents said that the home provided suitable activities all of the time. All of the respondents said that they liked the food provided all of the time. In the responses received from visiting healthcare professionals; • • • All respondents said that the home communicated clearly and worked in partnership with them. All respondents said that staff at the home demonstrated a clear understanding of the health care needs of residents. All respondents said that residents’ medication was appropriately managed within the home. Additional positive comments were made in writing to the Commission for Social Care Inspection, which are referred to later in the report but included; “I would like to say I am full of admiration for the way Anne Plevey and her staff run Keer Sands” “ We are extremely happy with the care at Keer Sands, it is just like home from home. We couldn’t wish for a better place and feel totally reassured by all staff” Mr and Mrs Plevey listen to advice offered and act upon the advice to ensure the home continues to offer an excellent service. What has improved since the last inspection? Keer Sands Residential Home F57 F09 S9869 Keer Sands Residential Home V227384 140705 Stage 41.doc Version 1.40 Page 7 Since the last inspection all hot water outlets now have thermostatically controlled valves on them thereby ensuring the residents are protected from possible accidental scalding. A number of people like to have some of the internal doors wedged open for ease of access to communal rooms and for air circulation in their bedrooms. However as this could present a risk should there be an outbreak of fire, Mr and Mrs Plevey are arranging for doors to have self closing devices fitted which would automatically release and close the doors when the fire alarm is sounded. Two doors have had the devices fitted to date. 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. Keer Sands Residential Home F57 F09 S9869 Keer Sands Residential Home V227384 140705 Stage 41.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Keer Sands Residential Home F57 F09 S9869 Keer Sands Residential Home V227384 140705 Stage 41.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 There are good arrangements for the needs of the residents to be assessed prior to admission. This means that management and staff are aware of people’s needs and can ensure they are capable of meeting them in the most appropriate way. EVIDENCE: People admitted to Keer Sands have pre-admission assessments to ensure the home can meet their needs. As part of the ‘Tracking process’ the inspector viewed the assessment for the last person admitted to the home. This covered various aspects of the person’s care needs including; Mobility Dressing Dietary Communication Orientation Medication General Health Keer Sands Residential Home F57 F09 S9869 Keer Sands Residential Home V227384 140705 Stage 41.doc Version 1.40 Page 10 From the pre-admission assessment a plan of care is developed ensuring the individuals needs are fully met. This ensures people are content in the care they receive. Keer Sands Residential Home F57 F09 S9869 Keer Sands Residential Home V227384 140705 Stage 41.doc Version 1.40 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 & 8 Arrangements to meet the needs of the residents are good including their health care needs. EVIDENCE: In discussion, Mrs Plevey confirmed that there were care plans in place for every resident in the home. As part of the tracking process the inspector viewed a selection of the residents’ care plans during the visit. In general, care plans were found to be of a good standard, linking well to assessments and addressing all areas of identified need. This is a small home with a fairly consistent staff team who are able to communicate people’s specific needs verbally on a daily basis. However there is a need to ensure the written care plans are explicit For example one plan of care states ‘Needs assistance when out walking’ The care staff need to know what assistance, thereby ensuring assistance is given as required. The comments received from relatives of the residents included; ‘I cannot stress enough my high opinion of the quality of care given in this wonderful home. It certainly is a most caring HOME’ Keer Sands Residential Home F57 F09 S9869 Keer Sands Residential Home V227384 140705 Stage 41.doc Version 1.40 Page 12 The health care needs identified during the pre- admission assessment form part of the plan of care. These reflect that the person’s Doctor visits when required as does the Chiropodist. During the inspectors visit to the home the District Nurse called to visit one resident. The residents said that their health needs are well met and that Anne calls for their Doctor to visit if they are not well. The questionnaires that the Commission for Social Care Inspection sent to health professionals who visit the home were returned with positive comments such as; ‘Very good relationship with nursing and medical services’ ‘Management of home and care of patients is excellent’ They also reflected; The residents medication is appropriately managed by the home. They can see their patient in private. Keer Sands Residential Home F57 F09 S9869 Keer Sands Residential Home V227384 140705 Stage 41.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 & 15 There are no restrictions for families and friends of the residents to visit the home. The residents benefit from seeing their family when they wish to. Arrangements and planning to provide good nutritional food are good. The residents are provided with good food to ensure healthy living. EVIDENCE: In their booklet called a ‘Statement of Purpose’, Keer Sands provide an undertaking that all residents will be able to receive visitors at any reasonable time. This was also confirmed in the written responses received to the survey carried out as part of the inspection. All respondents said that they were able to receive their visitors at any reasonable time and that they could always meet with their visitors in private. Keer Sands Residential Home F57 F09 S9869 Keer Sands Residential Home V227384 140705 Stage 41.doc Version 1.40 Page 14 The home enjoys good links with the local community, which are maintained through events such as coffee mornings and garden parties. People are taken out for walks in the locality and also enjoy trips out in a car. In addition, local clergy visit residents at the home on a regular basis. All residents who were consulted at the time of the inspection and as part of the written survey were very complimentary about the quality and variety of food provided at Keer Sands. The inspector enjoyed an appetising well-presented lunch during this inspection And observed the residents were served with an appetising meal in a dignified manner. The dining tables were well presented with appropriate cutlery and condiments to ensure people dine in a dignified manner. In discussion, the inspector was able to determine that mealtimes are always flexible and designed to fit around the individual needs of residents. Residents confirmed that they were able to take their meals wherever they wished. The inspector viewed menus, which confirmed that an appealing, varied and nutritious diet is offered to residents at the home. In addition, several people who were consulted commented favourably on the home baked cakes and biscuits, which were regularly provided. Indeed the inspector sampled a home made cake and tried hard to resist eating another. The cook was well aware of people’s dietary needs and catered for these, ensuring the contentment people have in the meals provided. Keer Sands Residential Home F57 F09 S9869 Keer Sands Residential Home V227384 140705 Stage 41.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 The arrangements for dealing with complaints are good. The residents can speak up and feel that they are listened to. The home provides a safe environment where the people are well protected from abuse. EVIDENCE: The home has a complaints procedure in place that includes timescales in which the complainant can expect their issues to be addressed, as well as advice to follow in the event that they are unhappy with the outcome. In addition the home has a system in place for recording any complaints made and subsequent action taken. It was noted during the inspection that the home had not received any complaints in the last twelve months. The comment cards received from residents and their relatives reflected that they were aware of how to complain and who to speak to if they were unhappy about any aspect of care. Keer Sands Residential Home F57 F09 S9869 Keer Sands Residential Home V227384 140705 Stage 41.doc Version 1.40 Page 16 The registered provider of Keer Sands works in the home on a full-time basis. As such, she spends a lot of time interacting with residents and in discussion with the inspector, explained that much of this time is spent encouraging residents to express their views and raise any concerns that they have. Through discussion and practice, the registered provider of Keer Sands demonstrates a genuine commitment to safeguarding the welfare and well being of residents in her care. The home have adult protection policies and procedure in place. The abuse policy states ‘inform management of any allegation. The inspector advised of the need to inform Social Services as the lead agency with regards to allegations of abuse as required under the guidance given by the Department of Health in their document ‘No Secrets’ Records of staff induction verified that the area of adult protection is addressed at the commencement of carers’ employment. The management of the home do not look after the pension books of the residents, as the families of the residents deal with these if the resident wishes them to. However the management will look after the personal spending money for people. This is securely stored and a record maintained of all transactions. The inspector advised on the benefit of having to signatures to all transactions, to protect the residents from financial abuse and stop the staff from being in a position where allegations could be made. Keer Sands Residential Home F57 F09 S9869 Keer Sands Residential Home V227384 140705 Stage 41.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 26 Keer Sands is a safe, clean and pleasant place in which to live. The residents feel safe and their accommodation is comfortable. EVIDENCE: Keer Sands Residential Home F57 F09 S9869 Keer Sands Residential Home V227384 140705 Stage 41.doc Version 1.40 Page 18 Keer Sands is located in an attractive area of Carnforth and a tour of the home confirmed that it is well maintained, including window boxes outside each window, which enhance the homely appearance. The home was found to be clean, warm and comfortable. The inspector viewed policies and procedures relating to infection control and found them to provide good guidance to staff in reducing the risk of cross infection. Policies and procedures also appeared to be in line with relevant guidance and legislation. Self closing devices have begun being fitted to internal doors, to ensure the residents can have their doors open when they wish but will close automatically should the fire alarm be sounded. Keer Sands Residential Home F57 F09 S9869 Keer Sands Residential Home V227384 140705 Stage 41.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 ,29 & 30 The level and calibre of staff is good. The residents benefit from a well recruited staff team. EVIDENCE: The inspector viewed staff rotas, which confirmed that staffing levels were in line with previous guidance issued by Lancashire County Council. Through discussion with the residents, carers and Mr and Mrs Plevey, the inspector was able to determine that the home has a very low turnover of staff. The home does not use agency staff at any time. During the visit the inspector viewed a selection of staff files. The information provided in staff files confirmed the registered provider of Keer Sands operates a thorough recruitment procedure so as to ensure the safety and well being of residents accommodated there. In all staff files viewed, a full employment history had been obtained and in discussion, the registered provider confirmed that any gaps in a candidate’s employment history would be investigated. In addition, two written references were available on all the staff files viewed, as well as Criminal Record Bureau disclosures. Keer Sands Residential Home F57 F09 S9869 Keer Sands Residential Home V227384 140705 Stage 41.doc Version 1.40 Page 20 The home has a formal induction procedure in place which is carried out for every new staff member. Areas covered in induction include health and safety, policies and procedures and daily working practices. The inspector was particularly impressed by induction workbooks developed by the registered provider relating to principles of care. The workbooks were of an excellent standard, covering areas such as privacy and dignity and inviting the readers to examine their own principles and values through written exercise. Through discussion and viewing records, the inspector was able to determine that staff are regularly enabled to access a variety of training courses pertinent to the health care needs of older people. In addition, the registered provider has recently developed an in-house training package on caring for people with dementia for which she has receive an award from a national organisation. 7 staff have achieved National Vocational Qualification level 2 in care, which exceeds the requirements of the National Minimum Standards. Keer Sands Residential Home F57 F09 S9869 Keer Sands Residential Home V227384 140705 Stage 41.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 &35 There is a commitment to continual monitoring of standards and developments within the home are driven through the experience, views and comments of residents. EVIDENCE: The views of residents and their representatives are actively sought on a regular basis through satisfaction surveys and residents’ meetings. In discussion, the registered provider confirmed that responses from surveys and comments made in meetings are analysed and used to make decisions about developments within the home. Residents are supported to manage their own financial affairs for as long at they are able or wish to do so. When this is not possible, third party advice such as from a relative or advocate will be sought. Keer Sands Residential Home F57 F09 S9869 Keer Sands Residential Home V227384 140705 Stage 41.doc Version 1.40 Page 22 During the visit, the inspector viewed records of residents’ financial transactions. These were found to be well maintained and in good order. However advice was offered in relation to having two signatures for all transactions, thereby protecting all involved. There is evidence in the 20 comment cards received from residents, relatives and professional visitors that the home is well managed. Comments include; ‘Management of the home is excellent’ ‘I am full of admiration for Anne Plevey’ Keer Sands Residential Home F57 F09 S9869 Keer Sands Residential Home V227384 140705 Stage 41.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x 3 x x x Keer Sands Residential Home F57 F09 S9869 Keer Sands Residential Home V227384 140705 Stage 41.doc Version 1.40 Page 24 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 OP 7 Regulation 15(1) Requirement Plans of care must be expanded upon to ensure the care staff are aware of the precise assistance that is required Timescale for action 30th Sept 2005 2. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP25 OP35 Good Practice Recommendations Locks should be fitted on all bedroom doors and keys provided within a risk management framework. Two signatures should obtained for each financial transaction in relation to the residents monies. Keer Sands Residential Home F57 F09 S9869 Keer Sands Residential Home V227384 140705 Stage 41.doc Version 1.40 Page 25 Commission for Social Care Inspection 2nd Floor, Unit 1 Tustin Court Port Way Preston. PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Keer Sands Residential Home F57 F09 S9869 Keer Sands Residential Home V227384 140705 Stage 41.doc Version 1.40 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!