Inspection on 31/10/06 for Kersal Dale

This inspection was carried out on 31st October 2006.

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

Kersal Dale 28/11/07

Kersal Dale 05/07/07

Kersal Dale 18/03/06

Kersal Dale 03/11/05

Kersal Dale 08/02/05

Kersal Dale 19/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Kersal Dale 48 Vine Street Salford Gtr Manchester M7 0PG Lead Inspector Sue Jennings Key Unannounced Inspection 31st October 2006 10:00 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 Kersal Dale DS0000008347.V309784.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. Kersal Dale DS0000008347.V309784.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kersal Dale Address 48 Vine Street Salford Gtr Manchester M7 0PG 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) 0161 792 3166 Mrs N Akram Mr U Akram Miss Chrisden Williams Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Kersal Dale DS0000008347.V309784.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home provides accommodation to a maximum of 35 service users who require care by reason of old age, not falling within any other category. The home must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 18th March 2006 Date of last inspection Brief Description of the Service: Kersal Dale is a residential care home for 35 older people. The building is set in its own grounds with landscaped gardens to the front and rear of the property. There is a drive in drive out route to the home and parking area to the side. The home is situated in a residential area of Salford. Internally there is a large lounge and dining area running down the centre of the building leading to a large glazed patio style lounge. Accommodation comprises of twenty-five single rooms, and five double rooms, on the ground and first floor. The home has good disabled access at the front of the property and both floors are accessible via a passenger lift, which also goes to basement level. Kersal Dale DS0000008347.V309784.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was undertaken as part of a key inspection, which includes an analysis of any information received by the Commission for Social Care Inspection in relation to this home prior to the site visit. The visit was unannounced and took place over the course of 5 hours on Tuesday 31st October 2006. During the course of the site visit time was spent talking to the manager, the owner, 2 residents and 3 members of staff to find out their views of the home. CSCI are trying to improve the way we engage with people who use services so we gain a real understanding of their views and experiences of social care services. We are currently testing a method of working where ‘experts by experience’ are an important part of the inspection team and help inspectors get a picture of what it is like to live in or use a social care service. The term ‘experts by experience’ used in this report describes people who have been appointed by Help the Aged, under the direction of the Commission for Social care inspection, to take part in the inspection of services for older people. Mr. Walter Park an Expert by Experience joined the inspector on this site visit. Mr. Park spoke to residents and observed resident and staff interactions. His comments and observations are added to this report and can be identified in bold text. The inspector spent time examining records and the residents’ and staff files. A tour of the building was also made. What the service does well: What has improved since the last inspection? Kersal Dale DS0000008347.V309784.R01.S.doc Version 5.2 Page 6 A policy regarding self-medication has been added to the medication policy. Fluid balance charts have been developed for use when resident’s fluid intake is poor. Advice has been taken from the infection control nurse and a policy has been developed. The quality assurance system has been further developed. 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. Kersal Dale DS0000008347.V309784.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 Kersal Dale DS0000008347.V309784.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are admitted to the home after a full assessment of needs has been undertaken. This ensures that residents’ care needs can be met. EVIDENCE: The Statement of Purpose and Function had been amended since the last inspection. The home provided a brochure that is given to prospective residents. On admission residents are given the Service User Guide and Statement of Purpose and Function. Staff worked closely with visiting professionals such as General Practitioners and district nurses. A pre-assessment form is in use, to ensure prospective residents are only admitted on the basis of a full assessment. Kersal Dale DS0000008347.V309784.R01.S.doc Version 5.2 Page 9 The assessment included the involvement of the prospective resident, his/her representatives and any relevant professionals. The manager of the home undertook the pre-admission assessment. Social workers’ assessments of needs were in place and the home had conducted thorough in-house assessments of need. Falls risk assessments had been undertaken where necessary. On admission to the home, residents have a further assessment period during which time the home formulates its own care plan. Kersal Dale does not provide intermediate care facilities. Kersal Dale DS0000008347.V309784.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall the health and personal care needs of the residents were being met at the home. EVIDENCE: All residents were registered with a general practitioner at the time of admission to the home. Records showed that arrangements had been made to access other health professionals and services required by residents. A random sample of care plans was examined. Each resident had an individual plan of care which had been generated from a social worker’s needs assessment and the homes own assessment process. Care plans included risk assessments although some work was required to ensure that risks and the action required to reduce risks are clearly identified. Kersal Dale DS0000008347.V309784.R01.S.doc Version 5.2 Page 11 Important information e.g. the need for thickening fluids for residents with swallowing difficulties had been highlighted. Risk assessments were in place for residents requiring pressure area care. The home kept a weight monitoring form that included comments when a residents weight varied. The care plans gave good detail about residents care needs. This was good practice. However, the daily record in care plans needed to be more detailed to reflect the care provided to residents. Medication was stored in a metal trolley this was secured to the wall in the dining area. The kitchen fridge was used to store medication requiring cold storage this posed a risk of cross infection. There is a requirement that medication is securely stored this cannot be achieved in the domestic refrigerator. Inhalers prescribed for residents were not labelled correctly the outer boxes were labelled but the item was not. There were a number of gaps in recording on the Medication Administration Record. It was evident that the staff on duty had a good understanding of good practice issues associated with privacy and dignity. During the inspection staff were observed knocking on bedroom doors and waiting for a response. Expert by Experience; When asked about some of the service provided the reply was, “A chiropodist comes about every 3 months, when I asked to see one sooner I was refused”. This issue was discussed with the manager during the site visit she confirmed that the person in question did in fact see the chiropodist every three weeks. Kersal Dale DS0000008347.V309784.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provided a good environment for the residents who live there, with some activities available. Residents were supported to maintain contact with family and friends, however some residents felt they were not able to exercise choice over their life. Meals served at the home were nutritious, well balanced and offered a healthy and varied diet for residents. EVIDENCE: The home’s cook has a Silver award from Salford Environmental Health Department. The midday meal consists of soup and a main course. The meal served on the day of the inspection was a choice of mushroom or tomato soup, fish pie with mixed vegetables and mashed potatoes or beef burger/sausages with mixed vegetables and mashed potatoes. The evening consists of a main course and a sweet. On the day of the site visit the meal was salmon or corned beef with tomatoes bread and butter. The Kersal Dale DS0000008347.V309784.R01.S.doc Version 5.2 Page 13 sweet was ice cream or peaches and cream. The expert by experience sat with the residents and had lunch. Discussion with the cook indicated that any broken equipment in the kitchen is recorded in the maintenance book and quickly repaired or replaced. The home showed good knowledge of equality and diversity by contacting the local Mosque for advice regarding one residents cultural needs and the proprietor buys and cooks Halal foods. The proprietor discussed previous experience of contact with the local synagogue and ministers of various faiths visit the home on a regular basis. The home operates an open policy on visiting unless restrictions are in place to protect the resident. Visitors can be seen in the lounges or in the privacy of the residents’ bedroom. Expert by Experience; Whilst talking to another resident about the care, food and the home in general, the response was - “It’s all right, but there is no opportunity to get out” . The same resident also said, “I’ve been told that I am spending too much time in a wheelchair”. When asked about some of the service provided the reply was - “A chiropodist comes about every 3 months, when I asked to see one sooner I was refused”. I then moved in the TV lounge. The TV was on but no one appeared to be watching, they were either asleep on just sitting.I spoke to a resident about the home and the facilities, asking about laundry and entertainment, “We have a pianist that comes sometimes, but they don’t tell us when its on” “My daughter does my washing I don’t want it to get mixed up” At lunch time I joined the residents in the dining room. There was a choice of either tomato or mushroom soup, a choice of either fish pie or burgers and sausage with mixed vegetable and two types of potato, followed by either tea, coffee or fruit juice. The portions were ample and we were asked if we wanted more. Two residents didn’t want the offered menu, but were given a further alternative, one having cooked fish the other a fried egg. I noticed that teaspoons were not provided for those putting sugar in their drinks. I later spoke to another resident who was going into the garden to smoke. I asked similar questions that I had put to other residents in particular to the activities provided, “I go to the bingo sometimes, but most of us don’t want to be bothered” Kersal Dale DS0000008347.V309784.R01.S.doc Version 5.2 Page 14 I made the following observations during my visit. • • • • • The staff were very attentive to the needs of the residents. The staff looked after the resident’s medication. There is a “No Smoking” policy - there is a smoke room in the basement. The lounges were tidied whilst the residents were at lunch There was a list of activities available posted in the dining room Kersal Dale DS0000008347.V309784.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had a complaints procedure that was known to residents. The home’s policies and procedures did not fully protect the residents. EVIDENCE: The home had policies and procedures relating to adult protection and Whistle Blowing. The Adult Protection policy advised staff to investigate allegations. Any allegations of abuse must be referred to the social services in line with the local Adult Protection Procedures. This document must be amended to give clear instructions to staff on the action to be taken in the event of an allegation of abuse. It was recommended that a flow chart of the action to be taken in the event of an allegation be produced and displayed in a prominent position for the senior care staff when they are in charge of the home. The home had a copy of the local Adult Protection procedures in line with the Department of Health ‘No Secrets’ guidance. The home’s complaints procedure was displayed in the entrance hall. This contained the time limits for making a complaint and the contact details of the Commission for Social Care Commission. The home and the Commission for Social Care Inspection had not received any complaints since the previous inspection. Kersal Dale DS0000008347.V309784.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained comfortable and provides residents with a safe and homely environment in which to live. EVIDENCE: The home felt comfortable and homely. All areas of the home were tastefully decorated and furniture was of a domestic nature and of a high standard. The premises were clean and free from offensive odours. The home’s environment had benefited from regular maintenance and re-decoration. The home provided two passenger lifts to enable residents’ access to the first floor. A variety of electrical hoists were available. Appropriate aids were fitted i.e. assisted baths and raised toilet seats for residents who required assistance doorways into the communal areas allowed wheelchair access. Kersal Dale DS0000008347.V309784.R01.S.doc Version 5.2 Page 17 Bedroom accommodation was provided in 5 double and 25 single bedrooms located on the ground and first floors. Privacy screens had been provided in all double rooms. All communal areas, bedrooms and toilets were fitted with an emergency call system. Bedrooms seen were personalised depending on residents individual choice some had few personal possessions but this was at the choice of the resident. Expert by Experience; The manager arranged for a member of staff the give me a guided tour of the home, we went up to the first floor, the first room I asked to see was a shower room/toilet which was clean and tidy, except that there were paint splatters on the floor. The proprietor was shown this shower room and stated that that area had been plastered recently and it looked like plaster marks. He stated that he would arrange for someone to clean the area. My guide showed me two or three single rooms which were clean and tidy, but with little evidence of personal belongings or artefacts. I asked to see one of the home’s double rooms - here again clean and tidy, but again no personal touches. I was informed that although there were several double rooms, none were being used by couples. The manager stated that it was the resident’s choice to have their room as they want it and some do not want anything bringing from their homes. Whilst on the first floor, I saw that there was ample provision of hand rails. I also commented that a fire door was open. My guide closed it. I later learned that the door is on a magnetic catch which releases when the fire alarm is sounded. I later asked a male resident, when he had last taken part in a fire drill. He replied “I don’t remember having done one”. Fire doors in the home are linked to the fire alarm system and all doors are held open by magnetic automatic closure systems and close when the fire alarm sounds. There was documentary evidence to show that fire drill had been carried out on the 21st August 2006 with 5 staff attending. There was no evidence that weekly fire checks of the fire alarm system were being carried out posing a potential risk to residents, staff and visitors to the home. The manager reported that the home had appointed a fire officer from an independent company to carry out checks of the fire alarm system on a regular basis and to carry out staff training. Kersal Dale DS0000008347.V309784.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The number of staff within the home was sufficient to meet the needs of the residents and had the relevant skills and training to be competent in their job role. EVIDENCE: It was noted that there was very little staff turnover at the home and many of the staff had been employed for a number of years. The staffing levels for the period covering the inspection were assessed and were maintained in accordance with the needs of residents. The files of four staff employed in the home were checked. There was no evidence of a formal staff induction that meets the Skills for Care National Standards. There was little written evidence to show that staff were receiving regular supervision. Evidence of training courses was seen on staff files. One newer member of staff did not have any references on file. The responsible person must ensure that two written references are obtained prior to new staff starting work. Seven of the staff had achieved NVQ level II and three staff had applied for the training. One member of staff had received training in relation to Adult Protection procedures. In order to fully protect residents the responsible person must ensure that all staff received training relating to Adult Protection. Kersal Dale DS0000008347.V309784.R01.S.doc Version 5.2 Page 19 A number of the home’s staff was attending training at a local college regarding Cultural Awareness. Kersal Dale DS0000008347.V309784.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s quality monitoring systems protected residents and the home had systems and procedures in place, which safeguards and protects resident’s financial interests. However fire practice procedures did not fully protect residents, staff and visitors. EVIDENCE: A quality assurance and quality monitoring system was in place, which includes obtaining views of residents and their relatives. Anonymous questionnaires had been sent out to resident’s relatives/representatives in an attempt to gain their views. The results were published in the service user guide. There were plans to replace this system with a new format. Residents’ views are sought with regard to meals. Kersal Dale DS0000008347.V309784.R01.S.doc Version 5.2 Page 21 None of the home’s policies or procedures were dated making it difficult to know when they were last reviewed. The manager had not registered to undertake NVQ level 4 registered managers award. It is recommended that the manager enrol for this training as soon as possible. The home is working towards achieving the investors in people award. There was evidence that fixed electrical and gas equipment was regularly maintained. As previously reported weekly checks of the fire alarm systems had not been carried out. Kersal Dale DS0000008347.V309784.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 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 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 Kersal Dale DS0000008347.V309784.R01.S.doc Version 5.2 Page 23 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. 1. Standard OP9 Regulation 13 Requirement There must be no gaps in recording on the Medication Administration Records. The registered person must ensure that labelling on those items dispensed in two containers be labelled on the item as well as the outer box. Appropriate secure storage must be provided for those medications requiring cold storage. The home must ensure that planned training in Adult Protection Procedures for all staff takes place and evidence is maintained. The manager must evidence that supervision is provided to all staff. The registered person must ensure that fire alarm systems in the home are regularly maintained and tested. Timescale for action 31/12/06 2. OP18 13(6) 31/01/07 3. 4. OP36 OP38 18(2) 13 30/12/06 31/12/06 Kersal Dale DS0000008347.V309784.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. Refer to Standard OP7 OP31 OP37 Good Practice Recommendations Daily records in care plans should be more detailed to fully reflect the care delivered over a 24-hour period. The manager should complete the NVQ Level 4 award. Policies and procedures for the home should be regularly reviewed and dated. Kersal Dale DS0000008347.V309784.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection CSCI, Local office 11th Floor West Point 501 Chester Road Old Trafford, Manchester M16 9HU 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 Kersal Dale DS0000008347.V309784.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!