Inspection on 15/12/08 for Kirby Close (10)

This inspection was carried out on 15th December 2008.

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

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

Kirby Close (10) 07/03/07

Kirby Close (10) 17/01/06

Kirby Close (10) 20/09/05

Kirby Close (10) 15/03/05

Kirby Close (10) 05/10/04

Similar services:

Park View (15)

Craigmore House

1 Lanark Close

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Prince Bishop Court

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Kirby Close (10) Kirby Close (10) South Shields Tyne And Wear NE34 9QF The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Karena Reed Date: 1 5 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 29 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Kirby Close (10) Kirby Close (10) South Shields Tyne And Wear NE34 9QF 01914545527 F/P01914545527 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): United Response Name of registered manager (if applicable) Gillian Dickinson Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 2 0 care home 2 learning disability Additional conditions: Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 29 A bit about the care home Kirby Close provides ordinary housing for two people who have a learning disability. The service cannot provide nursing care. There is a lounge, kitchen, three bedrooms, one of which is a bedroom and office combined and a bathroom,toilet on the first floor. There is a garden at the back.The home is situated in South Shields close to shops, public houses and places of worship. There are bus stops nearby.The home has its own transport. A Statement of Purpose and service user guide are available at the home.These guides describe the services and facilities provided by the home and how staff are trained to meet the care and support needs of people living in the home. CSCI inspection reports are also available at the home detailing the quality of care provided. Fees payable for living at the home at the time of inspection in December 2008 were 1648.25. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 29 How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is 2 stars. This means that the people who use the service experience good quality outcomes. We have reviewed our practice when making requirements,to improve national consistency.Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations,but only when it is considered that people who use services are not being put at significant risk of harm.In future,if a requirement is repeated,it is likely that enforcement action will be taken. How the inspection was carried out. Before the visit we looked at information we have received since the last inspection in March 2007, how the service dealt with any complaints and concerns since the last visit, any changes to how the home is run, the provider’s view of how well they care for people and the views of people who use the service and their relatives, staff and other professionals. The Visit: An unannounced visit was made on 15/12/08. During the visit we talked with people who use the service and staff, looked at Care Homes for Adults (18-65 years) Page 7 of 29 information about the people who use the service and how well their needs are met, looked at other records which must be kept, checked that staff had the knowledge, skills and training to meet the needs of the people they care for,looked around the building to make sure it was clean, safe and comfortable and checked what improvements had been made since the last visit. We told the person in charge what we found. What the care home does well The home provides residents with whatever length of time they need to decide if they wish to live at the home. There is a good standard of hygiene around the home. There is a very good level of staff training. Detailed information is collected about a new resident to ensure staff can provide the necessary levels of care and support to the person. There are good arrangements for residents to maintain contact with their family and friends. There is a very good standard of record keeping. Care Homes for Adults (18-65 years) Page 8 of 29 What has got better from the last inspection What the care home could do better The Statement of Purpose should be updated and made in an accessible format for people with learning disabilities so they may be more involved. Information should continue to be made accessible to involve residents in decision making in their lives. Care Homes for Adults (18-65 years) Page 9 of 29 Confidential information should not be displayed in a public area in order to respect the dignity of the resident. Consideration should be given to adapting the current environment as residents become more physically dependent due to illness or old age. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Karena Reed 33 Greycoat Street London SW1P 2QF 02079792000 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning Care Homes for Adults (18-65 years) Page 10 of 29 our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 11 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 12 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . There are good arrangements in place to ensure that the home can meet the needs of residents Evidence: The Statement of Purpose and service user guide for the home were examined. They were interesting and informative and contained the necessary information as required by the Care Homes Regulations 2001. The Statement of Purpose did not contain up to date information about staffing. They were not available in a way that might support people with learning disabilities. Records for the two residents showed that when they were admitted to the home an assessment of their care needs had been carried out before their admission. The resident and relevant people who knew them were involved in the initial assessment. The assessment form encourages staff to explore issues relating to equality and diversity as it refers to gender, cultural,religion and spirituality,educational and social histories,preferred daily routine and preferences. It also looks at mood,speech,behaviour,mental health,risks,sexuality and living skills.This information and the care managers assessment of the residents care needs were used to ensure Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: all the needs of the resident could be met by staff. The records contained a range of information. Residents have the opportunity to visit the home as often as they need in order to decide if they want to live there. A resident may come for meals, have overnight stays and be introduced to other residents at the home at a pace suitable to the individual. Residents living at the home have lived there for some years. Comments include: Discussions were held with the family,while I was present to see if I wanted to live at the home. I decided with the family and outside professional support. My family got all the information about the area and the house. Care Homes for Adults (18-65 years) Page 14 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . There are good arrangements in place to ensure that residents care and support needs are recorded and to ensure that residents are involved in all decision making in their lives. Evidence: There are detailed assessments in residents care plans. There is a system of reviewing the changing care needs of residents. Residents are well supported by staff and care plans show the amount of care and support that staff are providing to residents and they are updated as necessary. The staff on duty said that they are always given up to date information about the residents and their needs.The residents key worker meets informally with the resident to update their moving and handling plan and their care plan. Comments include Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: The home provides a safe, warm and comfortable environment for service users. The home looks after the needs of service users and their well being very well. It gives good quality care and respects the dignity of services users. Staff work with residents to promote their independence.They work hard to make service users achieve their goals through person centred planning. Residents are asked individually and consulted about decisions involving themselves and the running of the home. Discussions take place with residents about the running of the home,shopping,daily tasks,peoples activities,outings,any future happenings in the community,holidays,social events and trips out. The home supports residents to remain independent and take risks in order to live a more fulfilled lifestyle and up to date risk assessments were present in residents care records. Meetings with residents take place weekly . Comments include Service users meetings are in place weekly helping all to understand the needs of people and help with choices. There are service users meetings on a regular basis to see what activities I enjoy and if anything needs updating. The service user has the option and the choice due to meetings in place to discuss activities both learning and social. Residents also discuss with their key worker things they would like to do and the key worker will work with the resident to help ensure it happens. Choices are placed in front of residents by visual aids to enable a degree of decision making. Private information about health issues such as hospital appointments for a resident were displayed on a kitchen notice board,rather than in a less public place, such as the office which would have respected the confidentiality of the resident. Care Homes for Adults (18-65 years) Page 16 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents have access to a variety of activities which helps them to enjoy a good quality of life. Residents are also supported to keep in touch with their families. Evidence: Residents records and meeting minutes provided evidence that residents are consulted and asked their opinion and encouraged to make decisions. Comments include Choices are given and sometimes help is given to promote the choices. Being aware of moods and body language, the supporting staff are aware of signs from the service user which can be identified if they are happy or sad. Service users meetings are in place weekly helping all to understand the needs of Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: people and help with choices. Conversation and observation of residents and staff show that residents are provided with the necessary levels of support to help the resident maintain some level of independence and retain some skills to be more self sufficient in aspects of everyday living. Residents attend some day services if they wish to on a part time basis. Residents are encouraged to pursue their own interests and hobbies and are supported to do so listening to music, shopping and art. Residents also enjoy meals out at local pubs, , cinema, swimming, bowling, visiting museums and the seaside , theatre trips, attending discotheques and whatever is of interest to the resident. Within the home residents enjoy cookery theme nights, games nights, pamper sessions,arts and crafts,watching television and sensory activities. Residents have enjoyed trips to Spain and Yorkshire this year. Within the home residents bedrooms are equipped with their own televisions, radios, books, pictures and whatever is of interest to the resident. Residents care plans and case records detail any family involvement. Residents have accessible, pictorial care plans in their bedrooms so they can identify with the information. A communication board is also available for residents which is updated daily. It displays photographs of the staff members on duty each day, pictures showing residents what theyll be doing and what theyll be eating each day. Records and comment cards also provided evidence that residents are encouraged to maintain contact with family and friends, if they wish to do so, with staff providing any support that may be required. Residents are asked individually what they wish to eat each day. A light snack is available at lunch times and a larger cooked meal is served in the evening. On the day of inspection the meal to be served was spaghetti bolognese followed by yoghurt, ice cream or fruit. Care Homes for Adults (18-65 years) Page 18 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . There are good arrangements in place to ensure that residents health and social care needs are met. Evidence: Two care plans and case records were inspected. The daily records detailed the care and support required for different needs. They reflected the changing needs of service users as they become older. The care plans are also in a pictorial format so that residents may more easily identify with them. Some residents have moving and handling needs and assessments are in place detailing the amount of support required. Each resident requires different amounts of support with personal care tasks, such as bathing and dressing. Privacy and dignity are respected at all times. Records showed when residents had seen health professionals e.g. doctors, community nurses, psychiatrists and psychologists . Residents are referred for specialist health care if appropriate. Records also showed when residents had seen opticians and dentists. Staff who have completed medication training administer medication. A sample of medication records was examined and they were found to be in order. Clear directions were recorded and each dose of medication was signed for, or a code entered to verify the reason not given. No resident administers their own medication currently. A system could be put in place to oversee the medication of residents if they should Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: retain and administer their own medication. Comments include If there are any issues regarding the care of residents they are picked up straight away. Care plans are updated regularly. Regular health checks are carried out with residents. Care Homes for Adults (18-65 years) Page 20 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home has a good, clear, user-friendly complaints and protection system to ensure residents views are listened to and acted upon. Evidence: There is a complaints procedure which includes what complainants should do if they are not happy with the homes investigation and response. There is a simple procedure for residents to use to remind them of their right to complain. The home keeps a record of complaints. One complaint has been received by the home since the last inspection. It has been investigated by the manager and satisfactorily resolved. As part of staff induction, staff receive training about the rights of people with learning disabilities. The home has a Whistle Blowing policy and a copy of the Vulnerable Adults procedures of the Local Authority. Staff have received training about Protection of Vulnerable Adults and Prevention of Abuse. Residents can deposit money for safe keeping in the homes safe and records are kept of accounts. Comments include: Service user meetings find out if I have any concerns or issues. Care Homes for Adults (18-65 years) Page 21 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home currently provides a comfortable and safe environment for those living there and all areas are quite well maintained, clean, tidy and free from offensive odours. Evidence: The home is currently suitable for the residents but it is not physically adapted to meet the needs of the residents as they become older or more physically dependent. There is a small lavatory which is not suitable to accommodate a person who may require physical assistance. There is no through floor passenger lift and no bedrooms are situated on the ground floor. The home was clean, well decorated and well maintained. Since the last inspection the kitchen has been refurbished and is currently being redecorated due to a fire in the kitchen. A large television has been purchased for the lounge, patio doors have been replaced leading to the back garden, shrubbery and trees have been cut back. Bedrooms have been decorated. Plans are in place for the hallway and stairs to be decorated. Bedroom furniture is to be replaced. Residents can see visitors in private in their own rooms. Furnishings and fittings were domestic in design and in good condition apart from some damage to the staircase wall and the leather sofa was torn. Lighting was bright and domestic in design. Residents bedrooms were centrally heated. Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: All bedrooms were personalized according to individual taste. There was emergency lighting throughout the home. The home was clean and free from offensive odours. Care Homes for Adults (18-65 years) Page 23 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . There are enough staff,who have been properly recruited, trained and supported,to meet the needs of residents living in the home. Evidence: Examination of staff rosters and discussion with the person in charge showed that the numbers of staff are as follows 7: 00am- 10:00am 3 staff members 2:30pm- 10:30pm 2 staff members 10:30pm8:00am 1 sleep in staff member. Staff members carry out cooking and cleaning duties assisted by the residents. Staff stated that they enjoyed working in the home and were observed to be kind, caring and respectful to residents. Equal Opportunities legislation is adhered to when recruiting and selecting staff. The necessary checks are being carried out prior to the workers being appointed. CRB checks are carried out before a person is appointed. There is a good level of staff training. All staff members have achieved National Vocational Qualifications at level 2 and some staff have completed or are studying for an NVQ at level 3. Staff and their records showed that they also receive training or advice in other areas such as equality and diversity, infection control, food hygiene, complaints awareness, communication, Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: counselling skills, autism, medication,challenging behaviour, health and safety and person centred care. Comments include The service cares for all levels of staff. It has good sickness and holiday benefits, provides up to date training for all staff. All my training is up to date and updated when needed. Staff meetings are in place. All training relevant to my job is ongoing and up to date. Receive regular supervision from manager, support can be on a day to day basis. At the moment things are well in hand, if there are any issues, regarding the care of clients, they are picked up straight away. Care Homes for Adults (18-65 years) Page 25 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents and staff benefit from the ethos, leadership and management approach of the home which encourages the involvement of residents and staff and ensures that the health, safety and welfare of the residents are promoted and protected. Evidence: The manager has the relevant qualifications for managing the home. The home is well run and there is an ethos of involving residents and encouraging them to make choices for themselves. Residents living at the home have lived there for some time and appear to like living there. Documents detailing fire safety, risk assessments, water temperatures, financial records and statutory records were all up to date. Staff training relating to health and safety was up to date. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 29 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The Statement of Purpose should be in a format other than the written word so people may more easily understand the information. The information about staff working at the home included in the Statement of Purpose should be updated. Information about residents should not be displayed in a public area such as a kitchen. This will ensure that their privacy is respected and confidentiality is maintained. The accommodation should be made suitable for people who may become more physically dependent. 2 10 3 24 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 29 of 29 - 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!