Inspection on 30/04/08 for Larpool Lane (1) - North Yorkshire County Council

This inspection was carried out on 30th April 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Larpool Lane (1) - North... 31/05/07

Larpool Lane (1) - North... 22/06/06

Larpool Lane (1) - North... 03/01/06

Larpool Lane (1) - North... 25/08/05

Larpool Lane (1) - North... 12/01/05

Larpool Lane (1) - North... 27/04/04

Similar services:

Snydale Care Home

Abbey The

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Larpool Lane (1) - North Yorkshire County Council 1 Larpool Lane Whitby North Yorkshire YO22 4JE Lead Inspector Ray Burton Unannounced Inspection 30th April 2008 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 Larpool Lane (1) - North Yorkshire County Council DS0000034288.V364108.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. Larpool Lane (1) - North Yorkshire County Council DS0000034288.V364108.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Larpool Lane (1) - North Yorkshire County Council 1 Larpool Lane Whitby North Yorkshire YO22 4JE Address 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) 01947 603582 01947 602 806 larpool.lane@northyorks.gov.uk www.northyorks.gov.uk North Yorkshire County Council Mrs Avril Elizabeth Paton Care Home 52 Category(ies) of Old age, not falling within any other category registration, with number (52) of places Larpool Lane (1) - North Yorkshire County Council DS0000034288.V364108.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st May 2007 Brief Description of the Service: 1 Larpool Lane is a care home providing personal care and accommodation for older people. Although registered to provide accommodation for up to 52 persons, recent alterations to the building have resulted in a reduced occupancy of 45. The home is located on the outskirts of Whitby and is a twostorey building with a passenger lift and stairs between floors. Accommodation is provided in single bedrooms (there are no double rooms). There is a large and pleasant garden where suitable garden furniture is provided for those service users who wish to sit outside. The home is suitable for people with mobility difficulties as there is level access from the car park to the ground floor level of the home. A copy of the service users guide to the home is available and prospective residents are encouraged to visit the home before a decision is made to move in for a trial period. A copy of the latest Commission for Social Care Inspection report is available for prospective residents and relatives to read. The fees payable on the date of the inspection are £368.90 per week. There are additional charges for hairdressing and chiropody. Larpool Lane (1) - North Yorkshire County Council DS0000034288.V364108.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This report gives the findings of an unannounced key inspection that commenced on 30th April 2008 and was concluded on 9th May 2008. During the inspection a tour of the building was conducted, records examined and the inspector spoke to the people who live in the home, members of staff, the registered manager and visitors. What the service does well: What has improved since the last inspection? What they could do better: Care plans require further development especially with regard to assessment and management of risk. Mealtime routines should be examined and adjusted to provide a more flexible service. Staffing levels must be reviewed to ensure there are always sufficient members of staff on duty to meet the needs of the people living in the home. Larpool Lane (1) - North Yorkshire County Council DS0000034288.V364108.R01.S.doc Version 5.2 Page 6 The conversion of the remaining cubicle style lavatories and the replacement of the current nurse call system must be carried out as a matter of urgency. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Larpool Lane (1) - North Yorkshire County Council DS0000034288.V364108.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 Larpool Lane (1) - North Yorkshire County Council DS0000034288.V364108.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5. People who use this service experience good quality outcomes in this area. Prospective residents are given information prior to admission to enable them to make an informed decision about the suitability of the home and its ability to meet their needs. The homes assessment procedure no one is admitted unless his/her needs can be met. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: To help them make an informed choice about the suitability of the home potential residents and their families are given an information pack and, in addition, they are visited in their own home or hospital by the manager or a senior member of the staff team; during the visit an assessment of need is conducted and a decision made about whether the home is be able to meet those needs. Larpool Lane (1) - North Yorkshire County Council DS0000034288.V364108.R01.S.doc Version 5.2 Page 9 Prior to admission, prospective residents and their relatives are invited and encouraged to visit the home on at least one occasion to have a meal and meet with current residents and staff. Extended visits and overnight stays can be arranged before admission. All admissions are subject to a trial period during which time new residents are able to decide whether their needs can be met, and if they wish to continue to live in the home. The home does not offer intermediate care therefore standard six does not apply. Larpool Lane (1) - North Yorkshire County Council DS0000034288.V364108.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11. People who use this service experience adequate quality outcomes in this area. Personal care was conducted in a sensitive manner that upheld the dignity and privacy of residents. Care plans need to be further developed especially with regard to assessment and management of risk. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: The manager and members of staff had good knowledge of each resident and their needs and were able to say how those needs would be met, however examination of five care plans revealed this detailed knowledge was not always fully recorded. Care plans included a personal profile that in some, but not all cases, was very comprehensive and contained good background information that would assist staff to deliver support in the way most appropriate for the individual and in the way that he/she wished it to be delivered. It is important that all care Larpool Lane (1) - North Yorkshire County Council DS0000034288.V364108.R01.S.doc Version 5.2 Page 11 plans contain all relevant available information to assist staff to provide support in the way that people need and wish it to be given. Each care plan contained information about the general health of the resident and details of any specific condition or ailment. Monitoring of health was undertaken and healthcare needs addressed by community based healthcare professionals e.g G.P’s and the District Nursing Service. Risk assessments had been conducted however they were not always sufficiently detailed and did not fully explore identified risk to enable suitable risk management strategies to be put in place. The home had appropriate policies and procedures for the receipt, recording, storage, handling, administration and disposal of medicines. Medication was stored securely and administered by staff who had received training in the administration and safe handling of medicines. Residents assessed as being able to look after their own medicines were asked if they wished to keep them. Care plans revealed that risk assessments in respect of those people controlling their own medicines were not always reviewed sufficiently frequently to ensure any changes in their ability to look after their medication was noted and appropriate action taken. It was observed during the inspection that staff treated residents with respect, that they knocked on bedroom doors before entering and addressed residents courteously and appropriately. Residents told the inspector they were very happy living at Larpool Lane and praised staff for the way that they looked after them. A suitable policy was in place to deal with the illness and death of residents and Larpool Lane was looked on as a “home for life” with residents, unless medical needs dictated otherwise, being able to remain in the home during their last days. Staff recognised the importance of providing support and comfort, not only to the resident, but to family members who were encouraged and enabled to remain with their loved one during the final days. Larpool Lane (1) - North Yorkshire County Council DS0000034288.V364108.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. People who use this service experience good quality outcomes in this area. People living in the home said the lifestyle in the home met their expectations and that they were encouraged to make decisions about their lives. Staff encouraged and supported residents to maintain links with family and friends. A healthy and balanced diet was provided. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: There was a relaxed, informal and friendly atmosphere in the home. Residents were observed to be chatting in groups in various areas around the home, some were walking in the garden or sitting outside watching the world go by and taking advantage of the sunshine. Various activities, both inside and outside of the home, were organised and the manager said that funding had recently been obtained to allow a “rehab room” to be used for 2 hours each day for the purpose of organised activities and the maintenance of daily living skills such as baking and simple meal preparation. This room was also available for residents to meet in private with relatives and friends, to have a meal or to hold a private party for special occasions such as birthdays. Larpool Lane (1) - North Yorkshire County Council DS0000034288.V364108.R01.S.doc Version 5.2 Page 13 Ministers of religion from different denominations visited the home and conducted services for those who wished to attend. Menus showed a varied and balanced diet was served with alternatives being available should someone not wish to have the meal of the day. Residents made many favourable comments about the quality and variety of the food. Meals were generally served in the dining room at set times. Although there was some flexibility to allow for individual wishes, e.g. three ladies at their own request took their meals in a separate lounge, it was observed during the inspection that residents were assisted into the dining room half an hour before the meal was served. It is recommended that the mealtime routine is examined and adjusted to allow meals to be served more flexibly rather than people having to wait for everyone to be seated before the serving of meals is commenced. Larpool Lane (1) - North Yorkshire County Council DS0000034288.V364108.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18. People who use the service experience good quality outcomes in this area. The home had appropriate policies and procedures in place for the protection of vulnerable adults and for dealing with complaints. Residents felt confident that appropriate action would be taken to resolve any complaint or concern they might have. All staff had received training in adult protection. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: The home had a suitable complaints procedure, stating how complaints could be made, who would deal with them, the timescale for the process and what to do if not satisfied with the way in which the matter had been handled. Records showed one complaint had been received since the last inspection. The inspector spoke to several residents in groups and individually; all expressed satisfaction with life in the home and said they were happy living there, they said they had no complaints but knew what to do and who to see should they be unhappy about anything. Policies and procedures were in place to ensure the safety and protection of residents and to inform staff how to respond to any suspicion or allegation of abuse. All members of staff had received training in the protection of vulnerable adults. Larpool Lane (1) - North Yorkshire County Council DS0000034288.V364108.R01.S.doc Version 5.2 Page 15 The home had enlisted the services of an independent advocate who regularly visited the home to give advice to residents and to protect their interests, if necessary. Larpool Lane (1) - North Yorkshire County Council DS0000034288.V364108.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26. People who use this service experience good quality outcomes in this area. The environmental standard was good, providing residents with a comfortable and homely place in which to live, however not all of the toilet facilities have yet been brought up to an acceptable standard. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: The internal and exterior fabric of the building was maintained in good condition and records showed regular checks and servicing was undertaken of all equipment. A walk around the home revealed it to be clean, hygienic and free from offensive odours. The home provides comfortable and homely accommodation with sufficient communal space to enable residents to find a quiet corner if they wished to spend time quietly without resorting to having to retire to their bedrooms. A Larpool Lane (1) - North Yorkshire County Council DS0000034288.V364108.R01.S.doc Version 5.2 Page 17 small sun lounge had been equipped with toys and books etc so that young children could be happily occupied whilst their parents were visiting an elderly relative. Bedrooms had been personalised by the inclusion of furniture and other effects brought from the occupants own home. The home has a large, very pleasant garden with views across Whitby to the Abbey; unfortunately access is somewhat restricted for those people with mobility difficulties or who require the use of a wheelchair. The provider should consider ways of improving access to the garden, perhaps by widening the pathways. Since the last inspection various improvements have been made throughout the home: Five bedrooms have been converted into single disabled access lavatories (two incorporating level access shower units); a number of bedrooms have been re-decorated and fitted with new carpets; new furniture has been provided in all bedrooms. The registered manager acknowledged that not all environmental requirements made as a result of the last inspection had yet been met however, she said, the following work would be completed within the next 12 months: * Conversation of the remaining cubicle style lavatories to make single use lavatories. To ensure the safety, privacy and dignity of people living in the home, the above outstanding requirement must be carried out as a matter of urgency. Larpool Lane (1) - North Yorkshire County Council DS0000034288.V364108.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. People who use this service experience adequate quality outcomes in this area. Staffing levels are not always sufficient to meet the needs of the people living in the home. We have made this judgement using a range of evidence, including a visit to the service. EVIDENCE: Seven personnel files were examined; each contained evidence that all necessary checks, including Criminal Records Bureau (CRB) were carried out, and two satisfactory references obtained before commencement of employment. All new members of staff received induction training and there was ongoing mandatory training for all members of staff. It would be beneficial however if staff received specific training in age related conditions e.g. dementia, sight and hearing impairment. Staffing rosters showed four members of staff were generally on duty at all times throughout the day; however there were times when, because of staff sickness etc, only three were on duty. During the night there were two members of staff covering the home. Larpool Lane (1) - North Yorkshire County Council DS0000034288.V364108.R01.S.doc Version 5.2 Page 19 Members of staff told the inspector that whilst physical needs were always met they did not always have the time to meet the social needs of residents. They said: “There is not a lot of time for us to sit and talk to residents. Everything is very rushed.” “We would like to have the time to spend with residents but sometimes, although four are always rostered in, we are down to three and that is not enough to do all of the jobs and spend time with the residents.” The inspector received a telephone call from a family member of a resident; she said she was very happy with the way staff cared for her relative but expressed concern about the staffing levels. Staffing levels at the home have been problematic for some time and have been the subject of requirements made by the Commission for Social Care Inspection in the reports of the last two inspections. It is important that staffing levels (both during the day and at night) are kept under constant review and that they take into account the design of the building and accurately reflect the changing and increasing needs of the people living in the home. The provider must ensure there are always sufficient members of staff on duty to maintain the safety of residents and to meet their assessed needs, including social and emotional needs. Larpool Lane (1) - North Yorkshire County Council DS0000034288.V364108.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37, 38. People who use this service experience good quality outcomes in this area. A well run home with a registered manager who has the appropriate qualifications and experience to manage the home. Policies and procedures are in place and records are satisfactorily maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has the required qualifications and experience to run the home. She receives administrative assistance from two part-time (18hours in total) administration assistants, however she is included in the staffing rosters on four days a week; this allows only one day for management tasks. The provider should consider ways of adjusting the working pattern of the manager to allow her more time to concentrate on her management role. Larpool Lane (1) - North Yorkshire County Council DS0000034288.V364108.R01.S.doc Version 5.2 Page 21 The manager and staff were aware of their responsibilities under Health & Safety legislation. Regular checks of the building and equipment were undertaken, and maintenance and servicing undertaken to maintain a safe environment. Records were maintained in a satisfactory manner and were stored appropriately. Policies and procedures were in place covering all aspects of the management of the home and the health, safety and welfare of residents and staff. A designated representative, generally a family member, handled residents’ financial affairs. Any money held for safekeeping by the home on behalf of a resident was stored securely and a record kept of all financial transactions. The home had systems, both formal and informal, to measure success in meeting its aims and objectives and statement of purpose and to ensure residents rights and best interests were safeguarded: A quarterly quality assessment; regular formal staff supervision; Daily informal discussion with residents and regular contact with relatives. Larpool Lane (1) - North Yorkshire County Council DS0000034288.V364108.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 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 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 3 18 3 3 3 2 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 3 3 Larpool Lane (1) - North Yorkshire County Council DS0000034288.V364108.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? YES 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 OP7 Regulation 15 Requirement A written plan of care as to how the needs of each person living in the home are to be met in respect to their health and welfare must be developed for each person. These plans must be reviewed by care staff at least once per month and updated to reflect changing needs and actioned. (Previous time scales of 31/07/06 & 30/06/07 not met). 2. OP21 12 The registered person must provide sufficient appropriate lavatory facilities to ensure the privacy and dignity of people living in the home. (Previous time scales of 30/01/06, 31/12/06 & 30/08/07 not fully met). 01/10/08 Timescale for action 31/07/08 3 OP27 18 The registered person must ensure that at all times suitably qualified, competent and DS0000034288.V364108.R01.S.doc 30/06/08 Larpool Lane (1) - North Yorkshire County Council Version 5.2 Page 24 experienced persons are working at the home in such numbers as are appropriate for the health and welfare of the people living in the home. (previous timescale of 30/06/07 not met) 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 OP15 OP20 OP31 Good Practice Recommendations The manager should adjust the mealtime routine to allow greater flexibility. The provider should explore ways of making the garden more easily accessible to wheelchair users. The provider should consider ways of adjusting the working pattern of the registered manager to allow her more time to concentrate on the management role Larpool Lane (1) - North Yorkshire County Council DS0000034288.V364108.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Larpool Lane (1) - North Yorkshire County Council DS0000034288.V364108.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!