Inspection on 20/08/07 for Latimer Grange

This inspection was carried out on 20th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Latimer Grange 16/03/10

Latimer Grange 31/01/09

Latimer Grange 19/04/07

Latimer Grange 12/04/06

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Latimer Grange 119 Station Road Burton Latimer Northamptonshire NN15 5PA Lead Inspector Sarah Jenkins Unannounced Inspection 20th August 2007 08:00 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 Latimer Grange DS0000064335.V346973.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. Latimer Grange DS0000064335.V346973.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Latimer Grange Address 119 Station Road Burton Latimer Northamptonshire NN15 5PA 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) 01536 722456 01536 725217 tonylampitt@tiscali.co.uk Latimer Grange Limited Mrs Sharon Elizabeth Payne Care Home 27 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (27) of places Latimer Grange DS0000064335.V346973.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. No one falling within category DE(E) may be admitted into the home where there are 10 persons of category DE(E) already accommodated within the home. To be able to admit the male service user who is 57 years of age as applied for in Variation Application No.V29167 dated 1st February 2006 To be able to admit one person of category OP (under 65 years) named in variation application number V36294 dated 16 October 2006 The maximum number of residents that the registered provider can accommodate in Latimer Grange, Northamptonshire is 27. 19th April 2007 Date of last inspection Brief Description of the Service: Latimer Grange is a residential care home providing personal care for up to 27 older people over the age of 65 years, of which number, up to 10 can be older people with Dementia. Latimer Grange is situated close to the town centre of Burton Latimer. Accommodation consists of 19 single bedrooms, 14 of which have en-suite facilities, and 4 double bedrooms, two of which are en-suite. 5 of the single ensuite rooms were provided through a recent extension. The range of fees detailed as being charged at the home at the last inspection in April was £348-£477 per week. There are charges for continence wear supplied by the home of £17.40 per month, with a further £10.00 charged for disposal. Optional services such as hairdressing, newspapers and private chiropody services are charged separately. Information is made available to service users and their relatives in the form of the service users guide. Other relevant leaflets and items of information (for example access to advocacy) are available in the hallway. The inspection report is made available on request from the Registered Manager. Latimer Grange DS0000064335.V346973.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for Service Users and their views of the service provided. The primary method of inspection used was ‘case tracking’ which involved selecting three service users and tracking their care through meeting with the service user, a review of their records, discussions with the care staff and observation of care practices. The Inspector visited during the morning, in order to observe the early morning routines. One inspector conducted the visit, and the inspection site visit at the home was undertaken over a period of approximately six hours. Some service users have dementia conditions or are very frail and were less able to express their views through the nature of these disabilities. Establishing their choices and informed decisions was dependant to a large extent upon observations of their apparent satisfaction with their daily routines and the quality of their interactions and communication with staff. The inspection was conducted with the assistance of the Registered Manager and other staff. The Registered Manager has submitted the Annual Quality Assurance Assessment, but no feedback forms from service users or relatives had been returned to the Inspector at the time of the inspection. The Inspector viewed instead the recent internal Quality Audit questionnaires, distributed by the home and returned from relatives and visitors. The recent history of the home since the last inspection, including the response from the home in the form of its improvement plan, was reviewed as part of the inspection What the service does well: The staff at the home continue to provide a homely and friendly atmosphere and service users who expressed their views to the Inspector generally feel “well looked after” and that staff were “nice” and “helpful”. The quality of the catering provision was evident and service users praised the food and the menus, and were seen to be enjoying their meals, although some needed more assistance with this. The environment is pleasant and service users who could move around independently were seen to be freely enjoying walking or sitting in the garden area. Latimer Grange DS0000064335.V346973.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Latimer Grange DS0000064335.V346973.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 Latimer Grange DS0000064335.V346973.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): 3. Standard 6 was not assessed, as the home does not offer intermediate care. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users can be confident of staff facilitating their move into the home caringly, but assessment and initial care plans do not always accurately reflect service users needs EVIDENCE: The Inspector spoke with a service user who had been recently admitted to the home, and also discussed admission arrangements with an involved relative, and staff. Information is available to service users and enables them to make informed decisions. Admission arrangements are flexible according to need. From discussions and from records it was evident that specific details of prospective service users needs are not always transferred onto the initial care plan accurately, and staff do not always follow instructions as detailed. For Latimer Grange DS0000064335.V346973.R01.S.doc Version 5.2 Page 9 example the daily notes of a service user did not record her food preferences although a need for observation of her diet with an instruction that staff should establish the service users dietary preferences, had been recorded as part of the admission process and initial care plan. Latimer Grange DS0000064335.V346973.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health and personal care are generally well met but inaccuracies and shortfalls on care plans leave service users vulnerable to their needs being met erratically, with variable quality, or poorly. EVIDENCE: Service users care plans are too generalized and not sufficiently person centred to promote good care. For example the specific challenging behaviour of a service user to grasp objects or staff strongly, and to refuse to let go is not detailed in the care plan. Staff were observed to be unsure about how to deal with this behaviour and whilst sometimes the reaction from staff was appropriate, at other times it was observed not to be so. The service users behaviour was described on the care plan as “aggressive” with a lack of any indication as to what this meant in behavioural terms or whether specific Latimer Grange DS0000064335.V346973.R01.S.doc Version 5.2 Page 11 trigger factors had been observed. The daily notes were not conducive to establishing further information, or finding out ways of enhancing the service users quality of life, as staff only recorded minimal information such as “behaviour very aggressive”. Risk assessments are not always properly updated or sufficiently accurate to promote consistency from staff in care practices, or thereby service users wellbeing. There were no Moving and Handling assessments on service users who needed assistance. Service users were observed to be assisted inappropriately by staff. Service users other general healthcare needs appeared to be well met, with proper observation of need from staff, prompt input from health care professionals and a reasonable standard of recording. Service users who were able to comment that they felt “well looked after”. Medication administration was observed to be conducted in a professional manner in accordance with guidelines. The Registered Manager now undertakes auditing of medications received, administered and disposed of. Staff have received updated instruction and/or training and the improvement plan from the last inspection has been fully met in this area. Service users were generally treated with respect but staff lacked knowledge in the implications of this Standard, for example some service users dignity was compromised at mealtimes. (See “Daily Life and Social Activities section) Latimer Grange DS0000064335.V346973.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements to this outcome area are in process, with information being gathered on service users needs and wishes and the provision of regular activities between 2pm and 4 pm. EVIDENCE: There are now some histories of service users lives in service users care plans. These histories give information that enables staff to initiate relevant conversation and activities. The Registered Manager has undertaken the task of establishing and recording appropriate choices of activities for each service user and this is still in process. Staff are aware of the importance of stimulation and general conversation with service users and of the need to sit with them to enable this when possible, but at the time of the inspection they were seen to be largely too busy with aspects of physical care to be able to do this. The Inspector was informed that conversation and activities mainly took place later in the day. Latimer Grange DS0000064335.V346973.R01.S.doc Version 5.2 Page 13 Service users who were able to occupy themselves appeared to be enjoying more activity than the more frail. They were reading available newspapers, enjoying the garden and entertaining visitors. They indicated that they were generally happy with the activity levels but one person didn’t like the television being on constantly in the lounge area. Service users who were mentally frail were seen to be discouraged from wandering around. One person actively seeking interaction from staff was observed on more than one occasion to be directed back to their chair, where no activity or distraction was provided. Service users were positive about the provision of food at the home. Meals were observed to be of a good quality with plenty of choice including a cooked breakfast. The quality of assistance offered to service users in enjoying the provision was varied. One service user was properly assisted in her room by a staff member sitting with her to assist, and this was seen to be done sensitively and well. Other less able service users seated at the dining table were not properly assisted and this led to issues of compromised dignity. For example one service user was eating cereal with their fingers as they couldn’t find the spoon and another was drinking directly from the cereal bowl. During the time these service users lacked assistance from staff another service user was seen to take one of their drinks for herself. Staff were therefore unable to overview service users dietary intake. When staff did assist service users at the dining table this tended to be done by staff leaning over service users inappropriately. Latimer Grange DS0000064335.V346973.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): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users can be confident that they can approach staff with any concerns and that they will be heard and responded to. Some frail service users may be put at risk through lack of supervision. EVIDENCE: The Inspector reviewed the complaints record and found that there have been no recent complaints about the home to either the home itself or to the Commission for Social Care Inspection. The complaints procedures are available for residents and visitors, are included in the Statement of Purpose and Service User Guide, and freely available along with the comment book in the foyer of the home. The Inspector observed bullying behaviour from one service user to another less able service user who appeared to be distressed by this. The Registered Manager was informed. It was noted that this behaviour was a direct result of the service user apparently sitting in the “wrong” chair, and that when she moved she remained anxious as she was not sure where she could safety sit. She was heard to remark “I don’t know if I can sit in this chair”. The Inspector had previously alerted a staff member to the need of this same service user to be reassured on another matter and the staff member had done so without Latimer Grange DS0000064335.V346973.R01.S.doc Version 5.2 Page 15 recognizing the potential issue of the chairs although a more able service user was well aware of the problem and informed the inspector of details after the event. The Registered Manager informed the Inspector that staff are undertaking Protection of Vulnerable Adults training in early September as some new staff have not yet had this. Latimer Grange DS0000064335.V346973.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A comfortable and safe standard of accommodation is provided for the residents. EVIDENCE: Residents live in a homely, comfortable and clean environment. The home is decorated and furnished to a standard that creates a comfortable atmosphere. The internal courtyard provides a secure external environment for Residents with dementia, and there is appropriate seating, raised flowerbeds, and an aviary. Residents’ bedrooms showed evidence of personalisation, with small items of personal furniture, pictures and ornaments on display. Latimer Grange DS0000064335.V346973.R01.S.doc Version 5.2 Page 17 Service users and a visitor commented on the pleasant environment and outlook into the garden. There is now a covered veranda where service users may be outside even in rainy weather. Latimer Grange DS0000064335.V346973.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): 27,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The impact of staffing shortfalls (experience and training) both on the service users and the management of the home is judged to have adversely affected the quality of care and the outcomes for service users. The staff team as a whole, on duty at the time of the inspection were inadequately trained and experienced to properly care for service users. EVIDENCE: At the time of the inspection there were four care staff on duty although there are normally only three shown on the rota. There were shortfalls in service users care and supervision as detailed elsewhere on this report, due in part to the inexperience and lack of training of some of these staff. Only one of the staff on duty had received Moving and Handling training, and techniques observed by the Inspector to be used to assist service users, were inappropriate and put both staff and service users at risk of injury. The levels of National Vocational Qualification trained staff were not reviewed at this inspection. Latimer Grange DS0000064335.V346973.R01.S.doc Version 5.2 Page 19 The file on the most recently recruited staff member on duty showed no evidence of induction training. Discussion with this staff member revealed some shortfalls. There appears to have been a high turnover of staff recently at the home and the levels of training of staff teams have therefore been compromised through the inexperience of new staff recruited. When these matters were explored with the Registered Manager, she reported that three staff has left without giving notice since the last inspection, and two staff have been dismissed for gross misconduct. There has recently been a need to employ agency staff and some shifts are judged to have been inadequately covered when there has been only one regular staff member on duty. The Registered Manager reported that she has now recruited to the vacancies and six new staff are to start employment shortly. Staff decide among themselves who is the shift leader and this has potential to lead to ineffective leadership on shift. Staff are informally thought to be senior by reason of length of service or experience. There is no formal process of recognition of this through the validation of their competence or level of training, and no designated seniors or deputy Manager at the home. Whilst the Registered Owner has acted for the Manager in her absence in the past, he is now registered as the manager of another home and this will inevitably impact on his capacity to cover at Latimer Grange. The Annual Quality Assurance Assessment (AQAA) document submitted by the Registered persons to inform the inspection shows a general lack of full information. This is especially so in the area of staffing where information is minimal and does not give sufficient information to demonstrate, or to judge, whether staff issues are professionally managed or sufficiently prioritized. The supervision process and recruitment processes have been improved since the last inspection in accordance with the improvement plan submitted. Latimer Grange DS0000064335.V346973.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): 31,33,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The quality of the management of the home is variable. Whilst most issues identified at the last inspection have been responded to and improved, the staffing of the home needs management review as shortfalls in this area are impacting on the safety and protection of service users. EVIDENCE: Latimer Grange DS0000064335.V346973.R01.S.doc Version 5.2 Page 21 The Registered Manager continues to be keen to develop and update her own knowledge and training and to this end accesses relevant training courses that become available. There has been a prompt response by the Registered Manager to issues which arose at the last inspection and improvement in most identified areas is evident. Advice was given that lines of accountability within the home lack clarity and the Registered Managers job description does not appear to enable her to delegate management tasks appropriately to senior staff. The best interests of service users need to be considered in relation to staffing arrangements as detailed under the “Staffing” section of this report. The annual development plan for the home should be based on a proper review and decision-making process exploring and resolving the current difficulties in satisfactorily meeting service users needs. The inspector was informed at this inspection that the home no longer holds any money on behalf of service users and expenditures are invoiced through the accounting system. The Registered Manager needs to ensure the Health and Safety of service users through for example safe working practices (re Moving and Handling as detailed under the “Staffing” section of this report). Latimer Grange DS0000064335.V346973.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 x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 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 1 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x x x x 2 Latimer Grange DS0000064335.V346973.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 OP3 OP7 Regulation 14,15 Requirement Service users care plans must be person centred and must accurately reflect the care needs of service users to ensure that these needs are properly met. Suitable arrangements must be made for moving and handling service users, to ensure that they are safe. To this end suitable arrangements must be made to assess service users Moving and Handling needs, and to train staff in the assessed appropriate methods. 3 4 OP18 OP27 13,18 13,18 Service users must be properly protected from the risk of abuse. Staffing numbers and skill mix of qualified/unqualified staff must be appropriate to the assessed needs of service users, the size, layout and purpose of the home at all times, to ensure service users are properly looked after and protected. Staff must have appropriate induction and ongoing training to DS0000064335.V346973.R01.S.doc Timescale for action 20/11/07 2 OP7OP27 OP38 13,18 10/10/07 10/10/07 10/10/07 5 OP30 18 20/10/07 Latimer Grange Version 5.2 Page 24 meet the needs of service users. (Induction training required at last inspection) 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. Refer to Standard OP14 Good Practice Recommendations A review should be undertaken to explore where Service Users areas of choice can be extended. For example service users should be enabled to move safely and freely around the communal areas of the home. There should be clear lines of accountability within the home. The rota should identify the person who is left in charge of the shift when the Registered Manager is not on duty. In respect of Quality Audit, the annual development plan should review how the shortfalls identified on this report can be properly resolved, and necessary improvements, maintained. 2. OP27OP31 3 OP33 Latimer Grange DS0000064335.V346973.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Latimer Grange DS0000064335.V346973.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!