Inspection on 04/02/06 for Lowdell Close, 186-188

This inspection was carried out on 4th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 20 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lowdell Close, 186-188 14/12/06

Lowdell Close, 186-188 29/06/06

Lowdell Close, 186-188 24/08/05

Lowdell Close, 186-188 17/11/04

Lowdell Close, 186-188 22/07/04

Lowdell Close, 186-188 14/10/03

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Lowdell Close, 186-188 Yiewsley West Drayton Middlesex UB7 8RA Lead Inspector Mrs Rekha Bhardwa Unannounced Inspection 4 February 2006 09:30 th Lowdell Close, 186-188 DS0000027064.V276977.R01.S.doc Version 5.1 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 Lowdell Close, 186-188 DS0000027064.V276977.R01.S.doc Version 5.1 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 Adults 18-65. 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. Lowdell Close, 186-188 DS0000027064.V276977.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Lowdell Close, 186-188 Address Yiewsley West Drayton Middlesex UB7 8RA 01895 434697 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) Life Opportunities Trust Mrs Louise Anne Rees Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Lowdell Close, 186-188 DS0000027064.V276977.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th August 2005 Brief Description of the Service: This is a home for four adults with learning and physical disabilities. Two have profound disabilities. Although the home is not purpose built it has all the aids and adaptations the service users need. It is on two floors and there is a lift. All the bedrooms are single rooms and they are an adequate size for wheel chair users. The home is owned by Ealing Family Housing Association and managed by Life Opportunities Trust. It is on a housing estate and is a long walk to shops and other local amenities. There is a minibus for taking service users out of the home. There is a Sensory Room for the provision of stimulation to the service users. Activities are provided in house and outings are arranged. Two service users are taken to a weekly club for people with learning disabilities. The service users socialise with service users who live in homes managed by Life Opportunities Trust nearby. There were no vacancies on the day of inspection. Lowdell Close, 186-188 DS0000027064.V276977.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out as part of the regulatory process. A total of 5.30hours was spent on the inspection process over a period of two days. The Inspector carried out a tour of the home, inspected service user plans, servicing records, medication records and staff records. The purpose of this inspection was to follow up the requirements from the last inspection, and to view some additional standards. The majority of key standards were viewed at the last inspection and it is recommended that this report be read in conjunction with the last report to gain full inspection information for the home. The Inspector met with all four-service users on the first day of the inspection, the Manager designate and one support worker. All the service users have profound disabilities and the majority are unable to verbally communicate. The Registered Manager had left the home in December 2005; the Commission had not been notified of this as per Regulation 39 of the Care Homes Regulations 2001. A new Manager had been recruited and had commenced employment as the manager from the 6th January 2006. This inspection highlighted a number of shortfalls that must be addressed. It appears that the management systems and processes have not been followed and there is no overview of the home by senior management. What the service does well: What has improved since the last inspection? What they could do better: Lowdell Close, 186-188 DS0000027064.V276977.R01.S.doc Version 5.1 Page 6 This inspection highlighted a number of serious concerns in relation to employment procedures, health and safety and lack of quality monitoring systems. There are still outstanding issues with the environment that have yet to be addressed by the Housing Association. Staff employment records did not meet legislative requirements. Evidence of induction and foundation training to meet Skills for Care core standards was not available. It was not clear whether mandatory training was taking place within the specified time period. The systems for the management of health and safety are poor and do not protect service users. Systems for monitoring the quality of care and management were not in place. There has been a decline in the number of activities undertaken by service users outside of the home this includes the annual holiday. There has been little proactive intervention by the staff in this area. 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. Lowdell Close, 186-188 DS0000027064.V276977.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lowdell Close, 186-188 DS0000027064.V276977.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Service users are provided with information about the home. EVIDENCE: The Statement of Purpose and Service User Guide had been updated but not sent to the Commission. These were collected from the home on the second day of the inspection. Some parts of the Service User Guide are available in picture form. The home has a settled and long-standing service users group, with no admissions since 1996. Lowdell Close, 186-188 DS0000027064.V276977.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7, 9 & 10 There is a clear care planning system in place, which provides the staff with the information they need to meet the needs of the service users. The home has a good risk management system in place, which protects the safety of the service user. EVIDENCE: The service user plan for one service user was viewed. This was comprehensive and detailed the care that was required. The service user plan is reviewed 6 monthly and when there are any changes in the service users condition. Due to the profound nature of the service users physical and learning disabilities it is difficult for the service users to make decisions about their daily lives. The staff have a depth of knowledge of the service users in respect of their care needs. Care plans detailed the preferences of how service users personal care needs, dietary needs and social and leisure needs were to be met. Staff have a good knowledge and understanding of the communication methods that Lowdell Close, 186-188 DS0000027064.V276977.R01.S.doc Version 5.1 Page 10 are utilised by the service users. Staff were observed to communicate effectively with the service users. This is also recorded in the service user plan. None of the service users are able to manage their own finances. Small amounts of money are managed by the staff working in the home. Specific risk assessments relating to service users were available along with generic risk assessments. These were up to date. A confidentiality policy and procedure was in place. Service users records are held securely. Lowdell Close, 186-188 DS0000027064.V276977.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 14 & 16 Shortfalls in relation to accessing and staffing external activities do not allow the service users to choose from a range of appropriate leisure activities. EVIDENCE: All the service users at the home attend day centres and are also taken to evening clubs. A Church representative visits service users at the home regularly. One service user attends a local church. The Inspector was informed that none of the service users were able to have an annual holiday last summer, as there were staff shortages. Very few outings took place again due to shortages of staff and also the numbers of staff that are able to drive the minibus. Swimming no longer takes place as there are moving and handling concerns at the swimming baths. Some service users choose to listen to music and watch the television. Staff stated that they always knock on a service users bedroom door before entering the service users bedroom. Details on service users rights are Lowdell Close, 186-188 DS0000027064.V276977.R01.S.doc Version 5.1 Page 12 contained in the service users charter. Two of the service users can get involved in very simple tasks and the others can be involved by being present in the room. Lowdell Close, 186-188 DS0000027064.V276977.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 Shortfalls in the recording and management of medication potentially place service users at risk. EVIDENCE: The home uses the Boots Monitored Dosage System. Medications were appropriately stored. The Medication Administration Records viewed for all four service users contained several gaps in recording. It was not clear from the records viewed whether the medication had been administered or omitted. No service users are able to manage their own medication. For one service user Gaviscon had been prescribed as a prescription as required medication. From the records viewed the medication was being administered as a regular medication. The dose being administered had not been recorded. For this service user also a label had been placed on the Medication Administration Record. The Inspector was not clear about the training that staff had undertaken in relation to medication administration. Lowdell Close, 186-188 DS0000027064.V276977.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 The home’s adult protection policies need to be updated in conjunction with the Hillingdon’s safeguarding adults documentation. EVIDENCE: No progress had been made in updating the homes adult protection policy to dovetail with Hillingdon local authority safeguarding adult’s policy. This has been an outstanding requirement from the last two inspections and no progress has been made in relation to this. The action plan received by the Commission from the Registered Provider following the last inspection indicates that that the documentation will be reviewed once all staff have received training in the Protection of Vulnerable Adults. Staff have received training from the Safeguarding Adults Co-ordinator at Hillingdon but the documentation has still not been updated. Lowdell Close, 186-188 DS0000027064.V276977.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26 & 27 The standard of the environment within some areas of this home is poor and does not provide service users with an attractive and homely place to live. Service users individual bedrooms are personalised and suit their individual preferences. Shortfalls in providing the service users with a usable shower room on the first floor does not maximise the service users independence and choice. EVIDENCE: The Inspector undertook a brief tour of the home. All the service users bedrooms were viewed. Generally these were furnished and decorated according to individual tastes and had been personalised with photographs, personal items etc. These also contained the necessary adaptations to meet the assessed needs of the service users. There are signs of damage to the doorframes and walls where wheelchairs have knocked against the wall. The Manager designate informed the Inspector that this had been reported to the Housing Association who is responsible for the maintenance of the premises. Lowdell Close, 186-188 DS0000027064.V276977.R01.S.doc Version 5.1 Page 16 Several of the radiator covers in the corridors and service users bedrooms were broken and a potential hazard. The architect and the housing association had met and plans have been prepared for the patio area. At the time of the inspection quotes were being obtained for the work to be undertaken. There are three bathrooms for the service users to use. One assisted bath and one shower room are located on the first floor and one shower room is located on the ground floor. The Inspector noted that the shower room on the first floor was not in use as no shower mattress was available. The shower mattress from this shower room had been moved to the ground floor. No new shower mattress had been ordered for the first floor. It was noted that the service users accommodated on the first floor that required a shower were being taken to the ground floor for their shower. This is not acceptable. Lowdell Close, 186-188 DS0000027064.V276977.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 34, 35 & 36 The home had in place minimum levels of staff to meet the needs of service users. Staffing levels need to be reviewed to ensure that service users are able to have an annual holiday and participate in social activities outside of the home. The vetting and recruitment practices are poor and do not safeguard the service users. Shortfalls in staff receiving mandatory training potentially place the service users at risk of not having their individual and joint needs being met. EVIDENCE: The Inspector was informed that there is a minimum of two staff on duty on each shift. At night there is one sleep-in member of staff and a waking night staff on duty. At the time of the inspection there were two staff vacancies, one was for the Deputy Care Manager and the other for a care worker. The Deputy Manager post had been advertised internally and there had been no response to this advert, the organisation was in the process of advertising this post externally. Lowdell Close, 186-188 DS0000027064.V276977.R01.S.doc Version 5.1 Page 18 The Inspector also noted that the service users did not have an annual holiday last summer due to insufficient staffing levels. Two staff employment records were viewed. These did not contain the information as required by Schedule 2 of the Care Homes Regulations 2001. In one file there was no application form, no references and no proof of identity. On the other file viewed there was no health declaration and no photograph. The standards in relation to staff recruitment were poor. Staff training records were viewed by the Inspector. For one member of staff the records indicated that moving and handling training had taken place in 2004. For another staff member no fire safety training had taken place since 2004. Induction training records did not meet Skills for Care Standards. There was no evidence of foundation training for staff. Supervision records were available on both files viewed. Lowdell Close, 186-188 DS0000027064.V276977.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 & 42 The home does not review aspects of its performance through a programme of self-review and consultation and seeking the views of service users, staff and relatives. The Health and Safety systems in place in the home need to be reviewed to ensure that the safety of the service users, staff and visitors to the home is maintained at all times. EVIDENCE: At the time of the inspection there was no Registered Manager in post. The Deputy Manager had been promoted to the role of Manager from He has yet to apply for registration. The Registered Provider had not informed the CSCI that the previous Registered Manager had left in November 2005. Regulation 26 Visits were not taking place monthly. The last visit report received at the CSCI was dated 11/1/06. Prior to this no Regulation 26 Visits had taken place for November 2005 and December 2005. It was not clear how feedback on the service is obtained from the service users or their Lowdell Close, 186-188 DS0000027064.V276977.R01.S.doc Version 5.1 Page 20 representatives. The last service users meeting was held on the 9/7/05, there was no evidence that further meetings had been held. The Inspector viewed a sample of servicing records. PAT testing had taken place on the 6th January 2006 however no certificate was available for this. Water temperatures had been undertaken in January, the actual date, year and who carried out the checks had not been recorded. Fire drills had taken place on the however the log did not detail the staff in attendance. The Fire Risk assessment was dated December 2003 and had not been reviewed within the timeframe written in the risk assessment. The last health and safety audit viewed was dated October 2004. No further audits had taken place. The management of health and safety appeared to be poor; it appeared to the Inspector that there had been no overview of the home by the Registered Provider. Lowdell Close, 186-188 DS0000027064.V276977.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 x 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 x 23 2 ENVIRONMENT Standard No Score 24 1 25 x 26 3 27 1 28 x 29 x 30 x STAFFING Standard No Score 31 x 32 x 33 2 34 1 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 3 LIFESTYLES Standard No Score 11 3 12 x 13 x 14 2 15 x 16 3 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x 2 x x x 1 x X 1 x Lowdell Close, 186-188 DS0000027064.V276977.R01.S.doc Version 5.1 Page 22 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA14 Regulation 16(2)m Requirement Further arrangements must be made to enable service users to engage in social and leisure activities outside of the home with regard to the needs of the service users Labels must not be used on the Medication Administration Record. All medicines must be recorded when administered. Where medication has been omitted or refused by a service user the appropriate code used. Medicines must be recorded accurately when administered this must include the dose for service users requiring PRN medication. The homes policies and procedures for the Protection of Vulnerable Adults must be updated in conjunction with no secrets and dovetail with the Hillingdon Multi-Agency Adult Protection documentation. (Previous timescale of 14/11/05 not met) A full environmental audit of the home must be carried out. There DS0000027064.V276977.R01.S.doc Timescale for action 01/05/06 2 3 YA20 YA20 13(2) 13(2) 10/03/06 10/03/06 4 YA20 13(2) 10/03/06 5 YA23 13 (6) 01/04/06 6 YA24 23(2)(b) 01/04/06 Lowdell Close, 186-188 Version 5.1 Page 23 7 YA24 23 (2) (b) 8 YA24 13 (4) (a) 9 YA27 23(2) (n) 10 YA33 18 11 YA34 17 12 13 YA35 YA35 18 18 14 YA39 24 15 YA39 26 must be in place a programme of redecoration and refurbishment with timescales for completion. A copy of this must be forwarded to the CSCI. Wear and tear to the structure of the home caused by wheel chairs must be remedied. (Previous timescale of 21/11/05 not met) An Action Plan regarding the extention of the patio must be forwarded to the CSCI. This is restated from the last inspection. The Action Plan must include a timescale for completion not to exceed 01/05/06. This requirement is partially addressed. A shower mattress must be ordered and the first floor shower room be fully operational. A review of the staffing levels must be undertaken, this must include how outside activities are to be staffed in line with the service users dependency levels and assessed needs. Staff records must include all the information required under Schedule 2 of the Care Homes Regulations 2001. The home must have in place a system for ensuring that all staff undertake mandatory training. Induction and Foundation training to meet the Skills for Care core standards must be in place and implemented. An annual development plan for quality assurance, relevant to the size of the home, must be formulated and available in the home. A copy must be forwarded to the CSCI. Regulation 26 Visits must take place monthly. A copy of the report of the visit must be sent DS0000027064.V276977.R01.S.doc 01/04/06 01/05/06 01/04/06 01/05/06 01/04/06 01/04/06 01/05/06 01/05/06 17/03/06 Lowdell Close, 186-188 Version 5.1 Page 24 to the CSCI. 16 17 YA42 YA42 13(4) 23(4) There must be in place clear records regarding water temperature readings. The fire drill records must identify the staff attending each drill, the time of each drill, and what action, if any, was required. The fire risk assessment must be reviewed annually and whenever there are any relevant changes within the home or its grounds. All servicing certificates must be available for inspection. A full audit of health and safety systems must be carried out. All staff to include management must be up to date with training in all health and safety topics. 10/03/06 10/03/06 18 YA42 23(4) 17/03/06 19 20 YA42 YA42 17 12, 13(4) 17/03/06 01/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Lowdell Close, 186-188 DS0000027064.V276977.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection West London Area Office 58 Uxbridge Road Ealing London W5 2ST National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lowdell Close, 186-188 DS0000027064.V276977.R01.S.doc Version 5.1 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!