Inspection on 09/10/06 for Lower Clapton Road (Flat 1)

This inspection was carried out on 9th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lower Clapton Road (Flat 1) 08/01/08

Lower Clapton Road (Flat 1) 15/05/06

Lower Clapton Road (Flat 1) 25/07/05

Lower Clapton Road (Flat 1) 13/04/05

Lower Clapton Road (Flat 1) 25/10/04

Lower Clapton Road (Flat 1) 24/05/04

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 Lower Clapton Road (Flat 1) Flat 1 219 Lower Clapton Road Hackney London E5 8EH Lead Inspector Sandra Jacobs-Walls Unannounced Inspection 9th October 2006 13:30 Lower Clapton Road (Flat 1) DS0000010272.V314855.R01.S.doc Version 5.2 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 Lower Clapton Road (Flat 1) DS0000010272.V314855.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 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. Lower Clapton Road (Flat 1) DS0000010272.V314855.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lower Clapton Road (Flat 1) Address Flat 1 219 Lower Clapton Road Hackney London E5 8EH 020 8986 1876 020 8986 1876 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) Hackney Independent Living Team Ms Jennifer Johnson Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Lower Clapton Road (Flat 1) DS0000010272.V314855.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th May 2006 Brief Description of the Service: Lower Clapton Road (Flat 1) offers support, personal care and accommodation for a maximum of four service users who have learning difficulties. Some of the current service users are physically disabled and are living with complex health conditions. The home is situated within a modern small complex of flats at a busy intersection near Clapton Pond within the London Borough of Hackney. The home has good bus links and is within walking distance of local shops, and amenities including a post office. Hackney Independent Living Team, (HILT) manages the home, which is a voluntary sector provider of care services. Lower Clapton Road (Flat 1) DS0000010272.V314855.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection of Lower Clapton Road, Flat 1 took place on the afternoon of the 9th October 2006 for the duration of five hours. Assisting with the inspection process was the home’s registered manager and other staff on shift at the time of the inspection. The inspection process included the review of two service user files, discussions with staff, an accompanied tour of the home’s premises and the review of other key documentation. The purpose of the inspection was to assess the home’s performance against key National Minimum Standards and to gauge the home’s success in addressing outstanding requirements made at the previous inspection. As a result of the inspection findings four requirements and one recommendation was made. The inspector would like to thank all service users and staff who co-operated and contributed to the inspection. What the service does well: What has improved since the last inspection? The inspector was impressed by the service’s ability to address the physical needs of service users for whom, health care issues had significantly changed. The inspector noted that staff had worked well with other professionals, in particular occupational therapists and physiotherapists to determine how best emerging needs could be addressed. The inspector observed that necessary Lower Clapton Road (Flat 1) DS0000010272.V314855.R01.S.doc Version 5.2 Page 6 aids and adaptation was now in place to assist staff manage the safe handling of service users. The inspector also was encouraged to note that a number of environmental issues highlighted at the previous inspection had similarly been addressed. The home’s general environment and décor had improved significantly, making the home more pleasant and comfortable. Service users also had greater access to a range of recreational activities, which had been a longstanding issue at the home. The home had addressed satisfactorily the revision of the home’s complaints information, the maintenance of current care plans, and risk assessments. Monthly unannounced monitoring visits were now consistently evidenced. The inspector was also encouraged to note the increase in staff morale, which had been an issue at the last inspection. Staff who spoke with the inspector commented that a range of team issues had been worked through and there was a sense of the staff group now operating more cohesively. Some staff attributed this shift to the greater presence and attention of the registered manager at the home in recent months and the support received from senior management. 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. Lower Clapton Road (Flat 1) DS0000010272.V314855.R01.S.doc Version 5.2 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 Lower Clapton Road (Flat 1) DS0000010272.V314855.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgment had been made using available evidence including a visit to this service. EVIDENCE: No new service users had been admitted to the home since the last inspection. The inspector reviewed the home’s updated Statement of Purpose and Service User Guide documents. Information about the home’s complaints procedure had been appropriately amended as per the recommendations of the previous inspection report. Lower Clapton Road (Flat 1) DS0000010272.V314855.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgment had been made using available evidence including a visit to this service. EVIDENCE: As part of the inspection process the case files for two service users were reviewed. The inspector was informed by the registered manager that for other service users it had become necessary to complete re-assessment of their needs as their circumstances, (primarily their health care needs) had changed. For these service users, the re-assessment process was ongoing and it was the service’s intention to update existing care plans to address developing needs. The registered manager gave good illustration of service users’ participation in the decision making process. For example, service users had been involved in decisions regarding the re-decoration of communal areas of the home. Service users made decisions about their participation in organised activities such as attendance at social events organised by HILT or external groups and how and when they accessed the local community. Service users’ chose whether to participate in household chores and what and where they wanted to eat. Lower Clapton Road (Flat 1) DS0000010272.V314855.R01.S.doc Version 5.2 Page 10 The inspector was satisfied that risk assessments were in place for all service users and noted written risk assessments on the two service user files reviewed. The registered manager gave good illustration of newly devised risk assessments in place developed due to the changing needs of service users. These included risk assessments relating to the involvement of service users with new recreational activities such as attending local evening discos. Lower Clapton Road (Flat 1) DS0000010272.V314855.R01.S.doc Version 5.2 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): 12,13,15,16 & 17 Quality in this outcome area is good. This judgment had been made using available evidence including a visit to this service. EVIDENCE: A longstanding issue for the service had been the involvement of service users in more varied and meaningful recreational activities. It had been the inspector’s view that previously service users had limited access to more creative recreational activities and there was few opportunity for more stimulating participation. The registered manager indicated that since the last inspection service users had been encouraged by staff to widen their social networks by participating in social events based both at the home and within the local community. The inspector was informed that on a monthly basis a social event was held at the home to which service users and their friends were invited to attend. This is a new development. The inspector was also told that service users now had access to a local disco that was held regularly for people with learning disability. This activity was very much enjoyed by those service users who participated. Within the home, staff encouraged service users to enjoy music of their choice and regular massage treatment. Some service users were supported on a Lower Clapton Road (Flat 1) DS0000010272.V314855.R01.S.doc Version 5.2 Page 12 weekly basis to access the local community via HILT’s Occupational Team. Staff supported one service user who enjoyed bible study and religious music to participate in these activities. Service users enjoyed good contact with family and friends. One service user continued to have weekly outings with his father, while another service user’s mother was very much involved in his care and visited him at home regularly. The inspector reviewed the home’s menu planner for the week of the inspection and was satisfied that varied and nutritiously balanced meals were offered by the home. The menu planner also had written guidance to staff about the dietary requirements of service users including the need for increased fibre and liquid diet for the service user who had a related health condition and a high caloric diet for a service user who had a degenerative medical condition. Case files reviewed also contained explicit guidance regarding individual dietary needs. Lower Clapton Road (Flat 1) DS0000010272.V314855.R01.S.doc Version 5.2 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): 18,19 & 20 Quality in this outcome area is good. This judgment had been made using available evidence including a visit to this service. EVIDENCE: The four service users living at Lower Clapton Road, Flat 1 have been resident there for a number of years and their general and personal care needs are well known to staff. A new member of staff interviewed by the inspector commented that prior to assisting service users with their personal care tasks that she ‘shadowed’ experienced staff in an attempt to inform herself of service user personal care preferences. She also indicated that new staff were required to read information pertaining to the individual needs of service users prior to working with them independently of other staff. Files reviewed by the inspector also contained guidance to staff regarding the specific personal care needs of service users. Information was clear in outlining what tasks could be performed by service users independently of staff. The Person Centred approach to care adopted by the service supported this practice. With regard to the physical and emotional health needs of service users, the inspector was satisfied that these areas of service users lives were being well addressed as appropriate. As mentioned elsewhere in this report, in recent Lower Clapton Road (Flat 1) DS0000010272.V314855.R01.S.doc Version 5.2 Page 14 months the home had focused on the changing physical needs of some service users, which had become cause for concern. The inspector was informed and saw newly purchased aids and adaptations used to address the developing health care needs of service users. New mobile hoists were in place and one service user had a fully adapted bed with a specialised mattress to ensure safety and comfort while resting and receiving personal care. The registered manager commented that it was anticipated that ceiling tracking to facilitate the use of a hoist in the shower room would be in place shortly. This again had become necessary to address the health care needs of some service users. Files reviewed by the inspector indicted that the service was monitoring well the general and specific health care needs of all service users and there was good documentation on file that highlighted outcomes of medical/medication reviews. The registered manager informed the inspector that since the last inspection few changes had been made to service user medication. Files contained carefully documented medication information and all medicines were kept securely locked in accordance with the organisation’s medication policies. Staff confirmed that they had received medication training prior to being responsible for the administration of service users’ medication. Lower Clapton Road (Flat 1) DS0000010272.V314855.R01.S.doc Version 5.2 Page 15 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): 22&23 Quality in this outcome area is good. This judgment had been made using available evidence including a visit to this service. EVIDENCE: As mentioned elsewhere in this report, information about the home’s complaints procedure had been appropriately amended since the last inspection. The registered manager confirmed that since this time the home had received no complaints. The service does not operate a centralised system of recording any complaint, but makes use of a general incidents log. It was the inspector’s view that it was good practice to establish a separate complaints log to better gauge and monitor any future complaint against the home. The registered manager confirmed that there had been no instances or suspected instances of an adult protection nature. The inspector had previously reviewed the home’s adult protection procedures, which were considered satisfactory. The registered manager produced upon request, the local authority’s written adult protection protocols which staff must adhere to. The newly appointed support worker demonstrated fair working knowledge of the home’s adult protection procedures and indicated that this had been discussed during the induction process. The inspector saw good documentation of accidents and undesired incidents in the home’s accident and incidents book, some of which had previously been brought to the attention of the inspector as required by the reglations. Lower Clapton Road (Flat 1) DS0000010272.V314855.R01.S.doc Version 5.2 Page 16 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, 27 & 30 Quality in this outcome area is adequate. This judgment had been made using available evidence including a visit to this service. EVIDENCE: The inspector participated in an accompanied tour of the home’s premises. Since the last inspection there had been significant improvement in the home’s general environment and décor, key areas of the home, including some service user bedrooms and the lounge area had been re-decorated which had significantly improved the atmosphere and appearance of the home. The service will still need to repair damage to lower corridor and bedroom walls caused by the impact of wheelchair use. Due to the changing health care needs of some service users the home had purchased additional aids and had planned for further adaptations to be installed to assist meet identified needs. The registered manager informed the inspector of plans to install ceiling tracking in the shower room to facilitate safe use of newly purchased hoists. The inspector noted that renovation had begun in the shower room. This had been highlighted as being problematic at the previous inspection. The registered manager comment that following an assessment by occupational therapy services in conjunction with the re-assessment of service users health needs had resulted in the installation of additional bath aids and adaptations. Lower Clapton Road (Flat 1) DS0000010272.V314855.R01.S.doc Version 5.2 Page 17 The shower room had been reconstructed to ensure the safety of service users and staff while utilising the area. Further health and safety assessments of the area are required, particularly to determine the long term safety and security of the flooring and to make decisions about the purchase of a new bath The existing requirements with regard to the shower room is repeated however, acknowledgement was given to work completed thus far. A broken toilet seat seen in the bathroom must be replaced. The inspector was satisfied that the home was kept clean and hygienic. Lower Clapton Road (Flat 1) DS0000010272.V314855.R01.S.doc Version 5.2 Page 18 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): 32,34, 36 & 35 Quality in this outcome area is adequate. This judgment had been made using available evidence including a visit to this service. EVIDENCE: The registered manager and other senior staff interviewed during the inspection indicated that the competency of the home’s staff group was good. With the exception of one new member of staff, the staff team was well established, utilising regular bank staff as necessary. Staff were generally well experienced in the social care field and some were embarking on NVQ training. A new training officer post had been recently created at the organisation’s head office and a programme of key training (manual handling, food hygiene, first aid) was available to staff. The newly recruited member of staff commented that she felt well supported by the induction process and was preparing to participate in core foundation training. Staff commented on the home having a more positive atmosphere than in previous months. This they felt was attributed to the development of a stable staff team, with consistent management and the support of senior management. Staff indicated that this more positive outlook had given rise to new enthusiasm for service objectives, which translated into better outcomes for service users. It was the inspector’s observation that the service as a whole presented more positively than at previous inspections. Lower Clapton Road (Flat 1) DS0000010272.V314855.R01.S.doc Version 5.2 Page 19 The inspector was informed that generally all staff information was held at the HILT head office, this, the registered manager said was particularly true of CRB disclosure forms. The inspector agreed to liaise with HR personnel at the organisation’s head office to negotiate the inspection of staff records. The previous inspection had highlighted the need for regular staff supervision to be evidenced. During the inspection records were seen that confirmed individual staff supervision was being conducted consistently and was documented. Staff who spoke with the inspector indicated that they felt the frequency and quality of individual supervision had improved. Staff files reviewed by the inspector highlighted that staff annual appraisals were still outstanding. The registered manager commented that all staff appraisals had been scheduled and were due to be completed in the near future. This requirement is therefore repeated. Lower Clapton Road (Flat 1) DS0000010272.V314855.R01.S.doc Version 5.2 Page 20 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): 37,39 & 42 Quality in this outcome area is good. This judgment had been made using available evidence including a visit to this service. EVIDENCE: Service users of Lower Clapton Road, Flat 1 were benefiting from a better run home. The general atmosphere of the home and attitude of staff had improved, as had the overall environment and opportunities for service users’ social interaction. The home evidenced monthly monitoring visits were consistently being completed and that service monitoring via senior HILT managers had also increased. The inspector was satisfied that in general the health, safety and welfare of service users were promoted and protected. The service had clearly increased the standard of care provided which translated into better outcomes for service users. The inspector was encouraged by the findings of the inspection and would hope that the service continued to provide this level of care. Lower Clapton Road (Flat 1) DS0000010272.V314855.R01.S.doc Version 5.2 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 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 2 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Lower Clapton Road (Flat 1) DS0000010272.V314855.R01.S.doc Version 5.2 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 YA24 Regulation 23(2)(b) Requirement The registered person must ensure that damage to corridor and bedroom walls are replastered and re-decorated. The registered person must ensure that structural & decorative work needed to the home’s shower room is completed so that the entire shower is safely accessible to staff & service users whist in use. The registered person must ensure that the broken toilet seat seen in the bathroom is replaced. The registered person must ensure that staff appraisals are conducted at least annually and that training needs are identified and addressed. (Previous timeframe of 01/09/06 not met) Timescale for action 31/12/06 2. YA27 23 31/12/06 3. YA27 13(4)(c ) 15/11/06 4. YA35 18 01/12/06 Lower Clapton Road (Flat 1) DS0000010272.V314855.R01.S.doc Version 5.2 Page 23 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 YA22 Good Practice Recommendations It is recommended that the service develop a separate complaints log to record any future complaints against the home. Lower Clapton Road (Flat 1) DS0000010272.V314855.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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 Lower Clapton Road (Flat 1) DS0000010272.V314855.R01.S.doc Version 5.2 Page 25 - 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!