Inspection on 07/07/08 for Lyndhurst

This inspection was carried out on 7th July 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lyndhurst 14/01/08

Lyndhurst 07/02/07

Lyndhurst 12/07/06

Lyndhurst 07/10/05

Lyndhurst 05/05/05

Lyndhurst 27/10/04

Lyndhurst 27/04/04

Similar services:

Abbey The

Snydale Care Home

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 17/12/2008.

CARE HOMES FOR OLDER PEOPLE Lyndhurst 20 Oxford Road Dewsbury West Yorkshire WF13 4JT Lead Inspector Lynda Jones Key Unannounced Inspection 7th July 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lyndhurst DS0000026278.V367573.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. Lyndhurst DS0000026278.V367573.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lyndhurst Address 20 Oxford Road Dewsbury West Yorkshire WF13 4JT 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) 01924 459666 01924 455223 Mr Annamalai Subramanian Mrs Meena Subramanian, Dr Mohammed Ismail Kardasha Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Lyndhurst DS0000026278.V367573.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th January 2008 Brief Description of the Service: Lyndhurst is a care home registered to provide care and accommodation for up to fifteen older people. It is situated in a residential area of Dewsbury, set in extensive grounds. The home was formerly a private house that has been adapted for its current use. The accommodation is on two floors, with the majority of bedrooms being on the first floor. People who live at the home need to be reasonably mobile. The first floor can be accessed by stair lift but people need to cross the landing to access a second staircase leading to additional bedrooms. The provider informed us that the fees range from £362.54 to £374.32 per week. There are additional charges for chiropody, optician, dentist, hairdressing and newspapers. Lyndhurst DS0000026278.V367573.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Since the last key inspection in January 2008 we have visited the home once, on 30 April 2008, to carry out a thematic inspection. This was a short, focused inspection that looked in detail at how the service makes sure people are protected from abuse. We found that people who use the service are protected by care staff who will take action if they believe that people’s safety and wellbeing is at risk. But people cannot be assured that the policy about safeguarding will direct staff to take the right action, and inform the right people thereafter, should an allegation come to light. We also found that people cannot be assured that, when staff are recruited, every possible step is taken to protect them from unsuitable workers. In the report from the thematic inspection we made requirements for the policy about safeguarding and staff recruitment to be improved. This key inspection took place to assess the quality of care provided to people living at the home. The visit was unannounced and was carried out between 10.00 am and 2:30pm. As part of the inspection process we looked at all the information we have received about the service since the last key inspection. Discussion took place with people who live there and with the manager and staff on duty. Care practice was observed, various records were looked at and a tour of the home took place. We sent surveys to a sample of people who live at the home and to staff. We received feedback from 5 people who live there and 4 staff. Everyone was very positive about the service provided, we have included some of their comments in this report. What the service does well: Everyone is very friendly; they make visitors feel welcome when they call at the home. People can go and have a look around the home and pick up information about the service provided. People are always assessed before they move into the home to make sure that all of their needs can be met and it is the right place for them. Lyndhurst DS0000026278.V367573.R01.S.doc Version 5.2 Page 6 The care plans say what sort of care and support each person needs, this means staff have the correct information to look after people properly. They also contain valuable information about people’s daily routines and about what they like and dislike. Individual health care needs are met. Everyone told us that they always receive the medical support they need. There are activities on offer for people to join with if they want to. We asked the staff to tell us what they do well. These are some of their comments: “We provide good care” “We provide a safe, comfortable environment” “We have good relationships with residents and their families” What has improved since the last inspection? Up to date information about the home and the service is readily available so that it can be given out to people when they call to look round. Individual risk assessments are now in place to make sure health needs are carefully monitored and to make sure people are safe. The medication system is better managed. This means that people get their medication at the right times. The recruitment procedure has improved. Staff are being checked to make sure they are suitable to work with older people, gaps in employment histories are being explored. All staff have had adult protection training and safeguarding procedures have been improved. This means that staff are aware of their responsibility to protect people in their care. Staff training needs are easy to identify on the training matrix, this makes planning for training easier. The registered provider (the owner) is providing regular monthly reports on the conduct of the home and the care provided. The acting manager has applied to be registered by us. Lyndhurst DS0000026278.V367573.R01.S.doc Version 5.2 Page 7 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. Lyndhurst DS0000026278.V367573.R01.S.doc Version 5.2 Page 8 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 Lyndhurst DS0000026278.V367573.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 5 (standard 6 does not apply) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People are assessed before they move in to make sure that all their needs can be met. Information is available about the home to help people make a decision about whether the service is suitable for them. EVIDENCE: There is a Statement of Purpose and Service User Guide; which has been updated since the last key inspection. These documents provide people with information about the fees, the facilities at the home and about the service they can expect. A copy is on display in the entrance area. Copies are also available on request from the home for people to take away with them to look at later. Lyndhurst DS0000026278.V367573.R01.S.doc Version 5.2 Page 10 People are encouraged to visit the home and meet people to see if it suits them. One person who moved in recently said she spent the day there before making any decision about moving in. Information in the care plans shows that people are assessed before they move into the home. This is done to make sure that the home is the right place for them and that all of their needs can be met. The home does not provide intermediate care. Lyndhurst DS0000026278.V367573.R01.S.doc Version 5.2 Page 11 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 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Information in the care plans outlines the care and support that each person requires; which should ensure that their needs health and personal care needs are met. Medication is safely managed. EVIDENCE: Two care plans were looked at because we wanted to see what individual needs had been identified and what action staff are expected to take to meet these needs. The care plans contain some useful information about the sort of daily routines that people prefer. Personal support is tailored to meet individual needs and there is evidence that people are being consulted about how they want their Lyndhurst DS0000026278.V367573.R01.S.doc Version 5.2 Page 12 care and support to be delivered. We observed staff treating people with dignity and providing personal care in private. The staff have a good understanding of people’s needs. They know what people like and dislike and they know how people prefer to spend their time. We asked people living in the home if they receive the care and support they need and if staff listened to them. From the surveys, everyone said that they did. People told us “the care staff are very good” and “they always do what I require of them”. We asked people living in the home if they receive the medical support they need. All of the people that completed a survey said “always”. One person told us “they always call a doctor when I need one”. We could see from some of the plans that people are receiving health care from a range of people such as doctors, district nurses, dentists and opticians. Details of any visits are clearly documented in the care plan together with the advice given. In the information provided by the home they said they always involve other professionals when they are needed and they ask for advice on both for physical and mental health issues. We found moving and handling plans, nutritional assessments and Waterlow pressure sore risk assessments in the care plans. This is an improvement since the last inspection. In the information provided by the home they told us they have good contact and relationships with all families members that visit Lyndhurst. There has been an improvement in the way medication is managed since the last inspection. Medication administration records are easy to follow, the records are signed by senior care staff when the give out medication. The records show when medicines are received, administered and disposed of. Lyndhurst DS0000026278.V367573.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The staff have plenty of contact with people and they respect their preferred routines. People are treated with respect and dignity. EVIDENCE: There is a friendly, relaxed atmosphere at the home. The staff have time to chat to people, they know people really well and a lot of good-humoured banter is exchanged. They encourage people to be as independent as possible and spend their time as they wish. During the day people spent time in the lounge or in the dining room, which appears to be the main hub of activity. One person said she likes to sit in there because she can see “all the comings and goings”; the main entrance is at the rear and is overlooked by the dining room. Lyndhurst DS0000026278.V367573.R01.S.doc Version 5.2 Page 14 One person who lives there likes to keep busy by helping out with some light chores. The staff make sure that this individual is routinely involved in household tasks and they show her that they genuinely value the contribution she makes. In the surveys, people told us that there are always activities for them to take part in if they wish. One person said, “ I don’t take part because I’m not well enough to do so”. Some people choose to spend all their time in their rooms. The staff respect their preferred routines and call on them regularly throughout the day and take them their meals and drinks. When we asked the home to tell us what they do well in this area they said, “We listen to the views and the choices of the residents”. We also asked them to tell us about any improvements they have made over the past 12 months and they told us “training staff in the importance of activities. Recording the activities no matter how small”. There is a varied weekly menu. In addition, the cook asks everyone each day if they would like the meal of the day or if they would like an alternative. There is plenty of choice at teatime and suppertime. People told us they enjoyed the food. One person said, “I like the cakes and buns, in all probability I get too much to eat”. Lyndhurst DS0000026278.V367573.R01.S.doc Version 5.2 Page 15 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 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Complaints and adult protection issues are being dealt with properly. This means that staff are listening to people and keeping them safe. EVIDENCE: In the surveys, people told us they know about the complaints procedure and they know how to make a complaint. There is a complaints log to records the details and outcomes of any complaints made to the home. No complaints have been made since our last inspection in January 2008. In May 2008 a thematic inspection took place to look specifically at how the service protects people from abuse and makes sure that they are safe. We found that people using the service feel safe and secure; they are confident that they could speak out and that they would be listened to. The staff have received training about safeguarding people; which means they are aware of their responsibility to protect people in their care. We asked the home to revise their safeguarding policy, so that everyone has clear written guidance about what to do should an allegation be made, who Lyndhurst DS0000026278.V367573.R01.S.doc Version 5.2 Page 16 they can and should tell both inside and outside of the home, and how they will be supported. This is help to make sure that the right people investigate any allegation made with the minimum of delay. We also said the manager must make sure that she applies for a CRB for anyone whom she employs. This will help to safeguard people from unsuitable workers who should not be providing care. We looked again at the safeguarding policy and at staff recruitment procedure on this inspection and we found that both of these issues have now been addressed satisfactorily. Lyndhurst DS0000026278.V367573.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 24 and 26. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People live in a comfortable home but many areas require refurbishment and redecoration to improve the facilities. EVIDENCE: The communal areas of the home are clean and comfortable. There is no ventilation in the designated smoking area and although one person only uses it, the room smells strongly of cigarette smoke. An extractor fan or air filter needs to be fitted to improve the atmosphere in this room. Lyndhurst DS0000026278.V367573.R01.S.doc Version 5.2 Page 18 The bedrooms we looked at are personalised, most people have lots of ornaments and photographs around them. Everyone is encouraged to bring personal items with them when they move in. There have been some improvements since we last visited, for example, a new blind has been fitted in the bathroom, all the bedroom and toilet doors have working locks on them and a new window has been fitted in one of the bedrooms. The home would benefit greatly from a planned programme of refurbishment. In our report following the inspection, which took place in January 2008, we said that when we talked to staff no one could remember when bedrooms were last decorated. In some rooms the wallpaper is ripped and paintwork is chipped. The poor presentation of some of the rooms undermines the dignity of people who use the service. Two of the bedrooms have had non slip flooring fitted. In one of the bedrooms the flooring does not fit properly, giving it a raised “rippled” effect, which someone could stumble, and trip over. The acting manager said this was due to the poor quality of the floor covering and she said it would be replaced. In another room, the walls have been part painted but not completed because the home’s handyperson left without notice. There was no lampshade on central light in this room, a bedside lamp was left on the floor and a bed base was cracked, although a new one was on order. We asked the home to tell us about their plans for improving the environment over the next 12 months and in the information they provided before the inspection they told us they intend to “employ a handy person that is familiar with the workings of a care home. Decorate all communal areas. Decorate all bedrooms when needed or when a new resident arrives”. This will improve the appearance of the home. Everyone who completed a survey told us the home is usually fresh and clean. One person told us “cleaners need to stick to their jobs and don’t clean my room everyday because I don’t like it”. People should be consulted about the arrangements for cleaning their rooms so that this can be carried out in a way that suits them. Lyndhurst DS0000026278.V367573.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People’s needs are being met by staff that have been properly checked before they start working in the home to make sure they are suitable and safe to work with older people. EVIDENCE: The home is adequately staffed at all times to meet the needs of the people living there. During the day there is one senior member of the team on duty with two care staff, plus the manager. Throughout the night, there are two care staff on duty. There is domestic cover every day for five hours and a cook is available every day between 7.30 am and 2.45 pm. We asked people living at the home if staff are available when they are needed, most people said “always”. A training matrix shows at a glance what training staff have undertaken and what needs to be renewed. This is an improvement since our last visit. Most people have received the required mandatory training; the majority have achieved NVQ (National Vocational Qualification) level 2. Lyndhurst DS0000026278.V367573.R01.S.doc Version 5.2 Page 20 There has been an improvement in the staff recruitment procedure since the last inspection in January 2008. The job application form is better, references are always taken up and gaps in employment histories are always explored with prospective candidates before they start work in the home. This is to make sure they are suitable to work in the care sector. At the Thematic Inspection in April 2008, we asked the manager to make sure that the organisation applied for a CRB (Criminal Records Bureau) check before any new member of staff starts work at the home. Those requested by other organisations are not acceptable, because they do not give the manager information about the applicant; which is sufficiently up to date. This is now taking place. Lyndhurst DS0000026278.V367573.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People are consulted about the service and asked if it can be improved in any way. EVIDENCE: The acting manager has a number of year’s experience of working with older people in a residential setting. She has been in post since August 2007 and she has applied to be registered with us as the manager. It is important that there is a registered manager because this will mean that there is someone in control who is legally responsible for the day-to-day management of the home. Lyndhurst DS0000026278.V367573.R01.S.doc Version 5.2 Page 22 The registered provider calls at the home each week and is now completing monthly reports about the conduct of the home. This is an improvement since the last inspection in January 2008. These reports provide evidence that people are being asked for their views about the standard of care provided. The last available report was completed in June 2008. All staff have received supervision from the manager or deputy manager since the last inspection. This is an improvement since the last inspection. Discussion took place with the acting manager about the frequency of supervision. Formal supervision should take place at least six times a year. The records of money held on behalf of people living there were looked at. Receipts are available for all purchases made and the money held could be reconciled with the balance on the records. Each receipt is now numbered. This is an improvement; making it easier to cross-reference receipts with the details on the finance sheets. Records show that there is a plan in place to ensure that all staff receive individual training in fire safety. The deputy manager has already provided some staff with this training. We were unable to locate some of the documents showing that equipment used in the home is being serviced regularly. We saw evidence that fire equipment, stair lift and the emergency call system had been serviced but we could not find servicing details for the bath hoist. The acting manager said she did not know if there was a contract for the servicing of the hoist. This means that people’s health and safety could be placed at risk. Lyndhurst DS0000026278.V367573.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 X 2 2 X X 2 2 2 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 3 3 3 X 2 Lyndhurst DS0000026278.V367573.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO 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 OP19 Regulation 23 Requirement A programme of maintenance, decoration and refurbishment for the interior and exterior of the home must be continued so that people can live in a pleasant, well maintained environment (this requirement was first made on 7/2/07) Arrangements must be made to provide adequate ventilation in the designated smoking area. The bath hoist must be checked and certified as being safe to be used. Timescale for action 30/09/08 2. OP26 3. OP38 13(4) 13(4) 31/08/08 31/08/08 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 OP36 Good Practice Recommendations Formal supervision should take place at least six times a year. Lyndhurst DS0000026278.V367573.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lyndhurst DS0000026278.V367573.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!