Inspection on 11/07/06 for Lynwood Lodge

This inspection was carried out on 11th July 2006.

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

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

Other inspections for this house

Lynwood Lodge 12/03/06

Lynwood Lodge 07/11/05

Lynwood Lodge 28/01/05

Lynwood Lodge 14/07/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Lynwood Lodge 20-22 Broad Road Sale Manchester M33 2AL Lead Inspector Sue Jennings Key Unannounced Inspection 11th July 2006 09:15 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 Lynwood Lodge DS0000005620.V303900.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. Lynwood Lodge DS0000005620.V303900.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lynwood Lodge Address 20-22 Broad Road Sale Manchester M33 2AL 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) 0161 973 7210 0161 962 6424 Trinity Merchants Limited Care Home 21 Category(ies) of Dementia - over 65 years of age (10), Mental registration, with number disorder, excluding learning disability or of places dementia (1), Old age, not falling within any other category (21) Lynwood Lodge DS0000005620.V303900.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. A maximum of 21 service users within the category of old age (OP) who may additionally have a physical disability associated with age may be accommodated. A maximum of 10 service users within the category of Dementia-over 65 years of age (DE(E)) may be accommodated within the overall numbers. One named service user who is under 65 years of age requires care by reason of mental disorder excluding learning disability or dementia (MD). When this person leaves the home, the category for this place will revert to that of old age (OP). 12th March 2006 Date of last inspection Brief Description of the Service: Lynwood Lodge provides residential accommodation with board and personal care for up to twenty-one (21) service users within the category of old age (OP), who could also have a physical disability (PD/E). Trinity Merchants Limited owns Lynwood Lodge. The registered manager has recently left her employment and an acting manager was due to commence at the home on the day after the inspection. Lynwood Lodge is a large Victorian property, which is set in its own grounds. The grounds are enclosed and are accessible and well maintained. To the rear of the property is a patio and seating area. There is car parking space to the side of the property. The home has seventeen single and two double bedrooms. Thirteen single bedrooms are en-suite and both double bedrooms are en-suite. There is a passenger and stair lifts. The home is situated within a residential area of Sale and is close to the town centre, a local park, Metro and public transport. The current fees for accommodation at the home range from £350.00 to £450.00 per week the fees include all meals, laundry, NHS chiropody, Physiotherapy and entertainment. Additional costs include hairdressing, dry cleaning and telephone calls . Lynwood Lodge DS0000005620.V303900.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was undertaken as part of a key inspection, which includes an analysis of any information received by the Commission for Social Care Inspection in relation to this home prior to the site visit. The site visit was unannounced and took place over the course of 5.5 hours on Tuesday 11th July 2006. During the course of the site visit time was spent talking to the senior care officer in charge of the home and the manager from one of the sister homes in the Trinity Merchants group, 6 of the residents, a visiting Physiotherapist and 2 members of staff to find out their views of the home. Ten of the Commission for Social Care Inspection’s survey forms were sent to relatives by the home. The survey forms received from residents gave positive feedback about the home, meals and level of care provided. Time was spent examining records, documents and the residents and staff files. A tour of the building was also carried out. Most of the requirements from the previous inspection had been addressed and there was evidence that the home was continuing to work hard to develop the service. During this inspection the key National Minimum Standards were assessed. What the service does well: The home carries out an assessment of needs for each resident admitted to the home. Care plans included personal preferences and individual abilities such as mobility, dietary and communication needs. Risk assessments were carried out where a risk of falls had been identified. Residents were registered with a local General Practitioner (GP) and where possible retained their own GP. Each care plan contained a record of healthcare visits. Medication was stored in a lockable trolley and a policy on the use of homely remedies was available and the GP’s written approval for the use of homely remedies was kept. Controlled medicines were appropriately stored and records were accurate. Lynwood Lodge DS0000005620.V303900.R01.S.doc Version 5.2 Page 6 Visitors were welcomed in the home at anytime although they are asked to avoid mealtimes where possible. What has improved since the last inspection? What they could do better: Improvements were needed in the homes medication administration systems. Night staff should be included in the homes fire safety training and participate in fire drills. Lynwood Lodge DS0000005620.V303900.R01.S.doc Version 5.2 Page 7 Care plans needed to include a nutritional and oral healthcare assessment and the daily record needed to be more detailed to reflect the care delivered. Where possible care plans should be signed by the resident’s representative. The home must develop a policy regarding fire safety when workmen are on site. 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. Lynwood Lodge DS0000005620.V303900.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 Lynwood Lodge DS0000005620.V303900.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ care needs were assessed by the home prior to admission. EVIDENCE: The home carried out a pre-admission assessment of potential residents needs and copies were seen on individual residents files. The manager or a representative from the home usually visited a prospective resident in his or her own home to undertake the pre-admission assessment. This enabled the home to make sure they were able to meet the individual’s needs. Case tracking confirmed that a care manager’s assessment was held on file for those residents placed by the local authority. A more detailed assessment was carried out following admission. The needs assessments were generally clear and detailed. Lynwood Lodge DS0000005620.V303900.R01.S.doc Version 5.2 Page 10 Residents’ needs were reviewed on an ongoing basis. Information was available for staff regarding residents’ care needs. One resident spoken said, “I looked a few homes but I felt this was the nicest.” Another resident said, “My family were shown around by one of the staff. I have been here a while now and I like it very much.” Each resident had a statement of terms and conditions or a contract from the funding authority. The home did not provide intermediate care. Lynwood Lodge DS0000005620.V303900.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall the health and personal care needs of the residents were being met at the home. Care planning required reviewing to fully cover all aspects of the health needs of residents, however the implementation of the new care planning documentation would allow for this to happen. EVIDENCE: Four residents were case tracked from admission. Each had a care plan in place. It was noted that the care plans did not include a nutritional or foot care assessment. The visiting manager stated that the organisation had developed a new care plan format that included a nutritional assessment. The need for care plans to identify an individual’s needs and the action required by staff to meet them was discussed with the manager. Lynwood Lodge DS0000005620.V303900.R01.S.doc Version 5.2 Page 12 It is recommended that residents or their representative sign care plans to provide evidence that residents have been involved in the care planning process. The visiting manager explained that the home used a ‘handover sheet’ at the start of each shift to pass over information to staff. The staff felt this was the most effective means of ensuring information was passed from one shift to another. The ‘handover sheets’ contained personal information about a number of residents, which should be held on their individual care plans in line with the requirements of the DATA protection Act 1998. Comments on individual residents should be entered on the relevant care plan/daily record and the handover sheets used to reference the individual record. Each resident is registered with a local General Practitioner (GP) and where possible residents are able to retain their own GP. Access to other healthcare professionals was by GP referral. It was noted during a tour of the building that the open medication trolley was left unattended in one of the lounges creating a potential risk that medication could be tampered with. Furthermore it was noted that identical medication was being administered to one resident from a monitored dosage system and from a box dispensed to the resident prior to his/her admission and resulting in the resident’s medication being administered twice. The person in charge was advised to seek advice from healthcare professionals with regard to the misadministration of medication and to remove the box from the trolley and return the medication to the pharmacist for safe disposal. The good practice of retaining a list of staff responsible for administering medication including sample signatures and initials was in place. Where people are prescribed medication on a ‘when required’ basis, the care plan must include full instructions on its administration following consultation with the GP. Residents spoken to during the site visit said that they were well cared for. One resident said, “It is lovely here and this young man (referring to a member of care staff) is like a breath of spring.” Another said, “The home I was in closed down. I went to see a lot of other homes but I fell in love with this one the staff are lovely.” During the site visit a member of staff was observed shouting across the lounge to a resident asking if they wanted to go to the toilet. Training must be provided to staff to ensure that the dignity of residents is respected. Lynwood Lodge DS0000005620.V303900.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home offered a varied and nutritionally balanced diet to residents. Residents were encouraged to choose to participate in the activities available. EVIDENCE: Some areas of good practice were noted including the promotion of equality and diversity. Resident’s religious and or cultural needs were recorded and residents are able to attend religious services either in the community or a minister of their chosen denomination can visit them in the home if preferred. Family and friends are encouraged to visit regularly, where this is not possible staff at the home will assist residents to maintain contact via telephone or letter. One resident spoken to said, “ I am just off for a swim. I go over to the leisure centre most mornings while it is quiet.” Another resident was going to the local primary school where they taught the children to knit two days each Lynwood Lodge DS0000005620.V303900.R01.S.doc Version 5.2 Page 14 week. The resident said, “It keeps me occupied and I enjoy helping the children. I walk over to the school it is not far.” One resident said, “I like to help the staff in the mornings with the washing up it keeps me busy.” A physiotherapist, who was visiting the home at the time of the site visit, said, “I come in on a weekly basis and do an exercise class with the residents. It is a really good home they are very good with the residents.” There was evidence of trips to the local theatres and other venues. The meal was egg, chips, ham and peas with bread and butter. Hot and cold drinks were available. The cook said that she had been employed at the home since February and had completed the basic food hygiene course and was keen to undertake more training. The cook also said that the management and company were “very supportive” and “they have been great”. The cook said that she had tried to introduce some different meals like chilli and jacket potatoes and that she asks the residents what they think about the meals served each day. The cook stated “ I go round to each resident in the morning and ask them what they want for lunch from the two menu choices, if they don’t want either of them I will make them something else”. One resident spoken to said, “They are very good - if we don’t want the lunch they will make egg and chips or a sandwich or soup”. Another resident said, “The meals are tasty and there is always something I like. I am not a fussy eater but I am sure they would make me something else.” The menus were based on a four-week rota developed in consultation with residents and provided a balanced and nutritious diet. The company are planning a meeting with a food consultancy group in order to take advice about improving menus. This is good practice. Lynwood Lodge DS0000005620.V303900.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had a complaint procedure and there were policies and procedures in place to protect residents from abuse. EVIDENCE: The home has a complaint procedure and information about how to make a complaint is included in the home’s statement of purpose and function. The home had received one complaint since the last inspection and this was being investigated. The Commission for Social Care Inspection had not received any complaints in relation to this home. Staff spoken to knew about the complaint procedure and where to find it if it was asked for. Residents spoken to said that they felt safe in the home and that they would speak to a member of staff or the manager if they were unhappy with anything. Staff had received training in the protection of vulnerable adults (POVA). A copy of the Trafford Adult Protection Policy and Procedure was available. Staff spoken to said that they would inform the manager of any concerns they had regarding the abuse of a resident, or if someone made an allegation of abuse. Lynwood Lodge DS0000005620.V303900.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well maintained both internally and externally and was furnished to a good standard. EVIDENCE: The home felt comfortable and homely. All areas of the home were tastefully decorated and furniture was of a domestic nature and of a high standard. The premises were clean and free from offensive odours. The home’s environment had benefited from regular maintenance and re-decoration. Residents spoken to said that the staff keep it very clean, they change the beds and tidy the rooms. Rubber and metal treads had been fitted on the ends of each stair removing the risk to residents of trips and falls. The kitchen was clean and the cupboards had been repaired. Lynwood Lodge DS0000005620.V303900.R01.S.doc Version 5.2 Page 17 Cleaning products were stored in the basement. A tour of the building was carried out and bedrooms were personalised, clean and with no odours. Aids and adaptations had been provided for residents. Residents who had identified needs in the area of mobility were referred to the physiotherapist via their general practitioner for a professional assessment. The physiotherapist then arranged the provision of mobility aids. Privacy screens were provided in all double rooms. All communal areas, bedrooms and toilets were fitted with an emergency call system. Lynwood Lodge DS0000005620.V303900.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff appeared sufficient to meet the needs of the residents accommodated. However, improvements were needed in the recruitment procedures to protect service users. EVIDENCE: By agreement with the Commission, staff files are not kept in the home. All staff files for the 3 homes owned by Trinity Merchants Limited are kept at the head office. A sample of staff files was examined on 24 July 2006 and found to contain evidence of a staff induction, a statement of terms and conditions of employment, job description, an application form and two references. Proof of ID is held separately on a file for CRB disclosures. Where overseas workers were employed there was a copy of a work permit giving the home as the agreed place of work. The responsible person was aware that the permit was specific to the home named on the document. Copies of training certificates were held on file and the manager kept a training log for all staff. Staff spoken to confirmed that they had an induction period where they were told about policies and procedures and the basic principles of care, which include respecting residents and encouraging choice and independence. Lynwood Lodge DS0000005620.V303900.R01.S.doc Version 5.2 Page 19 Staff files provided evidence of ongoing vocational training in service related areas, e.g. moving and handling, food hygiene, safe administration of medicines and NVQ Level II and III. A number of Criminal Record Bureau (CRB) checks had not been received but the staff were already working at the homes. In order to protect residents, CRB and Protection of Vulnerable Adults List (POVA) checks must be obtained before new staff start work. References for staff were seen on file. Lynwood Lodge DS0000005620.V303900.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had systems and procedures in place, which safeguard and protect residents. EVIDENCE: During the visit it was noted that a number of internal doors on the ground floor specifically near the kitchen and lounge areas and some external doors were ‘wedged’ open this included doors fitted with an automatic closure system. The visiting manager explained that this was because the workmen had to access the rooms whilst carrying ladders and equipment. The home must develop a policy regarding fire safety in particular identifying who will be Lynwood Lodge DS0000005620.V303900.R01.S.doc Version 5.2 Page 21 responsible for ensuring all fire doors are closed in the event of the fire alarm being activated whilst workmen are on site. One of the residents said, “ the manager is leaving we had one manager for a long time and now this one is going” another said, “ it is very unsettling at the moment, the manager has left and there has been a change in staff, we are not sure what is going on”. The manager confirmed that the manager of the home had submitted notice and would be leaving that weekend. The Commission for Social Care Inspection had not been informed of the registered managers intention to leave the home as required by regulation 39 of the Care Home Regulations 2001. Lynwood Lodge DS0000005620.V303900.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable ENVIRONMENT CHOICE OF HOME Standard No Score 1 2 3 4 5 6 Standard No 19 20 21 22 23 24 25 26 Score X X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 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 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 2 Lynwood Lodge DS0000005620.V303900.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 15 & 13 Requirement Care plans must be reviewed in the context of Standard 3 and 7. This also includes: a) Each resident having a nutritional assessment and oral care and foot care details. b) Risk assessments being reviewed as part of the monthly review of the care plan. c) Daily records must be more detailed to fully reflect the care delivered over the 24hour period. (Previous timescale of 30/03/06 not met) 2. OP9 13 The registered person must make arrangements for the recording, handling, safe keeping, safe administration and disposal of medicines received into the care home. Training must be provided for staff in ensuring the dignity of the resident. DS0000005620.V303900.R01.S.doc Timescale for action 30/09/06 20/08/06 3. OP10 12 20/08/06 Lynwood Lodge Version 5.2 Page 24 4. OP38 23 The home must develop a policy regarding fire safety whilst workmen are on site. 20/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations The home should encourage residents or their representative sign care plans to provide evidence that residents had been involved in the care planning process. Lynwood Lodge DS0000005620.V303900.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ 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 Lynwood Lodge DS0000005620.V303900.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!