Inspection on 01/06/06 for Maple Leaf House

This inspection was carried out on 1st June 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 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

Maple Leaf House 14/08/07

Maple Leaf House 17/01/06

Maple Leaf House 20/10/05

Maple Leaf House 22/06/05

Maple Leaf House 01/09/04

Maple Leaf House 11/02/04

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

CARE HOMES FOR OLDER PEOPLE Maple Leaf House Kirk Close Ripley Derbyshrie DE5 3RY Lead Inspector Brian Marks Key Unannounced Inspection 1st June 2006 09:00 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 Maple Leaf House DS0000042716.V296639.R02.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. Maple Leaf House DS0000042716.V296639.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Maple Leaf House Address Kirk Close Ripley Derbyshrie DE5 3RY 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) 01773 513361 01773 513501 Not given home.fxg@mha.org.uk Methodist Homes for the Aged Michelle Whitmill Care Home 46 Category(ies) of Dementia - over 65 years of age (46) registration, with number of places Maple Leaf House DS0000042716.V296639.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th January 2006 Brief Description of the Service: Maple Leaf House is a 45-bedded care home with nursing for older people with dementia, operated by Methodist Homes, and which opened in August 2003. The home is situated on the outskirts of Ripley and is one storey and purpose built, with all facilities having level access. The home is divided into three wings, each accommodating fifteen people, with their own lounge, kitchenette and dining area. Décor, furnishings and fittings are of a high standard and all bedrooms are single and have en-suite facilities. There is an enclosed garden with outdoor seating. Support services are in place with a choice of GP, optician and dentist, and community psychiatric nurses, occupational therapists, physiotherapists and dietician are involved as required. The home has two activities coordinator posts, who have responsibility for ensuring that a good range of entertainment and in-house activities are arranged. The weekly fees for this home range from £585 - £599. Maple Leaf House DS0000042716.V296639.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection that took place at the home over a period of 7½ hours in one day, with a further short period on a second day. Additionally, time was spent in preparation for the visit, looking at previous inspection reports and other relevant documents and preparing a structured plan for the inspection. At the home, apart from examining documents, care files and records, time was spent speaking to the acting manager and 13 of the staff working at the home during the visit. The care records of 3 people who live at the home were examined in detail but because of the nature of their medical condition, they were not personally able to give a clear opinion of their life at the home. Additionally 5 visitors who were at the home during the day were spoken to. Since the last inspection visit in January 2006, the Registered Manager has been absent on extended sick leave and a manager from another section of the provider organisation, Methodist Homes, is currently managing the home, in an acting capacity. She was not present during the first part of the inspection, but was given verbal feedback during the session on the second day. What the service does well: This home was built to a high specification and provides a quality environment for staff and residents. It is spacious, light and airy and, as it is split into 3 units, the residents are accommodated in living environments that are homely in scale. All bedrooms are large and single and have en-suite facilities, and give levels of comfort and equipment for those people who have specialist nursing needs. There is a variety of communal space; this includes garden areas that are enjoyed by residents during the summer months. Staffing levels at the home have been set well above the minimum standard for this type of home and although the staff group is large, successful recruitment has produced a team with a variety of skills, knowledge and experience. Standards of induction of new staff to the home are good; staff are able to quickly get to know the individual needs of the people who live at the home and what is expected of them. The work of the staff group is guided by good quality documentation, particularly the personal care plans, and these cover a wide range of needs and activities that ensure they properly understand the individuals who live at the home. They are written in a clear style that helps staff work consistently and safely, and communication within the home between different staff groups and those on different shifts makes sure that everybody is aware of the important things that need to be done. Maple Leaf House DS0000042716.V296639.R02.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Maple Leaf House DS0000042716.V296639.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Maple Leaf House DS0000042716.V296639.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 5 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. People do not come to live at the home without their needs being assessed and the services they need from the home being identified. This makes sure that the care provided is right when they move in. EVIDENCE: From the files looked at, all the people who had come to live at the home had had there needs looked at the time they came to the home; this identified the type of care required and was included within the ‘Assessment of Daily Living’ document. However not all of the assessment records had been completed and aspects of the social experience and history of the person had not been described, which could lead to an incomplete picture of the person being obtained. Additional formal assessment documents had been completed where this was indicated; these looked at quality of skin health (Waterlow) and any wounds, nutrition, mobility, mental health and whether the person was suffering pain. From these a detailed care plan has been developed (see next section) that indicates how staff would provide help consistently and safely on a day-to-day basis. The staff spoken to commented how the documentation Maple Leaf House DS0000042716.V296639.R02.S.doc Version 5.2 Page 9 was easy to use and that they routinely referred to it. A recent photograph was not included in the care file of a newly admitted resident, which is required by law. From discussions with the visitors present, people wanting to come and live at the home are given opportunities to visit the home before coming to stay, as part of the assessment procedure, and this was observed to be happening during this visit. The home does not provide an intermediate care service so Standard 6 does not apply. Maple Leaf House DS0000042716.V296639.R02.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected 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 good. This judgement has been made using available evidence including a visit to the service. The care of all residents, including health care, was planned and given in a way that respected individuality and privacy. The administration of medicines needs to be more carefully recorded to ensure complete safety. EVIDENCE: The records of 3 residents were closely looked at and staff caring for these people were also spoken to during the inspection. The care plans include a comprehensive description about how staff care for individuals, divided into a number of important areas to reflect personal and health needs. Additionally, these documents identify areas of risk affecting the residents’ lives, and taken all together create a practical guide for staff to care for residents consistently and safely. The individual aspects of the care plans examined are looked at and evaluated by the home’s staff on a monthly basis, and revised where necessary. This indicates that care is being provided which is based on up-todate information. It was noted that this also applied to the original assessments and indicated that duplication of staff effort may be taking place. Maple Leaf House DS0000042716.V296639.R02.S.doc Version 5.2 Page 11 Good contact with specialist mental health care services was indicated in the records examined and this extended to the management of physical health care issues such as diabetes, cardiac and terminal care, with both local and hospital based professionals involved. The assessments and care plans, mentioned previously, indicated clearly the care steps needed to be carried out by nursing and care staff, and daily records examined showed how these had been done. Relatives spoken to indicated that care at the home was carried out properly and two were able to compare aspects of care favourably to that experienced in other settings. ‘Everything is done very well and she’s improved since she’s been here’. ‘He was in a lot of pain when he was first here but that is properly managed now and he’s much happier, and eating well’. ‘She is always treated sensitively and with respect and as an individual person’. The home operates the Monitored Dosage System for medicines management on behalf of the people living there and the examination of records and storage areas indicated everything to be generally satisfactory with clear procedures to be followed to ensure safety and consistency. However, there were instances where prescribing practice had been changed by the GP without these instructions being indicated on the record sheet, to be accompanied by the date and signature of the responsible nurse. As one of these instances involved a controlled drug, the implications for resident safety are quire serious. Maple Leaf House DS0000042716.V296639.R02.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected 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 the service. Residents at the home enjoy a life that they offers a range of stimulating and structured activities, with good contacts maintained with family and friends. Standards in the kitchen have been maintained, and the quality of meals is much appreciated. EVIDENCE: From a discussion with one of the home’s activities coordinators and with the visitors spoken to, the programme of social life at the home is developing well and residents join in where they are able. Some new activities have been tried since the last inspection visit – reflexology, life story books, simple domestic skills – and the coordinators have a room where they are able to carry out specific activities. Care staff are also involved with supporting activities in the communal areas and the home enjoys the regular involvement of 2 volunteers. As the home is operated by Methodist Homes there is good support for spiritual and religious activities, although an interest in this is not a requirement for living at the home. Examination of the menus at the home and discussion with kitchen staff indicated that a planned menu is provided at the home. Most meals are traditional in style to reflect the preferences of an older age group, and a Maple Leaf House DS0000042716.V296639.R02.S.doc Version 5.2 Page 13 choice is offered at all main meals with a cooked option additionally available for the teatime meal. Meals are based in principles of healthy eating, and fresh ingredients were in evidence in the kitchens and regular deliveries of food are made to the home; aspects of storage were satisfactory. Specific health needs are reflected within the catering arrangements, such as both weight loss and gain, diabetic problems and for those residents who require a softened or liquid diet. The residents mostly take their meals together in the 3 dining areas but some eat in their rooms and staff were observed giving direct assistance to those that needed it. Visitors reported that they are free to come to the home throughout the day and a good number were seen during the visit. The bedrooms are big enough to accommodate visitors but there is also a small sitting room on each wing for their use, which increases the options for privacy and bigger family groups. ‘I’m always very well received here and made to feel part of the home’ ‘I visit every morning and staff keep informed of anything that has happened’. They also reported that routines at the home were very flexible; for example, some late risers were seen having breakfast in the middle of the morning, which was their choice. The involvement of the Methodist Church network, as mentioned above, also increases community involvement of the home and allows residents a greater range of social contact. Maple Leaf House DS0000042716.V296639.R02.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be 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 the service. The home has comprehensive policy and procedures in relation to complaints and protecting residents from harm supported by a programme of staff training. Residents’ interests are additionally supported by outside professionals and family members. EVIDENCE: The home has a comprehensive complaints policy and procedure that has been centrally developed by the organisation and regularly updated. A copy of the policy is included in the Service Users Guide, which is given to residents and their representatives, and a summary is also on display at the home. The written records indicated that there had been no formal complaints made since the last inspection. The record of complaints is properly maintained so that monitoring of activity in this area can be carried out; all residents have family members or outside professionals looking after their interests. The home had a comprehensive policy on the protection of vulnerable people that had been developed by Methodist Homes; this also that includes reference to the procedures required by law and operated by the key public agencies, such as Social Services and the Police. A programme of staff training, organised by Social Services had been commenced and all care staff have now attended this which will enhance resident safety. Maple Leaf House DS0000042716.V296639.R02.S.doc Version 5.2 Page 15 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 the service. The home is clean, hygienic and offers good standards of comfort to residents in the bedrooms and communal areas. EVIDENCE: Observations made around the building during the visit and from discussion with the maintenance person indicated a planned approach to keeping the physical environment of the home in good order. He reported that he makes a weekly check of the entire building in order ‘ to keep on top of things’ and other staff and visitors reported that any faults and problems were always dealt with promptly and the building offered no safety risks. All residents are accommodated in single rooms with en-suite facilities and the standard of specialist equipment provided is high. The courtyard garden area is maturing steadily but had not been maintained at the time of the visit and was overgrown with weeds, reducing the facility for residents. The original design of the home had been made to a high standard, and specialist consultants had been employed who had advised on colour schemes and detailed features that Maple Leaf House DS0000042716.V296639.R02.S.doc Version 5.2 Page 16 made the home suitable for people with dementia who may be liable to be confused by their environment. The home was very clean and tidy, and free from odours at the time of this inspection. Relatives commented very favourably about the quality and speed of the laundry service of the home and all residents observed in the home wore clean and well-presented clothing. Maple Leaf House DS0000042716.V296639.R02.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to the service. The home is well staffed with experienced, skilled and knowledgeable people who are receiving regular training to help them assist residents in best ways. They join the home after the proper checks are made which make sure that only people who are right for the job look after the people living there. EVIDENCE: The staffing rota indicated that numbers of care staff on duty during the day are higher that the minimum required by law, and the staff spoken to confirmed this to be the case. Recruitment has continued to be successful at the home and records in the manager’s office indicated that staff vacancies at the home to be minimal. The acting manager reported that in fact overrecruitment had occurred and there were more staff in post than had been allowed for, which gives increased flexibility in providing care. A new post of deputy manager has been created but difficulties in recruitment to this post had resulted in a decision to leave it unfilled for the present. Progress has continued with the number of care staff completing a National Vocational Qualification (NVQ) at level 2 but the target is not yet achieved. It was recorded at 41 at the time of the inspection and the acting manager indicated that the target of 50 of care staff passing will be met later in 2006. From the examination of staff training records most staff had received training or updates in the ‘core’ health and safety subjects, with shortfalls for new staff in emergency first aid and food hygiene. Additionally only a few staff had been Maple Leaf House DS0000042716.V296639.R02.S.doc Version 5.2 Page 18 exposed to any training in respect of awareness of the needs of people with dementia. As this group is the one cared for at this home, knowledge of this subject will improve the skill and consistency of staff working. All staff have now received training in fire safety as required at a previous inspection. Examination of the files of the 2 newest staff indicated that recruitment and selection had been carried out properly and all checks required to ensure protection of the residents had been made. A copy of the staff contract was noted on each file; this contained details of the terms and conditions of their employment so that they have full knowledge of their rights and responsibilities as employees of the home. Maple Leaf House DS0000042716.V296639.R02.S.doc Version 5.2 Page 19 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 the service. The home has good systems of administration and management with the result that a homely, safe and open environment has been created. EVIDENCE: At the time of this inspection the home’s registered manager was on extended sick leave and a manager from another section of the provider organisation is covering her post, in an acting capacity. A number of comments were received from staff and regular visitors that this state of affairs had once again unsettled the running of the home and concerns were expressed that there were ‘undercurrents and bad feeling in the home at the moment’. In spite of this difficult transition period people were also saying that staff continued to provide a good service and were still willing to do ‘that little bit extra and to carry on doing their best’. Maple Leaf House DS0000042716.V296639.R02.S.doc Version 5.2 Page 20 As an organisation Methodist Homes is committed to providing a quality service and employs a number of systems to make sure that standards are monitored and maintained. Apart from an internal quality audit carried out by the home’s staff, in 2005 the organisation completed an extensive exercise called ‘Dementia Care Mapping’ with the help of outside consultants. This gave a very detailed picture of how care practices make an impact within the home, and offer guidance to staff and management on ways of improving. A direct survey of residents’ views was also carried out in 2005. A system of 1-to-1 staff supervision has been re-introduced so that they receive individual and confidential support from their manager and so that work can be monitored as well. Records indicated that this is fully established and the required frequency of meetings is being achieved for all staff. People from outside the home have recently audited records in relation the management of resident money. From an audit of Health and Safety practice in the home, records indicated that all matters were satisfactory in this area apart from the shortfalls in staff training, noted above. The maintenance person has developed a detailed programme of risk assessments and the provider organisation requires regular audits to be completed to ensure that monitoring standards remain high. Maple Leaf House DS0000042716.V296639.R02.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 Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Maple Leaf House DS0000042716.V296639.R02.S.doc Version 5.2 Page 22 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. 2. Standard OP3 OP9 Regulation 17 Schedule 3 13(2) Requirement All care files of people living at he home must contain a recent photograph. All changes to the administration of medicines indicated by the GP must be written up in full on the Record Sheet and signed and dated by the responsible person. The manager should achieve a qualification at NVQ level 4 (or equivalent) in management. Completion of the Registered Manager’s course will meet this recommendation. Timescale for action 31/07/06 31/07/06 3. OP31 9(2), 10(3) 30/09/06 Maple Leaf House DS0000042716.V296639.R02.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. 2. 3. Refer to Standard OP3 OP7 OP19 Good Practice Recommendations The assessments of the needs, prepared at admission to the home, should include details of the social history and previous life of the person coming to live at the home. All care records should include a photograph of the resident. Arrangement should be made to clear the gardens of weeds. Maple Leaf House DS0000042716.V296639.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Maple Leaf House DS0000042716.V296639.R02.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!