Inspection on 12/12/06 for Marillac

This inspection was carried out on 12th December 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

Marillac 07/02/06

Marillac 09/06/05

Marillac 18/11/04

Marillac 22/06/04

Marillac 03/11/03

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

CARE HOME ADULTS 18-65 Marillac Eagle Way Brentwood Essex CM13 3BL Lead Inspector Helen Laker Unannounced Inspection 12th December 2006 11:00 Marillac DS0000015544.V316209.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Marillac DS0000015544.V316209.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Marillac DS0000015544.V316209.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Marillac Address Eagle Way Brentwood Essex CM13 3BL 01277 220276 01277 221472 sreleanor@marillac.co.uk 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) Daughters of Charity Sister Eleanor Rodgers Care Home 50 Category(ies) of Physical disability (50), Physical disability over registration, with number 65 years of age (6) of places Marillac DS0000015544.V316209.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th February 2006 Brief Description of the Service: The Marillac is a care home with Nursing for Younger Adults who have physical disabilities and is registered with Commission for Social Care for the continuing care of 50 men and women with varying degrees of physical disabilities. The Home is located near Thorndon Country Park on the outskirts of Brentwood and is set in four acres of grounds. The M25, the A12 and Brentwood railway station are in close proximity. The building has been extended and adapted to provide three purpose built units, to provide a homely atmosphere for the service users and families. Trained nursing staff and carers are available for the provision of personal and nursing care. Physiotherapists and therapy assistants are also employed to provide therapies and treatments. There is a consultant physician who attends the Home weekly. Parking is available to the front and rear of the building. The home was first registered in July 2002 The Service User Guide and Statement of Purpose are available and are updated as required. The residents and their representatives are provided with this information and also the latest Commission for Social Care Inspection reports which are available on all units. At the time of this report the manager confirmed that the fees ranged from £910.00 to £1295.00 per week and a comprehensive pre inspection questionnaire was provided. Marillac DS0000015544.V316209.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine, unannounced inspection which took place over one day with one inspector in the home. There was a tour of the premises and grounds and an inspection of records and documentation. Time was spent discussing the care of the service users. The director in charge of the day to day management of the home and the deputy director were spoken with. Further feedback was also received from service users and care staff through survey and discussion. Responses have been included in the relevant sections of the report. A pre-inspection questionnaire and other reports and correspondence provided by the staff on duty were also used as evidence to inform this report. Twenty five National Minimum Standards were inspected on this occasion, twenty five overall outcomes were met and all requirements and recommendations detailed in the previous inspection report were met. Discussion of the inspection findings took place with the director in charge of the day to day management of the home and the deputy director at the end and throughout the inspection and guidance was given. What the service does well: What has improved since the last inspection? Medication administration and recording is being addressed appropriately. Recruitment procedures where shortfalls previously were evident have been addressed and are generally robust Supervision is undertaken on a regular basis and yearly appraisals for staff have been implemented The registration of the manager still has been finalised and processed Care planning and the initial and ongoing assessment of service users has improved and is being maintained. The health needs of service users are very well met and improved documentation now ensures clarity of needs. A large amount of refurbishment to the external and internal fabric of the home has been ongoing and is detailed in the body of this report. Marillac DS0000015544.V316209.R01.S.doc Version 5.2 Page 6 Activities, social activities and individual lifestyle continuance is encouraged and thoroughly enjoyed by service users, staff and relatives alike. 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. Marillac DS0000015544.V316209.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Marillac DS0000015544.V316209.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Present and prospective service users and their supporters are given adequate information about the home so that they can make informed choices. The admission procedure includes an adequate assessment which ensures that service users needs can be met. The home provides a caring environment where visitors are made welcome. EVIDENCE: Two of the homes most recent admissions, pre admission documentation were inspected. Detailed assessments of nursing and welfare needs had been completed prior to their admission to the home with the input of the service user where this was possible. There were also adequate records in respect of the assessment of these service users’ care and welfare needs carried out upon the service users admission to the home. There was evidence that service users health and welfare needs were reviewed on a regular basis and that other professionals such as physiotherapists, occupational therapists, dieticians etc are involved in reviews and assessments as appropriate. The home also has an in house counselling service. Service users needs and preferences in respect of social, cultural and religious beliefs were recorded and service users are supported in meeting these needs Marillac DS0000015544.V316209.R01.S.doc Version 5.2 Page 9 Due to the nature of the healthcare needs of service users at the Marillac unplanned admissions are not usually accepted. Marillac DS0000015544.V316209.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Each service user has an individual plan and service users are supported to take risks as part of an independent lifestyle via a process of assessment. The care planning process ensures that service users needs are met. The health needs of service users are well met and improved documentation now ensures clarity of needs. Personal support is provided in a way that promotes dignity. EVIDENCE: Marillac DS0000015544.V316209.R01.S.doc Version 5.2 Page 11 Care plans for three newly admitted and present service users were assessed. These were noted to be much improved since the last inspection in respect of how each service users nursing, care and social need were to be met including service users perceptions of care needs, preferences in respect of service users capabilities and activities of daily living such as times for getting up and going to bed, method and times for maintaining personal hygiene etc. All care plans, which were assessed, were noted overall to be reviewed on a regular basis and according to changes in service users needs. Where changes to treatment or care were necessary this was recorded within the plan and there was evidence that wherever possible service users were involved in planning and reviewing care plans. The home is aiming to ensure all care plans are person centred and reflect the homes essence of care and themed benchmaking system. Service users living at the home have very high nursing and physical care needs. As a result the majority of these service users rely on staff working at the home to protect their welfare. Service users who can make decisions are encouraged to do so and are supported according to their needs. Consent issues regarding sensor mats in service users rooms were discussed with the director and deputy director at the last inspection and are being addressed, with monitoring logs in place at night. There was evidence that service users and their relative or representatives where appropriate were offered opportunities to participate and contribute to the running of the home wherever this was practicable. Service users have the opportunity to attend regular meetings where proposed changes to the running of the home, which would have a direct effect on service users, are discussed. Minutes are kept and are also in large print. At the previous to last inspection the deputy director discussed her plan to develop the care plans and risk assessments, as she was aware that the present system could be improved and provide more detail and clearer instructions for staff, this has now been progressed and better clarity in care plans is now seen. Advice regarding restraint issues has been acted upon and appropriate documentation implemented. There was evidence that service users were encouraged to take responsible risks and detailed assessments of risks including actions to minimise or prevent unnecessary harm to service users were overall generally well maintained. Staff spoken with during this inspection could demonstrate that they understood the homes policy in respect of information given by service users and confidentiality issues. A policy was seen and staff confidentiality agreements discussed. It is recommended that confidentiality agreements are agreed with all staff upon their commencement of employment with the home. Information kept in the home, which related to service users is maintained securely. Each unit now has a unit clerk in post and a computer system to enable internal e mailing and the move to a less paper electronic process. The policy has been updated to reflect this. Marillac DS0000015544.V316209.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Social and educational activities take place and service users are very happy with the choices in routine available to them. Visitors are made welcome and overall the service user’s rights and responsibilities are recognised in their daily lives. EVIDENCE: Marillac DS0000015544.V316209.R01.S.doc Version 5.2 Page 13 Service users at the home who can access local amenities have access to a wide range of training courses at local colleges and staff encourage service users to pursue courses and activities according to personal choices and capabilities. At present five service users attend adult education. The home provides suitable transport with specially adapted vehicles and has just purchased another small mini bus. The home has an activities co-ordinator from Monday to Friday. A Christmas fayre, concerts and parties are underway. Service users are taken christmas shopping and musical entertainment including a cello player, a pianist and irish singers is planned. Some service users also went to Lourdes for a holiday this year. It was reported that service users who cannot access activities in the Community have one to one time with staff including use of the homes sensory room and computer suite. A designer has been commissioned to develop a new large sensory garden and the home is currently raising funds to facilitate this. The majority of service users living at the home have very complex care needs and cannot access the community. The Deputy Director previously stated that opportunities have been explored for service users living at the home to attend day centre facilities and at present two service users do. Service users families and friends are welcomed at the home and the input of volunteer groups and individuals is positively encouraged. Daily routines are tailored to the individual needs of service users according to their assessed wishes which are recorded wherever this is practicable. As in the previous four inspections service users spoken with have commented in a very positive manner about the food provided by the home. Records in the form of daily ‘food diaries’ were maintained in respect of the foods eaten by service users living at the home. These included service users comments made in respect of the quality of food provided. Service users who require specialist diets and therapeutic feeding programmes have care plans in place. Marillac DS0000015544.V316209.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that the health care needs of service users are identified and met. EVIDENCE: Marillac DS0000015544.V316209.R01.S.doc Version 5.2 Page 15 The input of specialist support from physiotherapists and occupational therapists is adequate for the needs of the service users living at the home. On Since the last inspection a part time OT has been employed and two physio’s one full time and one part time Two relatives raised concerns that in particular there was not enough physiotherapy support previously this has now been rectified. Two therapy assistants help both the physio and the occupational therapist. In addition to this the home has input from opticians, chiropodists, tissue viability, parkinson’s, epilepsy and MS nurse advisors. Aromatherapists, reflexologists, beauticians and also a hairdresser visit the home. There was evidence that pressure sores were being managed satisfactorily and the monthly log had been kept up to date. Nursing staff at the home are trained to manage a variety of medical conditions, which reduces the need for hospital admissions, which is very good practice and a medical practitioner reviews Service users on a weekly basis. The majority of service users living at the home cannot manage their own medication. Service users who are capable have detailed assessments of potential of risks in place, which are reviewed as required. Training updates are planned and ongoing for all nursing staff. Medication Administration Records were noted to be satisfactory. Marillac DS0000015544.V316209.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good 22, 23 This judgement has been made using available evidence including a visit to this service. The home has an appropriate complaints policy which informs complainants of their rights and assures them their complaint will be taken seriously. Staff are trained and aware of the issues relating to the protection of vulnerable adults. EVIDENCE: The inspector was informed that the homes records in respect of complaints would now include details of the time taken to investigate and respond to the complainant, and the outcomes. Although documentation is kept, and it is acknowledged that the home receives very few complaints, it is advised that a log still be kept. Complaints previously received have been thoroughly investigated and the complainant had been kept involved and informed of actions throughout the process. Most staff approx 50 to 60 working at the home have undertaken training regarding the protection of vulnerable adults and that information had been made available to staff who had yet to undertake this training. The home now has three staff who deliver the training also including the Deputy manager. Staff spoken with during this inspection could readily demonstrate that they understood what actions to take if there was any incident of witnessed or suspected abuse of service users living at the home. Marillac DS0000015544.V316209.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent 24, 30 This judgement has been made using available evidence including a visit to this service. The Marillac was clean and bright and airy and provided the service users with excellent homely and comfortable surroundings. EVIDENCE: The home is presented in an attractive and comfortable way and adequately meets the current needs of the service users. A huge amount of improvements have been done, are underway or planned Since the last inspection double glazing is now planned for the another section of the building and the front has already been done. The front hall has been refurbished, new furniture bought and all woodwork french polished. The water tanks have all been replaced. St Louise’s unit has had the main corridor, office and clinical room re papered, and bumper rails replaced. St Vincent’s unit has had a new corridor carpet, walls redecorated and art purchased to display. St Catherine’s unit has had a new clinical room. Some bedrooms have been redecorated and there is an ongoing programme of decoration. In addition all patios and pavements have been scrubbed. The flat roof has been replaced and the chimney repointed. The garden is to be developed into a sensory Marillac DS0000015544.V316209.R01.S.doc Version 5.2 Page 18 haven and a designer is already commissioned to see the project through to it’s finality A central stores system has been put in place and the home’s website www.marillac.co.uk has been relaunched. All areas of the home were noted to be maintained to a very high standard of cleanliness and hygiene and there were no offensive odours detected during the time of this inspection and cleaning staff are on at all times and separate laundry facilities available. Marillac DS0000015544.V316209.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good 32, 34, 35, 36 This judgement has been made using available evidence including a visit to this service. Good recruitment policies and practices were in place and practices evidenced. The home has an effective and competent staff team who receive training to the required standard. Supervisions and appraisals are in place and ongoing. EVIDENCE: Staff recruitment files for three members of staff were assessed. Improvements were noted and it is evident that the home operates a robust procedure and process for the recruitment of staff. Appropriate references, Criminal Records Bureau (CRB) disclosures and proof of individual’s identity were in place. Detailed records were maintained in respect of staff interviews and there was evidence that staff complete a probationary period before a decision is made to offer a permanent position. Detailed contracts of terms and conditions of employment and clear job descriptions were seen and are included in all staff’s files. Staff spoken with during this inspection demonstrated that they were fully aware of their roles and responsibilities within the home. Staffing has been Marillac DS0000015544.V316209.R01.S.doc Version 5.2 Page 20 restructured within a banding structure in line with the concept of agenda for change. Staff have the competencies and qualities required to meet service users’ needs and achieve Sector Skills Council workforce strategy targets within the required time-scales. Staff supervision records, which were assessed, were improved and detailed. Appraisals at the home are being done and staff working at the home do overall receive regular supervision, which meets the current national minimum standards. Marillac DS0000015544.V316209.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent 37, 39, 42 This judgement has been made using available evidence including a visit to this service. There is guidance and direction to staff and the home has in place practices that will promote and safeguard the health, safety and welfare of the people using the service. Health and safety fire requirements such as drills have been maintained regularly. EVIDENCE: Sr. Eleanor Rogers the home’s director has been back in post since October 2005 and is managing the day-to-day running of the home. She is a dual registered general nurse and in learning disabilities. She is also a registered nurse tutor with 40 years experience in the nursing field. An application has been processed by the Commission for her to be registered as the homes manager and approved and she is now registered. Marillac DS0000015544.V316209.R01.S.doc Version 5.2 Page 22 Regular meetings with service users and staff are held and the minutes of these were available for inspection. Service users, staff and visitors who were spoken with all confirmed that the home was managed in a manner which was open and promoted free exchanges of views, comments and suggestions. Records in respect of the service were noted to be maintained and stored appropriately. Certificates in respect of service and maintenance of gas, electric (including portable appliance testing), lifting and fire safety equipment at the home were noted to be satisfactory at the home’s previous inspection. Fire drills are now being regularly documented and undertaken and attendees names documented. A consultation with a private company representative, regarding fire safety and risk assessment was being undertaken on the day of inspection, this was to ensure the home is compliant with legal fire requirements. The home has a business plan for the management of the service which was available. There was evidence that the business is financially viable. There is a group of financial staff within the organisation and there appears to be efficient management of the business. Marillac DS0000015544.V316209.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 Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 4 3 3 LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 X 4 X 3 X X 3 X Marillac DS0000015544.V316209.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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Marillac DS0000015544.V316209.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 Marillac DS0000015544.V316209.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!