Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 26/06/06 for Maycroft Residential Home

Also see our care home review for Maycroft Residential Home for more information

This inspection was carried out on 26th 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

There is a stable staff group, which knows the residents and can provide the necessary care. There were adequate staff on duty on the day of inspection.The home provides residents with a suitable and safe environment, with comfortable furnishings and a large garden. The home provides safety measures in relation to residents leaving the building or their room at night. The inspector had lunch with the residents, who were seated in two dining rooms at small tables enabling conversations to take place. There was a choice of meal and it was presented well. Those resident who required some assistance were given individual attention. Specialist equipment to enable residents to maintain their independence when eating is provided by the home. The home is currently raising money for a minibus so that residents can have the opportunity to have trips out.

What has improved since the last inspection?

Care staff were busy but when spoken to they all felt the staffing levels were adequate to meet the needs of the residents. Medication Administration Records (MAR) sheets were completed satisfactorily and refusals were noted. This meets the recommendation from the last inspection. The staff files contained all the necessary records and checks. This meets the requirement from the last inspection. 8 Staff received First Aid training on 30th January 2006. This meets the requirement from the last inspection. The records required to be kept for each service user were in place on the files seen. This meets the requirement from the last inspection.

What the care home could do better:

The provision of suitable and varied activities is necessary to ensure residents have the stimulation and recreational facilities needed to promote their wellbeing. A programme of activities should be arranged, as far as practicable, with the residents and their families. Since all rooms have night sensors, allowing night staff to know which resident may need assistance, it would be good practice to have the resident and/or their relative to sign to agree this measure. It is understood that there are verbal agreements but a signed form would provide the necessary evidence. Where there are changes in medication made by the GP it would be good practice to put this information on the MAR sheet with who agreed the change and the date. This allows cross-referencing of the information in the GP notes.Care plans must be reviewed monthly and updated where necessary. This should also include risk assessments. It is understood that the home is currently updating all resident files to ensure compliance with the regulations and standards.

CARE HOMES FOR OLDER PEOPLE Maycroft Residential Home 73 High Street Meldreth, Royston Hertfordshire SG8 6LB Lead Inspector Alison Hilton Key Unannounced Inspection 26th June 2006 07:35 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 Maycroft Residential Home DS0000047648.V293035.R01.S.doc Version 5.1 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. Maycroft Residential Home DS0000047648.V293035.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Maycroft Residential Home Address 73 High Street Meldreth, Royston Hertfordshire SG8 6LB 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) 01763 260217 01763 260217 www.aermid.com Aermid Health Care Limited Joan Ogden Care Home 25 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (24), Old age, not falling within any other of places category (25) Maycroft Residential Home DS0000047648.V293035.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named service user under the age of 65 with a diagnosis dementia may be admitted 8th November 2005 Date of last inspection Brief Description of the Service: Maycroft is situated in the High Street in Meldreth, and within walking distance of the village amenities. The home is on 2 floors, with a passenger lift to the upper floor. The residents have a variety of sitting and dining areas, and sufficient space to move around the home. All rooms are single occupancy and there are currently no en-suite facilities. There are extensive gardens where service users can sit or walk, weather permitting and access has been improved, allowing more service users to enjoy the gardens if they choose. The home offers care to a maximum of 25 older people and older people with dementia. The cost of a placement is between £442 and £575 per week, with extra charges for hairdressing, chiropody and toiletries. Maycroft Residential Home DS0000047648.V293035.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection on Monday 26th June 2006 between the hours of 07:35 and 16:00. The inspector spoke to 10 residents, 7 staff and the manager. A tour of the home took place and records were seen. These included staff and resident files. Requirements from the previous inspection have been met. Resident and relative questionnaires were sent out and 13 were received prior to the inspection and 2 afterwards.. All relatives who completed the questionnaires felt welcome at the home, and were pleased with the overall care their relative received. 4 relatives felt there were occasions when there were not enough staff and 5 were not aware of the homes complaints procedure. Some comments made were “the home provides excellent care”, ” staff are friendly and welcoming”, and “their attitude to residents is understanding and caring”. A family member with or on behalf of the resident had completed the resident questionnaires, as most residents have a diagnosis of dementia or memory problems. 9 relatives questionnaires felt there were always sufficient staff but 7 said that there were only sometimes or usually sufficient staff. Only 5 felt that there were activities that they could take part in 10 felt this was the case sometimes and one felt there were no activities suitable for them. 8 residents always liked the meals and 8 usually liked them.12 usually knew who to speak to if they were not happy and 12 knew how to make a complaint. Some of the comments made in the questionnaires were, “ tea time meals can be poor”, “ lack of activities co-ordinator”, “ little stimulation”, “ staff are kind and caring”, “ staff shortages and lack of supervision”, and “ the meals are good and my relative eats better then they have ever done”. All these issues were discussed with the manager at the time of the inspection and will be reflected in the body of the report. There have been no complaints made to the home since the last inspection. There have been two Protection of Vulnerable Adults issues that have been dealt with according to the joint protocol between the Police, Social Services and Health. What the service does well: There is a stable staff group, which knows the residents and can provide the necessary care. There were adequate staff on duty on the day of inspection. Maycroft Residential Home DS0000047648.V293035.R01.S.doc Version 5.1 Page 6 The home provides residents with a suitable and safe environment, with comfortable furnishings and a large garden. The home provides safety measures in relation to residents leaving the building or their room at night. The inspector had lunch with the residents, who were seated in two dining rooms at small tables enabling conversations to take place. There was a choice of meal and it was presented well. Those resident who required some assistance were given individual attention. Specialist equipment to enable residents to maintain their independence when eating is provided by the home. The home is currently raising money for a minibus so that residents can have the opportunity to have trips out. What has improved since the last inspection? What they could do better: The provision of suitable and varied activities is necessary to ensure residents have the stimulation and recreational facilities needed to promote their wellbeing. A programme of activities should be arranged, as far as practicable, with the residents and their families. Since all rooms have night sensors, allowing night staff to know which resident may need assistance, it would be good practice to have the resident and/or their relative to sign to agree this measure. It is understood that there are verbal agreements but a signed form would provide the necessary evidence. Where there are changes in medication made by the GP it would be good practice to put this information on the MAR sheet with who agreed the change and the date. This allows cross-referencing of the information in the GP notes. Maycroft Residential Home DS0000047648.V293035.R01.S.doc Version 5.1 Page 7 Care plans must be reviewed monthly and updated where necessary. This should also include risk assessments. It is understood that the home is currently updating all resident files to ensure compliance with the regulations and standards. 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. Maycroft Residential Home DS0000047648.V293035.R01.S.doc Version 5.1 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 Maycroft Residential Home DS0000047648.V293035.R01.S.doc Version 5.1 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): 1,2,3,5,6 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to the home. Resident’s needs are fully assessed prior to admission ensuring the home to be a suitable placement. EVIDENCE: The home does not provide intermediate care. There was evidence on the two files seen of pre-admission assessments, which provided all the necessary information for the home to decide if it was suitable to admit the prospective resident. Contracts were seen and were signed by the residents’ relatives. The manager stated that residents and their relatives are welcome to visit and are actively encouraged to do so. Maycroft Residential Home DS0000047648.V293035.R01.S.doc Version 5.1 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): 7,8,9,10 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to the home. The individual plans of care provide the necessary information for staff to be able to care for the residents in the home. EVIDENCE: The files of three residents were inspected and found to contain all the necessary documents. There were photographs and where necessary charts relating to weight and pressure area care. This meets the requirement from the last inspection. The care plans were comprehensive but must be reviewed monthly and updated where necessary. This also applies to risk assessments. Any changes to the care of a resident must be updated to ensure all staff work with the resident for the best outcome in relation to their health and welfare. One file noted that the resident must be weighed fortnightly and there was evidence this was being done. On the other there was a weight loss of 6lbs over two weeks and the home was in contact with the GP, as any referrals to Maycroft Residential Home DS0000047648.V293035.R01.S.doc Version 5.1 Page 11 the dietician have to go through the surgery. There was a turning chart being completed for another resident and this was up to date and complete. There had been a medication change for one resident but no details on the Medication Administration Record (MAR) sheet as to who had changed the medication or when, however there was evidence in the GP notes that provided the evidence for this. In discussions with the manager it was suggested there be some cross-referencing so that it was evident immediately who made the change and when it had occurred. There was evidence of chiropody and district nurses and GP visits. Care staff were observed when dealing with residents and found to treat them with care and respect. Maycroft Residential Home DS0000047648.V293035.R01.S.doc Version 5.1 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): 12,13,14,15 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to the home. Residents are given opportunities to make choices so that they can take control of the way they lead their lives. EVIDENCE: The home does not have an activities co-ordinator and staff spoken to said they provided activities when they could. The manager said that individual likes and dislikes of residents are taken into account when thinking of activities within the home. She acknowledged that there were issues with the activities provided currently but still had an advert for an activities co-ordinator in place but there had been no applicants. She was informed of the comments made by the relatives of those residing in the home. The staff said that there are some outside entertainers that come in and that they did some games and quizzes, which the residents seemed to enjoy. The staff do also have time to sit and chat individually with residents and this is a valuable activity in itself and should be recorded formally. Maycroft Residential Home DS0000047648.V293035.R01.S.doc Version 5.1 Page 13 The questionnaires received showed that relatives felt welcome in the home and could speak privately with their relative. Residents spoken to said they had visitors and sometimes went out with them. They could not remember any activities provided by the home. Most residents have dementia and shortterm memory issues. It was discussed with the manager that there are specialist groups such as the Alzheimer’s Society, which provide ideas for suitable and varied activities for people with dementia. Residents said that they could get up and go to bed when they wanted. They agreed they had a choice of meals and like them. The meal on the day of inspection was mince, potatoes and greens or couscous and salad. The sweet was home made rice pudding and pears and/or yoghurt. There was an offer of extra for any resident that wanted it. The cook said that she prepares all meals and cakes and provides special cakes when it is a resident’s birthday. The manager said that the home is still advertising for a second cook, although care staff do support the present cook, but as kitchen assistants, and not as part of their care hours as at the previous inspection. Maycroft Residential Home DS0000047648.V293035.R01.S.doc Version 5.1 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): 16,18 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to the home. The home has an adequate complaints policy and procedure to ensure that complaints are dealt with appropriately. The home has followed the Adult Protection protocol on two occasions showing understanding of the protection of residents from abuse. EVIDENCE: The manager stated there have been no complaints since the last inspection. There is an adequate complaints policy and procedure that is provided in the homes statement of purpose and service user guide, but from the responses to the relatives’ questionnaire there are several who are not aware of it. In conversation with the manager it was suggested this was discussed at the next relatives meeting to ensure everyone is aware of the procedure. The home now keeps a record of all compliments paid to it and the staff working there. The manager stated that she is now a trainer in Protection of Vulnerable Adults (POVA) having completed the key practitioner course in January 2005 and updated in February 2006. Staff said they had completed the local authority POVA awareness course in February 2006. There have been two staff subject to investigation under POVA in the home and these have been dealt with according to the joint protocol. There have been two Protection of Vulnerable Adults issues that have been dealt with according to the joint protocol between the Police, Social Services Maycroft Residential Home DS0000047648.V293035.R01.S.doc Version 5.1 Page 15 and Health. The home has made a referral to the POVA list, which records the names of those who should not work with vulnerable people. Evidence on staff files showed that no staff member starts work without at least a POVA First check being completed and then a Criminal Record Bureau check (CRB) placed on file later. Maycroft Residential Home DS0000047648.V293035.R01.S.doc Version 5.1 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): 19,20,24,25,26 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to the home. The home provides a safe and well-maintained environment to ensure the welfare of residents. EVIDENCE: The home was clean and pleasant on inspection with no offensive odours. Specialist equipment is provided in the home where necessary and this includes special mattresses and hoists (in the bathrooms). There was evidence of other safety measures to provide a good level of protection for residents and these include stair gates and pressure mats in the bedrooms. One resident said her room was “kept spotless” and there was no evidence of dirt or dust in the rooms or bedrooms. The corridor carpet on the ground floor looks worn and in one area the join had frayed and could be dangerous for anyone who had a visual or mobility Maycroft Residential Home DS0000047648.V293035.R01.S.doc Version 5.1 Page 17 problem. On discussion with the manager it was suggested that for the safety of residents this carpet should be replaced. There are extensive gardens and residents spoken to said they enjoyed sitting outside when the weather permitted. Maycroft Residential Home DS0000047648.V293035.R01.S.doc Version 5.1 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): 27,28,29,30 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to the home. There are sufficient staff to meet the needs of the residents in the home. EVIDENCE: On the day of inspection the manager was on duty together with one head of care, three care staff, one cook, one administrator and two domiciliary staff. The rota showed that there is a minimum of four staff on during the day and two at night. The figures do not include the manager. Staff spoken to said that there are enough staff on duty but if there was an extra person am it would allow one person to concentrate on the medication and four to assist with personal care. Four staff have NVQ Level 2 and four staff are working towards it. Two members of staff are working towards NVQ Level 3. Staff said they had received updates on their mandatory training including dementia awareness. They all said the manager was open and inclusive with staff. The manager said that she has implemented a new system of recording training needs and this was shown to the inspector. This meets the requirement from the last inspection. Evidence on staff files showed that no staff member starts work without at least a POVA First check being completed and then a Criminal Record Bureau Maycroft Residential Home DS0000047648.V293035.R01.S.doc Version 5.1 Page 19 check (CRB) placed on file later. All other necessary documentation was on file. This meets the requirement from the last inspection. Maycroft Residential Home DS0000047648.V293035.R01.S.doc Version 5.1 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): 31,32,33,36,37,38 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to the home. Adequate measures are in place to ensure the health and welfare of residents in the home. EVIDENCE: Information on the pre-inspection questionnaire and inspection of records showed that all relevant checks to equipment such as the hoists, call system and lift had been completed. The Environmental Health Officer had last visited 23/1/06 and the Health and Safety Executive 22/4/06 with no requirements made. Weekly fire checks and lighting checks are completed. Maycroft Residential Home DS0000047648.V293035.R01.S.doc Version 5.1 Page 21 In June 2006 there was a fire safety awareness update for 17 staff. The homes accident book was checked and entries were adequate. Staff said that they received regular supervision and they would be quite happy to talk to the manager at any other time if they had an issue or problem. The manager said the home has regular relatives meetings where any issues can be discussed. The home does not have a quality assurance system in place to meet Standard 33. This was discussed with the manager and she will talk to her manager about how this can be completed. Maycroft Residential Home DS0000047648.V293035.R01.S.doc Version 5.1 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 CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X X X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 1 X X 3 3 3 Maycroft Residential Home DS0000047648.V293035.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP19 Regulation 13 (4) Requirement The registered person must ensure that all parts of the home to which residents have access are free from hazards to their safety. This is in relation to the ground floor corridor carpet, which is stained and frayed. The registered person must establish and maintain a system for reviewing and improving the quality of care at the home. Timescale for action 31/10/06 2 OP33 24 31/10/06 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 2 Refer to Standard OP7 OP12 Good Practice Recommendations The registered person should ensure that care plans are reviewed monthly and updated to reflect any changes. This also applies to risk assessments. The registered person should ensure that a variety of activities are provided to suit the needs of individual residents and that these are recorded. The records should include any 1-1 time spent with a resident and include DS0000047648.V293035.R01.S.doc Version 5.1 Page 24 Maycroft Residential Home 3 OP16 how this relates to individual well-being. The registered person should ensure that residents families understand the complaints procedure. Maycroft Residential Home DS0000047648.V293035.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB1 5XE 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 Maycroft Residential Home DS0000047648.V293035.R01.S.doc Version 5.1 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!