Inspection on 06/09/07 for Meadow, The

This inspection was carried out on 6th September 2007.

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

Meadow, The 02/08/06

Meadow, The 14/11/05

Meadow, The 25/07/05

Meadow, The 05/10/04

Meadow, The 01/06/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Meadow, The Meadow Drive Muswell Hill London N10 1PL Lead Inspector Mr David Hastings Key Unannounced Inspection 09:30 6 and 7 September 2007 th th 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 Meadow, The DS0000010726.V350234.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Meadow, The DS0000010726.V350234.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meadow, The Address Meadow Drive Muswell Hill London N10 1PL 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) 020 8883 2842 020 8442 1394 home.mus@mha.org.uk home.fxg@mha.org.uk Methodist Homes for the Aged Bridget Anne Clarence-Smith Care Home 40 Category(ies) of Dementia - over 65 years of age (0), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (0), Old age, not falling within any other category (0), Physical disability over 65 years of age (0) Meadow, The DS0000010726.V350234.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home only – Code PC To service users of the following gender: Either Whose primary care needs on admission the the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE(E) Physical Disability - Code PD(E) Mental Disorder, excluding learning disability or dementia - Code MD(E) The maximum number of service users who can be accommodated is: 40. 2nd August 2006 2. Date of last inspection Brief Description of the Service: The Meadow is a residential home run by Methodist Homes for the Aged. There are two floors, the ground floor provides care and support to sixteen older people with dementia and the first floor provides care and support to older people. One of the units on the first floor is currently admitting service users with mild dementia. Staffing levels have increased and it is the expectation that as a service user’s dementia becomes more progressive they could be moved to the ground floor unit with the minimum of disruption and distress. All rooms are single and have en-suite facilities. There is a lift to the first floor. The dementia unit is within a safe area, which includes a spacious and easily accessible garden. The first floor has a balcony and sun terrace and is divided into smaller wings, each with a separate dining area. There is a large communal lounge. The home is decorated to a high standard and is well maintained. Meadow, The DS0000010726.V350234.R01.S.doc Version 5.2 Page 5 The aim of the home is; To improve the quality of life for older people inspired by Christian concern. The home bases its care service on seven core principles Privacy, Dignity, Independence, Choice, Rights, Fulfilment and Spirituality. The current scale of charges range from £561 to £648 per week. A copy of this report is available on the CSCI website or/and from the home. Meadow, The DS0000010726.V350234.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on 6th and 7th September 2007 and lasted eight and a half hours. We were assisted throughout the inspection by the deputy manager who was both open and helpful. We spoke with six staff on duty during the inspection. We spoke with fourteen residents of the home and observed the interactions between staff and residents. We also spoke with two visitors to the home. We inspected the building and examined various care records as well as a number of policies and procedures. The residents we spoke with said they were very satisfied with the care and support they received. One resident told us, “It’s very nice here”. What the service does well: What has improved since the last inspection? What they could do better: Although the recording of medication has improved one requirement has been issued relating to medication that the home receives mid month from doctors. Any medication received by the home on behalf of a resident must be accurately recorded. Four good practice recommendations have been issued as a result of this inspection. These relate to the new care plans developed by the organisation, the “Service user guide” and the home’s quality assurance systems. The CSCI is confident that these will be complied with by the organisation. Meadow, The DS0000010726.V350234.R01.S.doc Version 5.2 Page 7 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. Meadow, The DS0000010726.V350234.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Meadow, The DS0000010726.V350234.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 (6 not applicable) People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Good information is available to prospective users of the service about the home. Assessments are completed before people move in to make sure that their individual needs can be met. EVIDENCE: We looked at the “Service User Guide”. This gives people information about the home and services and facilities available. Although the information was very good it would be helpful to include a statement about how the home encourages people from different backgrounds to use this service. A good practice recommendation has been issued that the home reviews the service user guide to include an equal opportunities statement. Three assessments were examined of people who had recently moved into the home. These assessments were detailed and covered all the elements required by this Standard including the assessment of physical, emotional, social and cultural Meadow, The DS0000010726.V350234.R01.S.doc Version 5.2 Page 10 needs. We also found that the information from these assessments was being recorded on peoples’ care plans as well. There was evidence that people moving into the home have a review of their placement after four to six weeks to see if they are happy at the home and whether they decide to move in on a permanent basis. All the residents we spoke with said they were happy with the care they received. One person told us the staff were, “Very kind”. Meadow, The DS0000010726.V350234.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The staff at the home know the residents very well and how best to support them. Residents have good access to health care professionals and they are treated with respect. Residents get the medication they require, at the right times and by appropriately trained staff. EVIDENCE: Six people’s plans of care were examined. The organisation has recently developed a new care plan format and the staff are currently updating information in the new plans. The new format is detailed but complex and the staff said they were struggling to put the right information in the right sections. This was not having an impact on residents as the staff group is stable and staff interviewed had an excellent knowledge of the needs of the people they support. A recommendation has been issued that staff should get advice and support from the organisation in order to improve their confidence Meadow, The DS0000010726.V350234.R01.S.doc Version 5.2 Page 12 in completing the revised care plans. This could include an example of a completed care plan so staff are aware of the expectations of the organisation. There was evidence from care plans that people have good access to health care professionals such as doctors, chiropodists, district nurses and opticians. People who use the service confirmed that they had good access to health care professionals. Appropriate risk assessments were in place relating to moving and handling, pressure care, nutrition and other risks associated with dementia. People who use the service can remain with their own doctor as far as possible and there are five doctors’ surgeries that currently visit the home. Satisfactory records were examined in relation to the receipt, administration and disposal of medication with one exception. It was found that a persons medication which had been obtained mid month was not accurately recorded on the medication administration chart. A requirement relating to this has been made in the relevant section of this report. The deputy manager dealt with this matter immediately it was discovered that an error had been made. All other medication records were accurate and where medication had not been given a reason for this had been recorded on individual’s MAR charts. Two requirements from the last inspection have been complied with. Records indicated that staff have undertaken medication training and only qualified staff administer medication at the home. No one at the home currently manages their own medication. We saw a number of examples of good staff interactions with people and staff were able to give practical examples of how they ensure the privacy of people they support. We saw staff knocking on resident’s bedroom doors before entering. People we spoke with told us that the staff were respectful towards them. Meadow, The DS0000010726.V350234.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use this service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides varied activities for people who use the service in order to keep them suitably occupied and engaged. The home encourages visitors, which ensures an interesting and lively atmosphere. Residents are able to exercise choice and control over their lives. The home provides people with a wholesome appealing balanced diet. EVIDENCE: Residents’ likes and dislikes regarding activities are being recorded on their individual care plans. The home employs an activities coordinator who provides activities for people on the first floor as well as people in the dementia unit. The activities coordinator has recently completed training in dementia care and was able to explain how this has informed her provision of activities in the dementia unit. Staff also provide activities for residents they support. During the inspection staff were observed sitting and chatting with residents, which made for a friendly and relaxed atmosphere. It was clear that the residents and staff were enjoying each other’s company. In the afternoon the residents were enjoying a violin recital. Residents we spoke with were positive about the range of activities available to them and Meadow, The DS0000010726.V350234.R01.S.doc Version 5.2 Page 14 said they could choose to join in or not depending on how they felt. The home also organises religious services for residents at the home. People’s religious needs and wishes are recorded in their care plan. Residents had requested, at a previous meeting to say a prayer before each meal and staff now facilitate this. Visitors to the home told us that they felt welcomed by staff and were offered tea or coffee when they visited. Residents told us that they could have visitors at any time. The home has an open visiting policy and the record of visitors that was examined indicated that there were regular visitors to the home throughout the day and evening. One visitor commented, “I find the kindness of staff impressive”. On the day of the inspection a number of friends and family were visiting people at the home. The home has regular residents’ meetings and minutes examined indicated that residents have a say in how the home is run. The minutes also provided evidence that residents are consulted about the menus in the home. Staff we interviewed were able to give us practical examples of how they offer choice to people living at the home. One resident told us, “We can go out we just have to let the staff know”. People we spoke with confirmed that they had choice and control over their lives. The kitchen was inspected. The kitchen was clean, fridge and freezer temperatures were being recorded and there were sufficient amounts of fresh fruit and vegetables available. The fly screen had been replaced and a requirement relating to this, which was issued at the last inspection has now been complied with. The chef was interviewed and had a good knowledge of individual resident’s dietary needs and preferences. People who use the service confirmed that the food was good at the home and that they always get enough to eat. The lunch on the day of the inspection was steak and kidney pie or jacket potatoes. Lunch was relaxed and sociable and staff were offering discreet assistance where required. Meadow, The DS0000010726.V350234.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously and responded to in a professional manner. People at the home are protected from abuse by clear policies and procedures and by an appropriately trained staff team. EVIDENCE: A satisfactory complaints policy was seen on display in the home. People we spoke to said they had no complaints about the service. Three complaints were recorded in the last twelve months and records seen indicated that these were dealt with appropriately and according to the policies and procedures in place. The home has a policy and procedure in relation to safeguarding adults from abuse. Staff we interviewed were able to give us examples of how people could be at risk from abuse and their responsibilities in relation to reporting any suspicions of abuse at the home. The organisation has a clear, “whistle blowing” policy, which staff were aware of and was on display in the staff room. Training in the protection of vulnerable adults has taken place for staff. People who use the service told us that they felt safe at the home. Meadow, The DS0000010726.V350234.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use this service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is decorated to a high standard and provides a safe, comfortable and hygienic living environment for people using the service. EVIDENCE: A tour of the home took place and we visited some residents in their rooms. The home is decorated and maintained to a high standard and the deputy manager told us there were no major maintenance issues. The garden next to the dementia unit has now been landscaped and looked very nice. Residents were observed walking around and enjoying the space. Both the dementia unit and the garden space have been secured so residents cannot accidentally leave the home and get lost. All rooms have been furnished with the individual resident’s furniture and each room has an individual feel. All toilets and bathrooms contained paper towels and anti bacterial soap to reduce the risk of cross infection. Training records indicated that staff have Meadow, The DS0000010726.V350234.R01.S.doc Version 5.2 Page 17 undertaken infection control training and people who use the service said that the home was always clean. There were no offensive odours detected throughout the home. One resident commented, “Everywhere is very clean”. Meadow, The DS0000010726.V350234.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The staff at the home work very hard to meet the needs of the residents and are provided with good training opportunities to further enhance their knowledge and skills. Recruitment practices are sufficiently detailed in order to protect residents at the home. EVIDENCE: On the day of the inspection there appeared to be sufficient staff to meet the needs of people using the service. People that we spoke with confirmed that there were enough staff to meet their needs. The staffing rota was satisfactory. People we spoke with were very positive regarding the care they received from staff at the home. One person said, “I think of the staff as my friends”. Residents and visitors also told us that they appreciated the stability of the staff team and that this has improved the quality of care provided. There have been problems in the past with NVQ training for staff. These problems with the outside training organisation have meant that the numbers of staff with NVQ level 2 or equivalent is not as high as it could be. Currently eight out of twenty-six staff have this qualification. Records indicated that more staff are now undertaking this training. Meadow, The DS0000010726.V350234.R01.S.doc Version 5.2 Page 19 Training records that were examined indicated that staff have undertaken appropriate training and staff interviewed were able to give examples of recent training they had attended and how the training had informed their work practices. Staff were positive about the training opportunities available to them within the organisation. Staff files were examined. These all contained the required information such as written references, proof of identity and CRB disclosures. This should ensure that no staff are employed at the home who may not be suitable to work with vulnerable people. Meadow, The DS0000010726.V350234.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The deputy manager of the home knows the residents very well and understands their needs. Residents do have opportunities to have a say in how the home is run. Residents’ financial interests are being safeguarded. The health and safety of residents and staff are promoted and protected. EVIDENCE: The registered manager has resigned from her post and the deputy manager told us that the organisation had carried out interviews for a new manager of the home. When the new manager is in post they will have to apply to the CSCI to be registered. Staff, visitors and residents of the home were very positive about the deputy manager and senior management of the home. Meadow, The DS0000010726.V350234.R01.S.doc Version 5.2 Page 21 People told us that they felt the home was well run. The deputy manager said that a friends and relatives support group is being established at the home. The organisation has developed a clear and detailed quality assurance system. A good practice recommendation has been issued that the results of these surveys are summarised and made available to people using the service as well as other interested parties. The home also has regular resident and staff meetings. The deputy manager said that some residents from the dementia unit attend the residents’ meetings. A good practice recommendation has been issued that the organisation develops ways of assessing the quality of care provision in the dementia unit. This could take the form of one to one sessions or by carrying out “dementia mapping”. Dementia mapping is an observational exercise, which is designed to find out how people with severe cognitive impairment experience the service. A comment book kept at reception contained very positive remarks from relatives and visitors to the home. People who we spoke with confirmed that they had a say in how the home is run. The deputy manager said that a few residents manage their own finances but the majority have their finances managed by either their family or the local authority. Small amounts of money are held by the home on the residents’ behalf to pay for hairdressing and other minor purchases. Random samples of individual accounts were inspected. All money is held separately and each account contained a clear audit trail with receipts. The maintenance certificates were checked for the water system, nurse call, lift, hoist, electrical systems, gas safety and fire appliances and these were all in place. Satisfactory records were also seen in relation to fire safety. Staff undertake fire drills on a regular basis. Records indicated that staff are undertaking the required health and safety training. If anyone at the home has a fall this is recorded and a falls analysis is carried out regularly to highlight any potential patterns. Meadow, The DS0000010726.V350234.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X 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 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Meadow, The DS0000010726.V350234.R01.S.doc Version 5.2 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 OP9 Regulation 13(2) Requirement The registered person must ensure that all medication received as a result of a doctor’s visit is accurately recorded on the person’s Medical Administration Chart. Timescale for action 01/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The registered person should ensure that the home’s “Service user guide” includes an equal opportunities statement detailing how potential residents from diverse backgrounds are welcomed and encouraged by the home. The registered person should ensure that staff receive advice and support from the organisation in order to improve their confidence in completing the revised care plans. This could include an example of a completed model care plan so staff are aware of the expectations of the organisation. DS0000010726.V350234.R01.S.doc Version 5.2 Page 24 2. OP7 Meadow, The 3. OP33 The registered person should ensure that results of any quality monitoring of the home are summarised and made available to residents and other interested parties. 4. OP33 The registered person should ensure that the organisation develops ways of assessing the quality of care provision in the dementia unit. This could take the form of one to one sessions or by carrying out “dementia mapping”. Meadow, The DS0000010726.V350234.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 Meadow, The DS0000010726.V350234.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!