Inspection on 16/12/04 for Mercian House

Care Homes For Adults (18 – 65)Bamville Road (1)Ward End Birmingham West Midlands B8 2TJUnannounced Inspection15th December 2004 Commission for Social Care InspectionLaunched in April 2004, the Commission for Social Care Inspection (CSCI) is the single inspectorate for social care in England. The Commission combines the work formerly done by the Social Services Inspectorate (SSI), the SSI/Audit Commission Joint Review Team and the National Care Standards Commission. The role of CSCI is to: • Promote improvement in social care • Inspect all social care - for adults and children - in the public, private and voluntary sectors • Publish annual reports to Parliament on the performance of social care and on the state of the social care market • Inspect and assess ‘Value for Money’ of council social services • Hold performance statistics on social care • Publish the ‘star ratings’ for council social services • Register and inspect services against national standards • Host the Children’s Rights Director role.Inspection Methods & FindingsSECTION B of this report summarises key findings and evidence from this inspection. The following 4-point scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The 4-point scale ranges from: 4 - Standard Exceeded (Commendable) 3 - Standard Met (No Shortfalls) 2 - Standard Almost Met (Minor Shortfalls) 1 - Standard Not Met (Major Shortfalls) O or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable. ESTABLISHMENT INFORMATION Name of establishment Bamville Road (1) Address Ward End, Birmingham, West Midlands, B8 2TJ Email address Name of registered provider(s)/company (if applicable) Mrs Janice Hutton Mr Festus Hutton Name of registered manager (if applicable) Mrs Janice Hutton Type of registration Care Home No. of places registered (if applicable) 3 Tel No: 326 0491 & 688 5797 Fax No: 688 5797Category(ies) of registration, with (number of places) Learning disability over 65 years of age (3) Registration number E060000040 Date first registered 30th July 2002 Was the home registered under the Registered Homes Act 1984 as amended? Do additional conditions of registration apply ? Date of last inspection Date of latest registration certificate 30th July 2002 Yes NO 24/3/04 If Yes refer to Part CBamville Road (1)Page 1 Date of inspection visit Time of inspection visit Name of inspector Name of inspector Name of inspector Name of inspector 1 2 3 415th December 2004 09:00 am Susan Scully Brenda O’NeillID Code145480Name of specialist (e.g. Interpreter/Signer) (if applicable) Name of establishment representative at the time of inspectionKeeling HuttonBamville Road (1)Page 2 CONTENTSIntroduction to Report and Inspection Inspection Visits Brief Description of the Services Provided Part A: Summary of Inspection Findings Inspector’s Summary Statutory Requirements/Good Practice Recommendations from last Inspection Conditions of Registration Statutory Requirements/ Good Practice Recommendations from this Inspection Part B: Inspection Methods & Findings National Minimum Standards for Care Homes for Adults (18 – 65) 1. Choice of Home 2. Individual Needs and Choices 3. Lifestyle 4. Personal and Healthcare support 5. Concerns, Complaints and Protection 6. Environment 7. Staffing 8. Conduct and Management of the Home Part C: Part D: D.1. D.2. D.3. Compliance with Conditions ( if applicable) Provider’s Response Provider’s Comments Action Plan Provider’s AgreementBamville Road (1)Page 3 INTRODUCTION TO REPORT AND INSPECTION Every establishment that falls within the jurisdiction of the Commission for Social Care Inspection (CSCI) is subject to inspection, to establish if the establishment is meeting the National Minimum Standards relevant to that setting and the requirements of the Care Standards Act 2000 as amended. This document summarises the inspection findings of the CSCI in respect of Bamville Road (1). The inspection findings relate to the National Minimum Standards (NMS) for Care Homes for Adults (18-65) published by the Secretary of State under the Care Standards Act 2000. The Regulations applicable to the inspected service are secondary legislation, with which a service provider must comply. Service providers are expected to comply fully with the National Minimum Standards. The National Minimum Standards will form the basis for judgements by the CSCI regarding registration, the imposition and variation of registration conditions and any enforcement action. The report follows the format of the NMS and the numbering shown in the report corresponds to that of the Standards. The report will show the following: • • • • • • • • Inspection methods used Key findings and evidence Overall ratings in relation to the standards Compliance with the Regulations Required actions on the part of the provider Recommended good practice Summary of the findings Providers response and proposed action plan to address findingsThis report is a public document. INSPECTION VISITS Inspections are undertaken in line with the agreed regulatory framework with additional visits as required. This is in accordance with the provisions of the Care Standards Act 2000. The following inspection methods have been used in the production of this report. The report is based on the findings of the specified inspection dates.Bamville Road (1)Page 4 BRIEF DESCRIPTION OF THE SERVICES PROVIDED Bamville Road is a 100 year old, domestic style end of terrace property situated in a residential area and in close proximity to a school within the Ward End vicinity of Birmingham. The home offers accommodation to three people with learning difficulties who have lived at the home for a significant number of years. The facilities include lounge, dining room, kitchen, laundry, rear garden, one ground floor and two first floor bedrooms and a small office. The bedrooms vary in size and one was noted to be quite small. The registered manager has arranged a sheltered area with seating within the rear garden for the service user who smokes; the facility permits staff observation from the kitchen window. There are no off road parking facilities. The first floor of the home was extended approximately 5 years ago with a view to increasing the accommodation to six service users; to date this has not been progressed although an application was submitted two years ago as it does not meet the existing standard and the application is unresolved. The home is well situated for local amenities, being close to bus and train routes and Ward End shopping facilities. Care is offered with normal lifestyle principals and service users are allowed to go out unaccompanied.Bamville Road (1)Page 5 PART ASUMMARY OF INSPECTION FINDINGSInspector’s Summary (This is an overview of the inspector’s findings, which includes good practice, quality issues, areas to be addressed or developed and any other concerns.) On the day of the visit the manager was taking one service user to the doctors. The manager was the only member of staff on duty. The manager told the inspectors that one member of staff had phoned in sick that morning. The assistant manager called into the home and remained to assist the inspectors with the inspection. The inspectors did not have the opportunity to speak with service users as the manager took all service users to the doctors with the one service user who had an appointment. The report will show that most of the records were not available. The visit was disappointing, as the inspectors could not complete a true reflection of the home and the experience and expectation of service user’s living at the home. The requirements out standing from the last inspection are carried forward as the assistant manager was unable to produce the records required to complete an accurate assessment of the standards. A further visit will be completed to ensure compliances with the requirements left at the last inspection and the NMS (national minimum standards).Bamville Road (1)Page 6 Requirements from last Inspection visit fully actioned? If No please list belowNOSTATUTORY REQUIREMENTS Identified below are areas not addressed from the last inspection report which indicate a non-compliance with the Care Standards Act 2000 and accompanying Regulations. The code in “Standard” is a cross-reference to the Standards described in full in the section “Inspection Findings”. No. Regulation Standard Required actions Timescale for action The home must develop comprehensive care plans following consultation with service users, that meet all aspects of service users needs; such documentation is subject to review at least every six months or when circumstances change. The home must document within the care plans the process regarding the right of service users to make informed decisions. The home must demonstrate how service users are encouraged and offered opportunities to participate in the day-to-day running of the home and to contribute to relevant policies and procedures.115 (1) (2) (a) to (d)YA630/6/04212 (2)YA730/6/04324 (1) (a) & (b)YA830/6/04413 (4) (a) to (c)YA42YA9The home must undertake risk assessments for service users (with specific details on health conditions such as Epilepsy, Diabetes and Poor Mobility), staff, the premises, food, and fire and infection control. Such documentation 11/6/04 is subject to regular review or when circumstances change. All risk assessments must be dated and signed by staff and service user if possible and / or next of kin. The home must collate the duty rota to comply with the Working Time Regulations 1998.517(2) schedule 4 18 (1) (a)YA33Requirement of Last Inspection and not assessed at this inspection and is carried forward.11/6/04Bamville Road (1)Page 7 619 (1) to (5) Schedule 2 17(2) Schedule 4(6)(e)YA34The home must operate a robust recruitment system by obtaining completed application form, two satisfactory references, photocopies of birth certificate and passport, a photograph and CRB check before employment is offered. The home must develop and provide all staff with job descriptions. The home must provide a structured programme of induction that reflects the content of the LDAF training and demonstrate that such has been carried out. Requirement of Last Inspection and not assessed at this inspection and is carried forward.31/5/04 and ongoing 31/5/04 and ongoing7YA31818 (1) (c)YA3531/5/04 and ongoing923(4)(a)(c)YA42The home must undertake and document monthly checks of the emergency lighting system. The home must develop all required policies and procedures as listed in Appendix 2 of the National Minimum Standards. Such documentation is subject to review at least annually or when circumstances change. Requirement of Last Inspection and not assessed at this inspection and is carried forward. The home must compile an inventory of each individual’s personal belongings, such documentation requires ongoing up dating. Requirement of Last Inspection and not assessed at this inspection and is carried forward. The home must document the opportunities offered to service users to maintain and develop social, emotional, communication and independent living skills. The home must document the range of leisure activities offered to service users and their personal preferences.31/5/041012(1)YA4030/7/041117 (2) Schedule 4 (10)YA2331/5/041216 (2) (m)YA1130/6/041316 (2) (m) & (n)YA1430/6/04Bamville Road (1)Page 8 1423 (2) (i)YA15Details of links with family and other relevant persons must be documented within individuals care plans. The fire procedure requires further development to include what to do, how to raise the alarm, how to move service users and the designated person for each shift. Staff must receive training in Adult Protection by a person competent to do so and a record of such training must be maintained for inspection. A person competent to do so must provide staff with training in epilepsy awareness. The home must maintain records of such training for inspection. A person competent to do so must provide staff with training in diabetes awareness. The home must maintain records of such training for inspection. Staff must receive formal supervision at least six times per year (pro rata for part time staff) that is fully documented; an annual appraisal must also be included. The home must develop a statement of purpose and on completion of such document forward a copy the CSCI. Requirement of Last Inspection and not assessed at this inspection and is carried forward. The home must develop a service user guide in an accessible format and on completion supply a copy to each service user. Requirement of Last Inspection and not assessed at this inspection and is carried forward. The home must provide each service user with a contract/statement of terms and conditions as specified within Standard 5.230/6/041523 (4 )YA4230/5/041618(1) 13 (6)YA2330/6/041718 (1) (c)YA3530/6/041818 (1) (c)YA3530/6/041918 (2)YA3630/6/042017 (1) Schedule 4 4 (1) (a) to (c) 4 (2)YA130/5/04215 (1) (a ) to (f ) 5 (2)YA130/5/04225 (1) (c)YA530/5/04Bamville Road (1)Page 9 2318 (2)YA33The home must hold staff meetings at least six times per year and the minutes collated circulated accordingly. Requirement of Last Inspection and not assessed at this inspection and is carried forward. The home must provide two comfortable chairs in each bedroom. Unless it is the service users wish or a risk assessment states otherwise. This must then be recorded on a care plan and subsequently reviewed. Requirement of Last Inspection and not assessed at this inspection and is carried forward. The home must provide staff with training in the ageing process by a person competent to do so. The home must maintain records of such training for inspection. The home must arrange for an electrical wiring examination to be carried out and a copy of the certificate forwarded to the NCSC. Requirement of Last Inspection and not assessed at this inspection and is carried forward. The home must develop a policy regarding COSHH and maintain a file on the COSHH products used within the home, including data sheets and Risk Assessments. Activity programmes must be developed for service users that includes information of how the Service User was assessed and what outcome the activity is to achieve. The home must consult service users views, likes and dislikes and include them where safe or risk assessed, with regular review into Care Plans and Activity Programmes. All staff must with support and sensitivity to service user Health and Safety consult the service user, giving information as to why certain decisions must be taken by the Manager to protect where reasonable the Health and Safety of service users and staff.30/7/042416 (2) (c)YA2630/7/042518 (1) (c)YA2130/6/042613 (4) (a)YA42Immediate and ongoing2713 (4)YA42Immediate and ongoing2816(m)(n)YA1130/6/042916(m)(n)YA1430/6/043018(1)(a)YA31YA4 2Immediate and ongoingBamville Road (1)Page 10 3118(1) 13(2)YA20The manager must make arrangements for all staff involved in the receipt, storage, administration, recording, handling and disposal of medication to complete an Accredited Medicines Training course. All certificates must be retained on staff files for inspection. The home must complete a Risk Assessment for any Service User self administering medication, ensuring regular reviews take place, this must also include Compliance Checks. The home must detail within its Statement of Purpose the arrangements made for dealing with complaints. The homes Adult Protection Procedure must be reviewed and amended to comply with the “No Secrets” document issued by the Dep’t of Health. The home must record fridge and freezer temperatures everyday and retain records. Any item of food removed from its original packaging must be labelled and dated when it is put back in the fridge. The home must have a current staff rota in place and retain all previous rotas, these must be made available for inspection All Risk Assessments for the building must be dated and signed, dates of review and comments must be included.27/8/043213(2)YA2030/6/04334(1)(c)YA2230/5/043413(6)YA2330/6/043513(3), 16(2)(g) 13(4)(c) 16(2)(g) 17(2) schedule 4 (7) 13(4)(a)(c)YA30Immediate and ongoing Immediate and ongoing Immediate and ongoing 30/6/0436YA3037YA3338YA423923(4)(a)(b) YA42 (c)(d)(e) 23(4)(a)(e) YA42The homes Fire Risk Assessment must be 30/5/04 completed and all staff informed of its contents. The home manager must identify which member of staff on duty is designated to deal with emergencies such as fire. Immediate and ongoing40Action is being taken by the Commission for Social Care Inspection to ensure compliance in regard to the above requirements. RECOMMENDATIONS Identified below are recommendations from the last inspection that have not been implemented Bamville Road (1) Page 11 No.Refer to StandardGood Practice RecommendationsCONDITIONS OF REGISTRATION THAT APPLY (OTHER THAN NUMBERS AND CATEGORY OF SERVICE USERS).MET (YES/NO)Bamville Road (1)Page 12 STATUTORY REQUIREMENTS IDENTIFIED DURING THE INSPECTION Action Plan: The Registered Person is requested to provide the Commission with an Action Plan, which indicates how requirements are to be addressed with the time scale within which such actions will be taken. This action plan will be made available on request to the Area Office.STATUTORY REQUIREMENTS Identified below are areas addressed in the main body of the report which indicate noncompliance with the Care Standards Act 2000, and accompanying Regulations 2001, and the National Minimum Standards. The Registered Provider(s) is/are required to comply within the given time scales. The code in “Standard” is a cross-reference to the Standards described in full in the section “Inspection Findings”. No. Regulation Standard * Requirement Timescale for action The home must develop comprehensive care plans following consultation with service users, that meet all aspects of service users needs; such documentation is subject to review at least every six months or when circumstances change. The inspectors were unable to assess compliance; records were not available for inspection. The home must document within the care plans the process regarding the right of service users to make informed decisions. The inspectors were unable to assess compliance; records were not available for inspection. The home must demonstrate how service users are encouraged and offered opportunities to participate in the day-to-day running of the home and to contribute to relevant policies and procedures. The inspectors were unable to assess compliance; records were not available for inspection.115 (1) (2) (a) to (d)YA61/2/05212 (2)YA71/2/05324 (1) (a) & (b)YA81/2/05Bamville Road (1)Page 13 413 (4) (a) to (c)YA9The home must undertake risk assessments for service users (with specific details on health conditions such as Epilepsy, Diabetes and Poor Mobility), staff, the premises, food, and fire and infection control. Such documentation is subject to regular review or when circumstances change. All risk assessments must be dated and signed by staff and service user if possible and / or next of kin. The inspectors were unable to assess compliance; records were not available for inspection. The home must collate the duty rota to comply with the Working Time Regulations 1998.1/2/05517(2) schedule 4 18 (1) (a)YA33The inspectors were unable to assess compliance; records were not available for inspection.1/2/05619 (1) to (5) YA34 Schedule 2The home must operate a robust recruitment system by obtaining completed application form, two satisfactory references, photocopies of birth certificate and passport, a photograph and CRB check before employment is offered. The inspectors were unable to assess compliance; records were not available for inspection. The home must develop and provide all staff with job descriptions.1/2/05717(2) Schedule 4(6)(e)YA31The inspectors were unable to assess compliance; records were not available for inspection. The home must provide a structured programme of induction that reflects the content of the LDAF training and demonstrate that such has been carried out. The inspectors were unable to assess compliance; records were not available for inspection.1/2/05818 (1) (c)YA351/2/05Bamville Road (1)Page 14 The home must undertake and document monthly checks of the emergency lighting system. 9 23(4)(a)(c) YA42 The inspectors were unable to assess compliance; records were not available for inspection. The home must develop all required policies and procedures as listed in Appendix 2 of the National Minimum Standards. Such documentation is subject to review at least annually or when circumstances change. The inspectors were unable to assess compliance; records were not available for inspection. The home must compile an inventory of each individual’s personal belongings, such documentation requires ongoing up dating. The inspectors were unable to assess compliance; records were not available for inspection. The home must document the opportunities offered to service users to maintain and develop social, emotional, communication and independent living skills. The inspectors were unable to assess compliance; records were not available for inspection. The home must document the range of leisure activities offered to service users and their personal preferences. The inspectors were unable to assess compliance; records were not available for inspection. Details of links with family and other relevant persons must be documented within individuals care plans. The inspectors were unable to assess compliance; records were not available for inspection. 1/2/051012(1)YA401/2/051117 (2) Schedule 4 YA23 (10)1/2/051216 (2) (m)YA111/2/051316 (2) (m) & (n)YA141/2/051423 (2) (i)YA151/2/05Bamville Road (1)Page 15 1523 (4 )YA42The fire procedure requires further development to include what to do, how to raise the alarm, how to move service users and the designated person for each shift. The inspectors were unable to assess compliance; records were not available for inspection. Staff must receive training in Adult Protection by a person competent to do so and a record of such training must be maintained for inspection. The inspectors were unable to assess compliance; records were not available for inspection. A person competent to do so must provide staff with training in epilepsy awareness. The home must maintain records of such training for inspection. The inspectors were unable to assess compliance; records were not available for inspection.1/2/051618(1) 13 (6)YA231/2/051718 (1) (c)YA351/2/051818 (1) (c)YA35A person competent to do so must provide staff with training in diabetes awareness. The home must maintain records of such training for inspection. 1/2/05 The inspectors were unable to assess compliance; records were not available for inspection. Staff must receive formal supervision at least six times per year (pro rata for part time staff) that is fully documented; an annual appraisal must also be included. The inspectors were unable to assess compliance; records were not available for inspection. The home must develop a statement of purpose and on completion of such document forward a copy the CSCI. The inspectors were unable to assess compliance; records were not available for inspection.1918 (2)YA361/2/052017 (1) Schedule 4 YA1 4 (1) (a) to (c) 4 (2)1/2/05Bamville Road (1)Page 16 215 (1) (a ) to YA1 (f ) 5 (2)The home must develop a service user guide in an accessible format and on completion supply a copy to each service user. The inspectors were unable to assess compliance; records were not available for inspection. The home must provide each service user with a contract/statement of terms and conditions as specified within Standard 5.2 The inspectors were unable to assess compliance; records were not available for inspection. The home must hold staff meetings at least six times per year and the minutes collated circulated accordingly. The inspectors were unable to assess compliance; records were not available for inspection. The home must provide two comfortable chairs in each bedroom. Unless it is the service users wish or a risk assessment states otherwise. This must then be recorded on a care plan and subsequently reviewed. The inspectors were unable to assess compliance; records were not available for inspection. The home must provide staff with training in the ageing process by a person competent to do so. The home must maintain records of such training for inspection. The inspectors were unable to assess compliance; records were not available for inspection. The home must arrange for an electrical wiring examination to be carried out and a copy of the certificate forwarded to the NCSC. The inspectors were unable to assess compliance; records were not available for inspection.1/2/05225 (1) (c)YA51/2/052318 (2)YA331/2/052416 (2) (c)YA261/2/052518 (1) (c)YA211/2/052613 (4) (a)YA421/2/05Bamville Road (1)Page 17 2713 (4)YA42The home must develop a policy regarding COSHH and maintain a file on the COSHH products used within the home, including data sheets and Risk Assessments. 1/2/05 The inspectors were unable to assess compliance; records were not available for inspection. Activity programmes must be developed for service users that includes information of how the Service User was assessed and what outcome the activity is to achieve.2816(m)(n)YA11The inspectors were unable to assess compliance; records were not available for inspection.1/2/052916(m)(n)YA14The home must consult service users views, likes and dislikes and include them where safe or risk assessed, with regular review into Care Plans and Activity Programmes. The inspectors were unable to assess compliance; records were not available for inspection. All staff must with support and sensitivity to service user Health and Safety consult the service user, giving information as to why certain decisions must be taken by the Manager to protect where reasonable the Health and Safety of service users and staff.1/2/053018(1)(a)YA31YA421/2/05The inspectors were unable to assess compliance; records were not available for inspection.Bamville Road (1)Page 18 3118(1) 13(2)YA20The manager must make arrangements for all staff involved in the receipt, storage, administration, recording, handling and disposal of medication to complete an Accredited Medicines Training course. All 1/2/05 certificates must be retained on staff files for inspection. The inspectors were unable to assess compliance; records were not available for inspection. The home must complete a Risk Assessment for any Service User self administering medication, ensuring regular reviews take place, this must also include Compliance Checks. The inspectors were unable to assess compliance; records were not available for inspection. The home must detail within its Statement of Purpose the arrangements made for dealing with complaints. The inspectors were unable to assess compliance; records were not available for inspection. The homes Adult Protection Procedure must be reviewed and amended to comply with the “No Secrets” document issued by the Dep’t of Health. The inspectors were unable to assess compliance; records were not available for inspection. The home must record fridge and freezer temperatures everyday and retain records.3213(2)YA201/2/05334(1)(c)YA221/2/053413(6)YA231/2/053513(3), 16(2)(g)YA30The inspectors were unable to assess compliance; records were not available for inspection.1/2/053613(4)(c) 16(2)(g)YA30Any item of food removed from its original packaging must be labelled and dated when it 1/2/05 is put back in the fridge.Bamville Road (1)Page 19 3717(2) schedule 4 (7)YA33The home must have a current staff rota in place and retain all previous rotas; these must be made available for inspection. The inspectors were unable to assess compliance; records were not available for inspection. All Risk Assessments for the building must be dated and signed, dates of review and comments must be included. The inspectors were unable to assess compliance; records were not available for inspection. The homes Fire Risk Assessment must be completed and all staff informed of its contents. The inspectors were unable to assess compliance; records were not available for inspection. The home manager must identify which member of staff on duty is designated to deal with emergencies such as fire. The inspectors were unable to assess compliance; records were not available for inspection. The offensive odour in one service user bedroom must be addressed. The lock on the door in the outside toilet must be removed and replaced with a lock that can be overridden in the event of an emergency. Records pertaining to service users must be available for inspection. The garage to the rear of the property must be secure. The fence panel to the rear of the property must be replaced.1/2/053813(4)(a)(c)YA421/2/053923(4)(a)(b) (c)(d)(e)YA421/2/054023(4)(a)(e)YA421/2/054116(2) (k)YA26YA301/2/054213(4)(a) (c) YA27YA421/2/054317(2) (b) 13(4) (c) 23(2) (b) 13(4) (c) 23(2) (b)YA7YA61/2/0544YA421/2/0545YA421/2/05Bamville Road (1)Page 20 4613(4) (c) 23(2) (b)YA42YA24The electrical socket in one service users bedroom must be secured to the wall.1/2/05Bamville Road (1)Page 21 RECOMMENDATIONS Identified below are areas addressed in the main body of the report which relate to National Minimum Standards and are seen as good practice issues which should be considered for implementation by the registered Provider(s). The code in “Standard” is a cross-reference to the Standards described in full in the section “Inspection Findings”. No. Refer to Good Practice Recommendations Standard ** Note: You may refer to the relevant standard in the remainder of the report by omitting the 2-letter prefix e.g. YA10 refers to Standard 10.PART BINSPECTION METHODS & FINDINGSThe following inspection methods have been used in the production of this report Direct observation Indirect observation Sampling • Pre-inspection questionnaire • Records • Care plans / Care pathways • Meals • Activities • Other enter details here ‘Tracking’ care and support Group discussion with service users Individual discussion with service users Group discussion with staff Individual discussion with staff Discussion with management Service user survey Relatives/significant others survey/feedback Visiting professionals survey / feedback Tour of premises Formal interviews Document reading Additional inspection information: YES NO YES YES NO NO NO NO NO NO YES NO YES YES NO NO NO YES NO YESBamville Road (1)Page 22 Number of service users spoken to at time of inspection Number of relatives/significant others the inspectors had contact with Number of letters received in respect of the service CRB check for the responsible individual seen CRB check for the manager seen Certificate of registration was displayed at the time of the inspection Certificate of registration accurately reflected the situation in the service at the time of inspection Total No. of care staff employed (excluding managers) Total No. of staff with nursing qualifications employed Date of inspection Time of inspection Duration of inspection (hrs)1 0 0 NO NO YES YES X X 15/12/04 10AM 3The following pages summarise the key findings and evidence from this inspection, together with the CSCI assessment of the extent to which the National Minimum Standards for Adults (18-65) have been met. The following scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The scale ranges from: 4 - Standard Exceeded 3 - Standard Met 2 - Standard Almost Met 1 - Standard Not Met (Commendable) (No Shortfalls) (Minor Shortfalls) (Major Shortfalls)0 or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. “X” is used where a percentage value or numerical value is not applicable.Bamville Road (1)Page 23 Choice of HomeThe intended outcomes for the following set of standards are: • • • • • Prospective service users have the information they need to make an informed choice about where to live. Prospective service users’ individual aspirations and needs are assessed. Prospective service users know that the home they 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.Standard 1 (1.1 – 1.4) The registered person produces an up to date statement of purpose setting out the aims, objectives and philosophy of the home, its services and facilities and terms and conditions; and provides each service user with a service users guide to the home. The statement of purpose should clearly set out the physical environmental standards met by the home in relation to standards 24.2, 24.9, 25.3, 25.5, 27.2, 27.4 and 28.2; and a summary of this information should appear in the service users’ guide. X X Range of fees charged From To £ £ (per week) NO Any charges for extras If yes, please state what the extras are 0 Key findings/Evidence Standard met? The inspectors were unable to inspect this standard. The assistant manager told the inspectors all records were locked in the upstairs office. On the day of the inspection the manager had taken one service user to the doctors, and had taken the other two service users with her. The manager was aware of the inspectors visit and left the assistant manager to assist the inspectors. The manager however took the keys with her and the assistant manager was usable to gains access to the office. Standard 2 (2.1 – 2.8) New service users are admitted only on the basis of a full assessment undertaken by people competent to do so, involving the prospective service user, using an appropriate communication method and with an independent advocate as appropriate. 0 Key findings/Evidence Standard met? The inspectors were unable to assess this standard, as records were not available for inspection.Bamville Road (1)Page 24 Standard 3 (3.1 - 3.10) The registered person can demonstrate the home’s capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home. 0 Key findings/Evidence Standard met? The inspectors were unable to assess this standard. Records were not available for inspection.Standard 4 (4.1 - 4.5) The registered manager invites prospective service users to visit the home on an introductory basis before making a decision to move there, and unplanned admissions are avoided wherever possible. 0 Key findings/Evidence Standard met? The inspectors were unable to assess this standard. Records were not available for inspection.Standard 5 (5.1 - 5.5) The registered manager develops and agrees with each prospective service user a written and costed contract/statement of terms and conditions between the home and the service user. 0 Key findings/Evidence Standard met? The inspectors were unable to assess this standard. Records were not available for inspection.Bamville Road (1)Page 25 Individual Needs and ChoicesThe intended outcomes for the following set of standards are: • • • • • 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.Standard 6 (6.1 – 6.10) The registered manager develops and agrees with each service user an individual Plan which may include treatment and rehabilitation, describing the services and facilities to be provided by the home, and how these services will meet current and changing needs and aspirations and achieve goals. 1 Key findings/Evidence Standard met? The inspectors were able to sample a diary that the manager records information of activities of the service user. The information contained in the dairy was not on a daily basis. Records showed entries were completed in an ad hoc way. For example entries had been made for December 5,6,7,8, no entries had been made before these dates or after these dates. The service user was attending the doctors on the day of the visit, however this had not been entered into the diary. When the inspectors asked the assistant manager what the service user was going to the doctors for his knowledge was very limited. Shortly after the visit some care plans were sent to the Commission. The care plans did not show how the service user’s needs were being met. There was no information to indicate the service users involvement in any aspect of daily living tasks or the care plan being drawn up some amendments had been made to the care plan and the inspector was unable to identify what the changes meant. There was no format to the care plans sent to the commission and the inspector was unable to case track the care plans to see if they were meeting the service user’s needs. There was no record of who had made the changes or when they were made. It is the responsibility of the registered manager to review the care plans involving significant professionals and family, friends and advocates as agreed with the service user. Any agreed changes must be recorded and actioned and evidence of when and by whom the agreed changes were made must be available.Bamville Road (1)Page 26 Standard 7 (7.1 – 7.7) Staff respect service users’ right to make decisions, and that right is limited only through the assessment process, involving the service user, and as recorded in the individual Service User Plan. 0 Key findings/Evidence Standard met? The inspectors were unable to assess this standard. Records were not available for inspection.Standard 8 (8.1 – 8.5) The registered manager ensures that service users are offered opportunities to participate in the day to day running of the home and to contribute to the development and review of policies, procedures and services. 0 Key findings/Evidence Standard met? The inspectors were unable to assess this standard. Records were not available for inspection.Standard 9 (9.1 – 9.4) Staff enable service users to take responsible risks, ensuring they have good information on which to base decisions, within the context of the service user’s individual Plan and of the home’s risk assessment and risk management strategies. 0 Key findings/Evidence Standard met? The inspectors were unable to assess this standard. Records were not available for inspection.Standard 10 (10.1 – 10.6). Staff respect information given by service users in confidence, and handle information about service users in accordance with the home’s written policies and procedures and the Data Protection Act 1998, and in the best interests of the service user. 0 Key findings/Evidence Standard met? The inspectors were unable to assess this standard. Records were not available for inspection.Bamville Road (1)Page 27 LifestyleThe intended outcomes for the following set of standards are: • • • • • • • 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.Standard 11 (11.1 – 11.4) Staff enable service users to have opportunities to maintain and develop social, emotional, communication and independent living skills. 0 Key findings/Evidence Standard met? The inspectors were unable to assess this standard. Records were not available for inspection.Standard 12 (12.1 – 12.6) Staff help service users to find and keep appropriate jobs, continue their education or training, and / or take part in valued and fulfilling activities. 0 Key findings/Evidence Standard met? The inspectors were unable to assess this standard. Records were not available for inspection.Bamville Road (1)Page 28 Standard 13 (13.1 – 13.5) Staff support service users to become part of, and participate in, the local community in accordance with assessed needs and the individual Plans. 0 Key findings/Evidence Standard met? The inspectors were unable to assess this standard. Records were not available for inspection.Standard 14 (14.1 – 14.6) Staff ensure that service users have access to, and choose from a range of, appropriate leisure activities. 0 Key findings/Evidence Standard met? The inspectors were unable to assess this standard. Records were not available for inspection.Standard 15 (15.1 – 15.5) Staff support service users to maintain family links and friendships inside and outside the home, subject to restrictions agreed in the individual Plan and Contract (subject to standards 2 and 6 if necessary). 0 Key findings/Evidence Standard met? The inspectors were unable to assess this standard. Records were not available for inspection.Standard 16 (16.1 – 16.11) The daily routines and house rules promote independence, individual choice and freedom of movement, subject to restrictions agreed in the individual Plan and Contract (subject to Standards 2 and 6 if necessary). 0 Key findings/Evidence Standard met? The inspectors were unable to assess this standard. Records were not available for inspection.Bamville Road (1)Page 29 Standard 17 (17.1 – 17.9) The registered person promotes service users’ health and wellbeing by ensuring the supply of nutritious, varied, balanced and attractively presented meals in a congenial setting and at flexible times. 0 Key findings/Evidence Standard met? The inspectors were unable to assess this standard. Records were not available for inspection.Bamville Road (1)Page 30 Personal and Healthcare SupportThe intended outcomes for the following set of standards are: • • • • 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.Standard 18 (18.1 – 18.11) Staff provide sensitive and flexible personal support and nursing care to maximise service users’ privacy, dignity, independence and control over their lives. 0 Key findings/Evidence Standard met? The inspectors were unable to assess this standard. Records were not available for inspection.Standard 19 (19.1 – 19.5) The registered person ensures that the healthcare needs of service users are assessed and recognised and that procedures are in place to address them. No. of incidents where service users have been taken to Accident & Emergency during last 12 months No. of service users with pressure sores at the time of inspection (from information taken from care notes) XX0 Key findings/Evidence Standard met? The inspectors were unable to assess this standard. Records were not available for inspection.Bamville Road (1)Page 31 Standard 20 (20.1 – 20.14) The registered manager and staff encourage and support service users to retain, administer and control their own medication, within a risk management framework, and comply with the home’s policy and procedure for the receipt, recording, storage, handling, administration and disposal of medicines. 0 Key findings/Evidence Standard met? The inspectors were unable to assess this standard. Records were not available for inspection.Standard 21 (21.1 – 21.8) The registered manager and staff deal with the ageing, illness and death of a service user with sensitivity and respect. 0 Key findings/Evidence Standard met? The inspectors were unable to assess this standard. Records were not available for inspection.Bamville Road (1)Page 32 Concerns, Complaints and ProtectionThe intended outcomes for the following set of standards are: • • Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm.Standard 22 (22.1 – 22.7) The registered person ensures that there is a clear and effective complaints procedure, which includes the stages of, and timescales for, the process and that service users know how and to whom to complain. No. of complaints made to the home during last 12 months No. of these complaints fully substantiated No. of these complaints partly substantiated No. of these complaints not substantiated No. of these complaints not yet resolved No. of complaints sent direct to CSCI Percentage of complaints responded to within 28 days X X X X X X X 0 Key findings/Evidence Standard met? The inspectors were unable to assess this standard. Records were not available for inspection.Bamville Road (1)Page 33 Standard 23 (23.1 – 23. 6) The registered person ensures that service users are safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory abuse or self-harm, or inhuman or degrading treatment, through deliberate intent, negligence or ignorance, in accordance with written policy. The home has an Adult Protection procedure (including Whistle Blowing) which complies with the Public Disclosure Act 1998 and the DOH Guidance No Secrets No of staff referred for inclusion on POCA/POVA lists YESX0 Key findings/Evidence Standard met? The inspectors were unable to assess this standard. Records were not available for inspection.Bamville Road (1)Page 34 EnvironmentThe intended outcomes for the following set of standards are: • • • • • • • 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.Standard 24 (24.1 – 24.13) The home’s premises are suitable for its stated purpose; accessible, safe and well maintained; meet service users’ individual and collective needs in a comfortable and homely way; and have been designed with reference to relevant guidance. 1 Key findings/Evidence Standard met? The inspectors had the opportunity to see service user’s bedrooms. The assistant manager told the inspectors service users choose what they have in their bedrooms. One service user had a chair in the room that was pushed up against the wardrobe. The inspectors were told this chair was not used. The chair must be removed if not in use and stored appropriately. The bedroom did not contain all the furniture required by this standard. The inspector saw no evidence to indicate that any discussion had taken place with regards to the service users choosing what they wanted in their bedrooms In one service users bedroom the electrical socket was coming away from the wall. This must be secured to the wall. The service user in one room was using a double adapter for electrical appliances. The manager must look at alternatives to prevent overloading the sockets. The kitchen was domestic in style and generally clean. The inspectors noted that tiles were broken on the kitchen wall surrounding the sink these must be replaced. The inspector asked for one item of food to be disposed off during the inspection that was passed its use by date. In one bathroom there was no shower curtain. The fence panel was missing to the rear of the property giving access to the property adjacent to the home. This must be replaced. The garage to the rear of the property contains various items of furniture. The furniture being stored was balanced on top of each other. There is open access to the garage and service users have access to the garage. This must be secured or the contents removed.Bamville Road (1)Page 35 Standard 25 (25.1 – 25. 11) The registered person provides each service user with a bedroom, which has useable floor space sufficient to meet individual needs and lifestyles. Total no. of single bedrooms with at least 10 sq.m usable space or additional compensatory space Pre-existing homes only (1st April 2003) – single bedrooms below 10 sq.m usable space or additional compensatory space Total no. of wheelchair users accommodated for in rooms at least 12 sq.m Total no. of wheelchair users accommodated for in rooms less than 12 sq.m Total no. of shared rooms at least 16 sq.m Total no. of shared rooms below 16 sq.m Percentage of places within single rooms: 100 80 - 99 Less than 80 Total no. of single bedrooms Number of single bedrooms with en suite Total no. of double bedrooms Number of double rooms with en suite Key findings/Evidence This standard not assessed. YES NO NO X 1 0 0 Standard met? 0 X XX X X XBamville Road (1)Page 36 Standard 26 (26.1 – 26.4) The registered person provides each service user with a bedroom that has furniture and fittings sufficient and suitable to meet individual needs and lifestyles. 1 Key findings/Evidence Standard met? Service user’s bedrooms did not contain all the furniture required by this standard. The bedrooms seen by the inspectors required decorating and some furniture required repair. All bedrooms require a minimum of two electric sockets, secondary lighting, a lockable facility an easy chair, and table to sit at. One service users bedroom had a strong offensive odour. The manager must ensure the odour is eliminated. The assistant manager was unable to give the inspectors any information regarding this service user or what strategies were in place to assist this service user with the management of the odour. Standard 27 (27.1 – 27.6) The registered person provides service users with toilet and bathroom facilities which meet their assessed needs and offer sufficient personal privacy. 1 Key findings/Evidence Standard met? One bathroom where there was a shower facility had no shower curtain. The inspectors noted a pair of clinical gloves that had been repeatedly used. The assistant manager was unable to say what the gloves had been used for and disposed of them during the visit. All personal towels must be removed from the communal areas. All bars of soap must be removed from communal areas. The home has an outside toilet that was cold and damp. The toilet seat was broken. The assistant manager told the inspectors that service users use this toilet. The toilet seat must be repaired and the leak must be identified and repaired. In the toilet the door has a bolt. This must be replaced with a lock that is accessible in the event of an emergency.Standard 28 (28.1 – 28.3) A range of comfortable, safe and fully accessible shared spaces is provided both for shared activities and for private use. 0 Key findings/Evidence Standard met? This standard not assessed.Bamville Road (1)Page 37 Standard 29 ( 29.1 – 29.8) The registered person ensures the provision of environmental adaptations and disability equipment necessary to meet the home’s stated purpose and the individually assessed needs of all service users. 0 Key findings/Evidence Standard met? This standard not assessed.Standard 30 (30.1 – 30.9) The premises are kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of infection, in accordance with relevant legislation, published professional guidance and the purpose of the home. 2 Key findings/Evidence Standard met? The home was seen to be generally clean. One bedroom had an offensive odour and must be addressed. The home has a policy on infection control. The home has a laundry, which is domestic in style. The kitchen was seen to be clean and tidy. The inspectors noted a food item passed its use by date. The assistant manager disposed of this item during the inspection. The recording of fridge and freezer temperature must be kept up to date. COSHH items were kept securely in a locked cupboard.Bamville Road (1)Page 38 StaffingThe intended outcomes for the following set of standards are: • • • • • • 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.Standard 31 (31.1 – 31.7) The registered manager ensures that staff have clearly defined job descriptions and understand their own and other’s roles and responsibilities. 0 Key findings/Evidence Standard met? The inspectors were unable to assess this standard. Records were not available for inspection.Standard 32 (32.1 – 32.6) Staff have the competencies and qualities required to meet service users’ needs and achieve Sector Skills Council workforce strategy targets within the required timescales. 0 Key findings/Evidence Standard met? The inspectors were unable to assess this standard. Records were not available for inspection.Bamville Road (1)Page 39 Standard 33 (33.1 – 33.11) The home has an effective staff team with sufficient numbers and complementary skills to support service users’ assessed needs at all times. Staff numbers/hours relating to the needs of service users are based on guidance recommended by the Department of Health. Personal Care No. service users High needs No. service users Medium needs No. service users Low needs Total no. of hours needed No. of staff with NVQ level 2 or above No. of Trainees registered on Sector Skills Council training programme X X X X X No. of full time equivalent Staff with nursing qualification (where applicable) No. staff hours allocated No. staff hours allocated No. staff hours allocated Total Hours Provided X X X X Nursing X X XXX0 Key findings/Evidence Standard met? The inspectors were unable to assess this standard. Records were not available for inspection.Standard 34 (34.1 - 34. 8) The registered person operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. 0 Key findings/Evidence Standard met? The inspectors were unable to assess this standard. Records were not available for inspection.Bamville Road (1)Page 40 Standard 35 (35.1 - 35.8) The registered person ensures that there is a staff training and development programme which meets the Sector Skills Council workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users’. 0 Key findings/Evidence Standard met? The inspectors were unable to assess this standard. Records were not available for inspection.Standard 36 (36.1 - 36.8) Staff receive the support and supervision they need to carry out their jobs. 0 Key findings/Evidence Standard met? The inspectors were unable to assess this standard. Records were not available for inspection.Bamville Road (1)Page 41 Conduct and Management of the HomeThe intended outcomes for the following set of standards are: • • • • • • • 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.Standard 37 (37.1 – 37.4) The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. Registered manager qualified to level 4 NVQ in Management and care [by 2005]. NO0 Key findings/Evidence Standard met? The inspectors were unable to assess this standard. Records were not available for inspection.Standard 38 (38.1 – 38.6) The management approach of the home creates an open, positive and inclusive atmosphere. 0 Key findings/Evidence Standard met? The inspectors were unable to assess this standard. Records were not available for inspection.Bamville Road (1)Page 42 Standard 39 (39.1 – 39.10) Effective quality assurance and quality monitoring systems, based on seeking the views of service users, are in place to measure success in achieving the aims, objectives and statement of purpose of the home. 0 Key findings/Evidence Standard met? The inspectors were unable to assess this standard. Records were not available for inspection.Standards 40 (40.1 – 40.6) The home’s written policies and procedures comply with current legislation and recognised professional standards, covering the topics set out in Appendix 2 of the National Minimum Standards for Adults (18-65). 0 Key findings/Evidence Standard met? The inspectors were unable to assess this standard. Records were not available for inspection.Standard 41 (41.1 – 41.3) Records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. 0 Key findings/Evidence Standard met ? The inspectors were unable to assess this standard. Records were not available for inspection.Bamville Road (1)Page 43 Standard 42 (42.1 – 42.9) The registered manager ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. 1 Key findings/Evidence Standard met? Records in the home indicated that all the safety checks had been completed however the inspectors noted that documentation signed to say the checks had been completed did not have the identification of who had completed the checks. The manager must contact the individual contractors to obtained certificates of compliance for the electrical portable testing and emergency lighting. The manager has still not sent the certificate for the 5 yearly electrical wring. This has been a requirement of the last two inspections. The garage must be secured to prevent service users entering while it is being used as storage. The lock must be removed from the outside toilet and a lock fitted that can be overridden in an emergency. The leak in the out side toilet must be repaired. The seat must be replaced in the outside toilet. The electrical socket in one service users bedroom must be secured to the wall. All outstanding requirements from the last inspection must be completed. Standard 43 (43.1 – 43.7 ) The overall management of the service (within or external to the home) ensures the effectiveness, financial viability and accountability of the home. 0 Key findings/Evidence Standard met ?Bamville Road (1)Page 44 PART C(where applicable)COMPLIANCE WITH CONDITIONSCondition CommentsComplianceCondition CommentsComplianceCondition CommentsComplianceCondition CommentsComplianceLead Inspector Second InspectorSusan Scully Brenda O’NeillSignature Signature SignatureRegulation Manager Jane Rumble Date Public reportsIt should be noted that all CSCI inspection reports are public documents.Bamville Road (1)Page 45 PART DD.1PROVIDER’S RESPONSE TO IDENTIFIED STATUTORY REQUIREMENTSRegistered Person’s comments/confirmation relating to the content and accuracy of the report for the above inspection.We would welcome comments on the content of this report relating to the Inspection conducted on 15th December 2004 and any factual inaccuracies: Please limit your comments to one side of A4 if possibleAction taken by the CSCI in response to provider comments: Bamville Road (1) Page 46 Amendments to the report were necessaryNOComments were received from the provider Provider comments/factual amendments were incorporated into the final inspection report Provider comments are available on file at the Area Office but have not been incorporated into the final inspection report. The inspector believes the report to be factually accurateYESNote: In instances where there is a major difference of view between the Inspector and the Registered Provider both views will be made available on request to the Area Office. D.2 Please provide the Commission with a written Action Plan within a month , which indicates how requirements are to be addressed and stating a clear timescale for completion. This will be kept on file and made available on request.You will also note that the Commission has identified in the inspection report good practice recommendations and it would be useful to have some indication as to whether you intend to take any action to progress these. Status of the Provider’s Action Plan at time of publication of the final inspection report: Action plan was required YESAction plan was received at the point of publicationYESAction plan covers all the statutory requirements in a timely fashion Action plan did not cover all the statutory requirements and required further discussion Provider has declined to provide an action planNOYESOther: enter details here Bamville Road (1)Page 47 D.3PROVIDER’S AGREEMENT Registered Person’s statement of agreement/comments: Please complete the relevant section that applies.D.3.1 I of confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) and that I agree with the requirements made and will seek to comply with these. Print Name Signature Designation Date Or D.3.2 I of am unable to confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the above date(s) for the following reasons:Print Name Signature Designation Date Note: In instance where there is a profound difference of view between the Inspector and the Registered Provider both views will be reported. Please attach any extra pages, as applicable.Bamville Road (1)Page 48 Bamville Road (1) / 15th December 2004Commission for Social Care Inspection 33 Greycoat Street London SW1P 2QF Telephone: 020 7979 2000 Fax: 020 7979 2111 National Enquiry Line: 0845 015 0120 www.csci.org.ukS0000017076.V202697.R01© This report may only be used in its entirety. Extracts may not be used or reproduced without the express permission of the Commission for Social Care Inspection The paper used in this document is supplied from a sustainable source - 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!