Inspection on 02/06/05 for Millbridge

This inspection was carried out on 2nd June 2005.

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

Millbridge 26/09/06

Millbridge 17/11/05

Millbridge 01/02/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Millbridge 4 Lynn Road Heacham Norfolk PE31 7HY Lead Inspector Christopher Handley Announced 2 June 2005 9.30am 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 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. Millbridge I55 S61023 Millbridge V223893 020605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Millbridge Address 4 Lynn Road Heacham Norfolk PE31 7HY 01753 643106 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) gsaraogi@I-n-h.co.uk Integrated Nursing Homes Limited Position vacant Care Home 52 Category(ies) of Dementia - over 65 (52) registration, with number Old Age (52) of places Millbridge I55 S61023 Millbridge V223893 020605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1 February 2005 Brief Description of the Service: Millbridge is a 52 bedded Care home with nursing, and provides care for elderly people and elderly people over 65 who have Dementia. It is a large detached home which has had a number of extensions added, one of which was recently completed to a high standard. It is set in its own grounds on the edge of the village of Heacham, three miles from Hunstanton. The home receives its medical services from the local Medical Centre. The home was purchased by Integrated Nursing Homes in 2004 year. Millbridge I55 S61023 Millbridge V223893 020605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection and was carried out as part of the annual inspection programme. The inspection commenced at 9.30 am and took place over 8 hours. On the day of the inspection there were 44 residents in the home. Preparatory work had been undertaken before hand, and 22 comment cards had been received in the CSCI office. The Inspector carried out a full tour of the home accompanied by the Manager, and a wide range of records, polices, and care plans, were examined as part of this inspection. During the inspection 6 residents, 8 visitors, and 6 members of staff were spoken to, as part of the inspection process. The Manager and Regional Manager were also spoken to. What the service does well: What has improved since the last inspection? What they could do better: * Develop a Quality Assurance system for the home * Further develop the clinical skills of Nursing staff to met the nursing needs of residents. Millbridge I55 S61023 Millbridge V223893 020605 Stage 4.doc Version 1.30 Page 6 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. Millbridge I55 S61023 Millbridge V223893 020605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Millbridge I55 S61023 Millbridge V223893 020605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,&3. The home provides good information to prospective residents to the home. The Contracts are set out in a simple format, and are explained to residents and relatives. The home carries out pre-admission assessments which are of a high standard. EVIDENCE: The Statement of Purpose and Services Users Guide were seen by the Inspector. They are well set out, contain all the information required and are in a print size which makes the document easy to read. All residents are supplied with a Terms and Conditions. This agreement document is clearly set out, contains all the necessary information and is set in a large print to assist the residents read the document. This document is read with the resident/relative if needed, to ensure that they understand the content. The resident/relative retains a copy of this document, and a signed copy is kept in the office. Millbridge I55 S61023 Millbridge V223893 020605 Stage 4.doc Version 1.30 Page 9 A pre-admission assessment is carried out on all prospective residents to ensure that the home can meet the needs of the prospective residents. These documents are detailed and well set out. There is an assessment of the prospective residents physical, mental, and social needs, thus provided a good range of information upon which to base a decision. Millbridge I55 S61023 Millbridge V223893 020605 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 & 10. All residents have an individual care plan but these are not fully completed and do not evidence involvement by the service users so the home cannot be sure they are fully meeting need. The health care needs of residents are met. The home medicine policy is sound and the practice is safe, and comprehensive. The practice of providing privacy for residents is respected, and provided. The homes practice in caring for the dying is of a high standard, and provides comfort to relatives at such times. Millbridge I55 S61023 Millbridge V223893 020605 Stage 4.doc Version 1.30 Page 11 EVIDENCE: All residents have an individual care plan, which is clearly marked “Private and Confidential”. They are stored securely. Five care plans were read by the Inspector. A number of blank spaces were seen, including a Risk Management document, and care must be exercised to ensure that all documentation is fully completed. The plans seen contain the essential element of care planning namely assessment, planning, implementation and review. In the plans are a series of assessments including Nutritional Assessment, Waterlow Risk Assessment Activities of Daily living Assessment, a night care plan, and a Mental Health questionnaire. In the documents seen there was no written evidence of residents or relatives being involved in reviews of care and the Inspector recommends that there should be. The management of these documents, and writing in them continues to improve and the Manager and staff are commended for this. The health care needs of residents are assessed and met. All residents have a G.P. who would refer residents on to the appropriate department if needed. A wide range of health care providers visit the home. The optical, dental, and auditory needs of residents are met by local services. At present there are four residents who have pressure sores of varying severity, all of which are being actively treated, and the tissue viability nurse is involved in their care. The medicines in both parts of the home were inspected. The medicine are kept in medicine trolleys, one in the Coach House and one in the old house, which are locked and also locked to the wall. There are good records of administration, which are neatly initialled. The home maintains a list of signatures of those nurses who administer medicines. Only trained nurses administer medicine in this home. The home has a detailed medicine policy. There are no residents who self medicate. There are no Controlled Drugs in the Home at present. Insulin is kept in a refrigerator, which was free of ice. Staff who are undertaking the adaptation-nursing course administer medicine under supervision of trained nurses. The home has copies of the UKCC Guidelines on medicines. The staff in this home are aware of the importance of medicines, and they monitor the effect of medicines closely. Medicines are reviewed on a regular basis. The home enjoys a good working relationship with the supplying pharmacist. If staff had any concerns about the effects of medicines on residents they would contact the prescribing doctor. In view of the good standard of practice in this matter the Manager may wish to explore the possibility of some nursing staff undertaking Nurse prescribing training, which would extend their role, and give a more efficient medicine service to residents. Millbridge I55 S61023 Millbridge V223893 020605 Stage 4.doc Version 1.30 Page 12 The importance and practice of privacy forms part of the induction of staff to the home. Privacy is always provided at all times especially when any form of personal care is being provided. The residents spoke very highly of this practice as did a number of visitor spoken to,” They always knock on the door”,” They always respect our privacy” were frequently said. Any consultation or examination would be carried out in the privacy of the residents room. Residents are called by their preferred name. Care and comfort are provided to the dying and to their relatives and friends. Representatives of religious organisations are contacted if that is the wish of the dying person or their relative. Staff ensure that any pain relief is provided. The resident spends their last days in their own room surrounded by friends, and the practice of the home is that there is always a member of staff available to sit with the dying person. Refreshments for relatives and short breaks are arranged. The religious beliefs and practices and wishes of the dying person are carried out. The home has polices and procedures for care of the dying. Cards and letters received from relatives of the recently bereaved were seen by the Inspector, they addressed staff with heartfelt thanks for the care they provided to their dying relative, and for the attention and gentleness their relative had received. The Assistant Manager has undertaken the ENB Palliative Care Millbridge I55 S61023 Millbridge V223893 020605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 & 13. There is a good range of activities provided in the home, which match the residents likes and needs. There is good contact between the home and the community. EVIDENCE: The home has an Activities Organiser for 28 hours weekly, and a wide range of activities are carried out, Crafts, Bingo, Music and Movement, crosswords, and sing songs. Frantic Theatre, Excel 2000, Aroma therapy, Massage therapy, Film Afternoon, are also undertaken. There are residents meetings. Birthdays are celebrated and the home first birthday was recently celebrated. The mobile library calls to the home on a regular basis and there All the activities are advertised in the homes newsletter which list all the activities and events to take place. This news letter is well set out and is published monthly, and the person responsible for it is commended. Residents interviewed spoke well of these activities “There’s always plenty to do” said one, and “We know what’s on” said another. Millbridge I55 S61023 Millbridge V223893 020605 Stage 4.doc Version 1.30 Page 14 The home has numerous links with the community which take many forms. Residents are taken out to Heacham, Hunstanton and the nearby Lavender fields for tea. The mobile library calls to the home on a regular basis. The home recently held a very successful scarecrow competition, which received wide spread publicity of a very favourable nature. Representative of local churches visit the home on a regular basis. Visitors are positively welcomed by staff to the home. There are a number of relatives who visit their relatives in the home on a frequent basis, and have done for a long period of time, the Inspector spoke to three of these visitors, who all spoke very highly of the home and the welcome that they received when they visited and they have developed a close friendship between themselves and staff. The menu was seen by the Inspector it appears to be varied, nutritious, and interesting, Special diets are provided and they are recorded. The home has developed a high standard of catering and all the residents interviewed spoke very highly of the meals provided, saying that there were interesting and varied, and that there was always enough. Drinks and small refreshments can be provided outside of meal times if needed. The Inspector spoke briefly to the cook who told the inspector that his aim was to provide a very high standard of catering to all residents and to try and meet individual likes and dislikes. Millbridge I55 S61023 Millbridge V223893 020605 Stage 4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17 & 18 Residents are aware that there is complaints procedure in the home and know how to raise any concerns if they had any Residents legal rights are protected. Staff have an awareness Adult Abuse Protection. EVIDENCE: The home has a complaints procedure which is displayed around the home. The residents interviewed were aware that there is a complaints procedure and they also knew how to make a complaint should they need to do so. Since the last inspection there have been two complaints about the home. Both complaints were thoroughly investigated by the home and the CSCI were notified in writing about them both. The first one concerned poor communications and none of the elements were upheld. The second letter of complaint had eight element to it, two of the elements which related to the heat of one room were found to be upheld. The legal rights of residents are up held. Some residents used their postal votes and others went to the polling station in the recent election. If needed the Manager would facilitate legal advice. The home has an Adult Protection procedure and training on this matter has been provided. When asked about this the staff gave the Inspector sound replies, which showed that they had some knowledge of this important matter. Millbridge I55 S61023 Millbridge V223893 020605 Stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25, & 26. The residents rooms are comfortable and are of a high standard. They are personalised to meet the resident likes and preferences. They are clean and tidy The home is neat clean and tidy and odour free. The fire exits and fire doors were free of obstruction EVIDENCE: The Inspector made a tour of the home accompanied by the Manager and a large number of rooms were seen. The residents rooms are pleasantly decorated and furnished. They appear well furnished and some of belong to the resident. All the rooms have an individual look to them with a range of ornaments, personal pictures, and photographs. The residents and the their relatives spoken to, spoke very highly of the rooms, which were neat clean and tidy. There is a range of adjustable beds and chairs to meet the needs of residents. Millbridge I55 S61023 Millbridge V223893 020605 Stage 4.doc Version 1.30 Page 17 All rooms are naturally and individually ventilated. The central heating in rooms can be controlled by the resident. Pipe work and radiators are protected. Emergency lighting is provided throughout the home and is tested on a regular basis. The water is stored and distributed at the required temperature and the temperatures are tested and recorded on a regular basis. This record was seen. The home was neat clean and tidy on the morning of the inspection. The home has a laundry and food is not taken through this facility. There are hand washing facilities in the laundry. The laundry floor is impermeable. There are polices and procedures for the control of infection and the safe handling and disposal of clinical waste, dealing with spillages, provision of protective clothing, and hand washing. The services and facilities comply with the Water supply (Water Fittings) Regulations 1999. Millbridge I55 S61023 Millbridge V223893 020605 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28, 29, & 30 The management of the home have a practice stance to staff recruitment and training which ensures that the service users are in safe hands and cared for by competent staff. EVIDENCE: The Manager said that there were 7 members of staff who had NVQ level II, and that a further 2 currently undertaking it. There are 4 members of staff who have NVQ level III, and 4 members of staff who are taking it at the moment. There are 2 members of staff who are taking the NVQ III assessors award. There are 4 members of staff who are tasking NVQ level IV as part of their adaptation training. Both catering and domestic staff have NVQ level II in hotel and catering services. The Manager and senior staff are warmly commended for their support to staff undertaking this training. This will help to ensure that the quality of care provided in the home will further improve by enhancing the skills of staff. The Inspector was shown a detailed training plan. Millbridge I55 S61023 Millbridge V223893 020605 Stage 4.doc Version 1.30 Page 19 The Manager, with the Regional Manager has undertaken a survey Skills Matrix of trained staff. This matrix identifies the additional post graduate skills of nursing staff now required to carry out some nursing techniques. This present Matrix identifies 22 such skills and it is intended to further develop this area of training for the trained nurses. This matrix ensures that there is a known level of clinical skill available in the home so that should these procedures be required, they can be implemented. It also shows any deficit of clinical skills and identifies any training need. The home has a comprehensive recruitment procedure, which is based on equal opportunities. This was seen by the Inspector. Two written references are obtained, Police and POVA checks are carried out. Interviews are carried out by two people. Interviews are well prepared for, the home has an interview questionnaire which was seen. A written job offer is sent to the successful candidate, Terms and Conditions, and job description are supplied, and a Code of Conduct is provided to the new employee. Based on what was seen and said, it is obvious that the home takes great care in employing staff, and thus protecting the welfare residents. There is a training and development training programme which meets TOPPS specification including the foundation training programme. Other training provided includes Fire Prevention, First Aid, Food Hygiene, and Abuse Awareness. Millbridge I55 S61023 Millbridge V223893 020605 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33,35,36 & 37. The current manager has all the skills and experience which should mean that he will manage the service in the best interests of the service users. Service users’ views are sought but the outcomes need to be shared with the service users and the Commission. Residents’ financial interests are safe guarded by the home’s practice in regard to personal monies in this home. Supervision is becoming an established feature of the management and development of staff. The home holds a wide range of records, which are held secure. Millbridge I55 S61023 Millbridge V223893 020605 Stage 4.doc Version 1.30 Page 21 EVIDENCE: The Manager has worked at the home since November 04. and has been Manager since April 05. He is a qualified RGN, RMN, and has the ENB 998 & ENB 953, Certificates. He has undertaken the Moving and Handling Trainers Course, First Aid, and has undertaken other management training. He is currently taking his NVQ level 4. His Fit Person interview is to be arranged in the near future. He responsible for this home only. He has a written job description. The Manager described his approach for the home. It is one of having a shared a sense of vision, having high standards, supporting, encouraging and developing staff, and monitoring care provided. Staff, especially nursing staff, are employed in sufficient numbers ,to enable a high quality of skilled nursing care and personal care to be provided. The home undertakes surveys of the services it provides. The home has developed a special form for this, which was seen by the Inspector, it is comprehensive and easy to understand. When completed these forms are then collated into graph forms, a number of which were seen by the Inspector. In this manner the home can see which areas are improving in the opinion of the users of their services. The home has made initial equerries with regard to implementing a quality assurance scheme for the home but it needs to share the outcomes of the surveys with the stakeholders and the Commission. The home holds personal monies on behalf of residents. There is a written procedure for this. which states that there is an upper limit of £50 per resident. The monies are held in separate containers and there is an individual records for each resident. The entries are clearly recorded, and the accounts are audited on a regular basis and this is written in red. Receipts are provided for monies handed in. The Inspector recommends that a numbered receipt are provide to person handing money in. These monies are held in a secure facility. Supervision is carried out and recorded. The home has developed a dedicated form for this and copies of this were seen. The supervision covers aspects of practice, the philosophy of the home, and career development needs. A wide range or records required by regulation were seen during the process of this Inspection. The records are kept securely. Millbridge I55 S61023 Millbridge V223893 020605 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 4 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 x 15 3 COMPLAINTS AND PROTECTION x x x x x 3 3 3 STAFFING Standard No Score 27 x 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 2 x 3 3 3 x Millbridge I55 S61023 Millbridge V223893 020605 Stage 4.doc Version 1.30 Page 23 No Are there any outstanding requirements from the last inspection? 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 Regulation None Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard 35 7 33 Good Practice Recommendations It is recommended that numbered receipts are provided when monies are handed in. It is recommended that the involvement of service users in their care planning process is recorded. The surveys carried out with service users should be shared with all stakeholders and the Commisson. Millbridge I55 S61023 Millbridge V223893 020605 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 3rd Floor Cavell House St Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Millbridge I55 S61023 Millbridge V223893 020605 Stage 4.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!