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Inspection on 14/11/06 for Millington Springs

Also see our care home review for Millington Springs for more information

This inspection was carried out on 14th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

What the care home does well

Service users spoken with were all positive about the care received and life within the home. All said that staff were kind, caring and respectful. The two relatives spoken with were also positive about the way staff provided care and staff professionalism. The home provides a comfortable and homely environment and the atmosphere on entering was warm and welcoming. Service users are enabled to participate in varied activities and spoke highly of these. A wholesome and varied diet is on offer and service users said that meals were of a high standard. Service users spoken with were confident in their relations with staff and said they felt comfortable to air any concerns should they arise. Thorough recruitment policy and procedures are in place to protect service users.

What has improved since the last inspection?

The identified service users care plan has been reviewed and kept up to date ensuring needs are fully met. The floor covering in the identified bedroom has been replaced thus eradicating the malodour. The manager is currently working on a staff training matrix to fully demonstrate training that has taken place and evidencing that staff are fully trained and competent to do their jobs. The manager has prepared a draft quality assurance questionnaire, this is still to be finalised. Records identified at the previous inspection were available for inspection therefore ensuring service users and staff are further protected. Staff were observed to be seated whilst assisting service users with eating therefore ensuring dignity is promoted and upheld. The manager said that the patio area is kept under review and there are plans in the future to replace/update this area to ensure risk to service users is minimised. A key to the duty rota is now supplied so that staff on duty may be easily identified.

What the care home could do better:

To ensure appropriate risk assessments and management are in place for service users with challenging behaviour and/or complex needs to ensure service users are fully protected. Continue to complete the staff training matrix to demonstrate that staff are fully trained in mandatory areas. Continue to complete the quality monitoring and auditing systems to further demonstrate that the home is run in the best interest of service users. Four good practice recommendations were also made as follows: To ensure computerised plans of care are personalised to fully reflect individual needs and choices. Develop service users reviews to ensure these are service user focused to reflect service users current care and condition. Ensure evidence to demonstrate that registered nurses professional identification numbers are check on a periodical basis is available to enhance the recruitment polices and procedures. Emergency lights are tested on a monthly basis to further protect service users.

CARE HOMES FOR OLDER PEOPLE Millington Springs Portland Road Selston Nottinghamshire NG16 6AN Lead Inspector Karmon Hawley Key Unannounced Inspection 14th November 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Millington Springs DS0000057365.V306665.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Millington Springs DS0000057365.V306665.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Millington Springs Address Portland Road Selston Nottinghamshire NG16 6AN Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01773 581114 Elder Homes Midlands Ltd Tina Frances Kapp Care Home 42 Category(ies) of Dementia (5), Old age, not falling within any registration, with number other category (42), Physical disability (5) of places Millington Springs DS0000057365.V306665.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One physically disabled named service user aged 49 with nursing needs can be admitted. 10th February 2006 Date of last inspection Brief Description of the Service: Millington Springs is a purpose built home with 32 bedrooms, sited on Portland Rd, Selston, Nottinghamshire. The home provides personal care with nursing for older people and the home can also cater for physically disabled people and ten people with dementia care needs. The home has 3 lounges, 5 bathrooms, all with shower facilities, 1 walk in shower facility and 14 WCs. One bedroom has en-suite facilities and one bedroom has a shower cubicle. A pleasant garden area is provided at the rear and adequate car parking facilities to the front of the building. The home was purchased by Elder Homes Midlands Ltd and has undergone some refurbishment. The manager said that the current weekly fees for the home are £288 residential care and £475 nursing care high dependency needs. Rates are dependant upon needs and are further discussed during the preadmission procedure. The fees does not cover the cost of hairdressing and chiropody. Millington Springs DS0000057365.V306665.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place in six hours and was performed by one inspector. The main method of inspection was case tracking, this is a method of sampling the records of four randomly selected service users to ascertain if the needs of service users are appropriately assessed and identified needs are being catered for by the home to maintain optimum health and wellbeing of the service user. Five service users and two relatives were spoken with during the inspection so as to give the inspector an insight into the conditions and standards within the home. All were satisfied with the care received and the standards within the home. The manager assisted in the inspection process and two staff members were spoken with. The inspection included a thematic enquiry as part of a national pilot scheme. This consisted of asking a number of standardised questions to a sample of the residents. The registered person was informed and the agreement of residents was sought before asking a set of questions about the care they received. What the service does well: What has improved since the last inspection? The identified service users care plan has been reviewed and kept up to date ensuring needs are fully met. The floor covering in the identified bedroom has been replaced thus eradicating the malodour. The manager is currently working on a staff training matrix to fully demonstrate training that has taken place and evidencing that staff are fully trained and competent to do their jobs. Millington Springs DS0000057365.V306665.R01.S.doc Version 5.2 Page 6 The manager has prepared a draft quality assurance questionnaire, this is still to be finalised. Records identified at the previous inspection were available for inspection therefore ensuring service users and staff are further protected. Staff were observed to be seated whilst assisting service users with eating therefore ensuring dignity is promoted and upheld. The manager said that the patio area is kept under review and there are plans in the future to replace/update this area to ensure risk to service users is minimised. A key to the duty rota is now supplied so that staff on duty may be easily identified. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Millington Springs DS0000057365.V306665.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Millington Springs DS0000057365.V306665.R01.S.doc Version 5.2 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 the following standard(s): 3 and 6 The quality rating for this outcome area is good. This judgement was made using evidence available including a visit to the service. Service users may be assured that their needs will be assessed and met prior to moving into the home. The home does not offer intermediate services. EVIDENCE: The manager visits prospective service users within the community to carry out a preadmission assessment prior to them entering the home. The preadmission assessments seen within service users case notes covers the requirements of the standard. One service user spoken with said that this had occurred prior to entering the home. Service users may also visit the home and spend time there before making a decision to move in. The home does not offer intermediate services. Five questions as part of the thematic pilot were asked in this outcome area. Service users responses were as follows: Millington Springs DS0000057365.V306665.R01.S.doc Version 5.2 Page 9 1) Do you have an up to date copy of the service user guide? Two service users said yes they do whereas two were unsure. 2) Since coming into the home have you had any information about the changes to the cost of your care? No one had as yet been informed of any changes. 3) Do you have a written contract or statement of terms and conditions? Two service users said yes they did whereas two did not know. 4) Has the contract changed since you came to live here? No one was aware of any changes. There were no copies of contracts available within service users files. The manager said this was because new contracts are in the process of being drawn up and would be issued soon. 5) Before you came here did anyone talk with you to find out what your care needs were? Two said yes and two said no. A needs assessment was in all four service users files case tracked. Millington Springs DS0000057365.V306665.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 The quality rating for this outcome area is good. This judgement was made using evidence available including a visit to the service. Service users health, personal and social care needs are set out in an individual plan of care, however it is recommended that attention is given to some computerised plans of care to ensure that these remain personalised. To ensure service users and staff are fully protected appropriate risk assessments as identified are required. It is also recommended that service users reviews develop to become service user focussed to reflect service users current care and condition. Service users health care needs are met. Service users are protected by the homes medication policies and procedures. Service users feel they are treated with respect and their right to privacy is upheld. EVIDENCE: Four service users care files were seen which showed that service users undergo various assessments such as the activities of daily living, manual handling, pressure area care and nutritional needs. Information gained formed the plan of care. Care plans in place were mainly personalised and reflected Millington Springs DS0000057365.V306665.R01.S.doc Version 5.2 Page 11 service users needs and preferences however in some cases where computerised care plans were used these did not fully reflect this. Risk assessments were in place for a number of identified needs, however additional information and management plans for challenging behaviour and complex needs such as diabetes were not in place. Reviews were taking place, however these were not service user focussed to fully reflect service users current care and condition. Daily records were maintained and contained significant events. Service users spoken with said that their needs were met. The two relatives spoken with spoken highly of care offered. The staff spoken with were able to discuss service users needs and how they support them in meeting these. There was evidence seen within service users files to show that the multidisciplinary team and specialist services are accessed as required. One service user spoken with said they may see the doctor at any time. Relevant aids and equipment were available throughout the home. Staff spoken with confirmed this, however one member of staff felt that an additional hoist would prove beneficial. Appropriate medication policies and procedures were in place for medication. Service users medication records were checked against the prescription, these corresponded. There was evidence of medication signed into the building. Special instructions were highlighted. One handwritten entry had not been signed by two members of staff, the manager said that this was not normal practice and she would follow this up. Staff undergo an induction on commencing employment which covers maintain service users privacy and dignity. Staff spoken with were able to discuss how they maintaining this whilst care is delivered. Service users spoken with said that staff were kind and respectful at all times and their privacy was maintained. Millington Springs DS0000057365.V306665.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 The quality rating for this outcome area is good. This judgement was made using evidence available including a visit to the service. Service users find the lifestyle experienced in the home matches their expectations and satisfies their needs. Service users are enabled to maintain contact with relevant others. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome and appealing balanced diet in pleasing surroundings. EVIDENCE: The manager and staff spoken with said that the routines of the home were flexible and service users may choose how and where they spend the day. Service users spoken with said they were happy and settle with life within the home and they felt that they could do as they wish. An activities coordinator is employed who offers a variety of activities such as arts and crafts, flower arranging and games should a service user wish to participate. Service users had recently helped with the bonfire night posters and are currently working on the Christmas posters. Outside entertainers also visit the home. The manager said there are no restrictions on visitors and they may visit at any time and be receive in private should they wish. Two relatives spoken with Millington Springs DS0000057365.V306665.R01.S.doc Version 5.2 Page 13 said that they are always made welcome and are free to visit at any time. Service users spoken with confirmed this. Staff were able to discuss relevant issues of equality and diversity and how service users are treated as individuals and their rights and choices are upheld. Service users spoken with said that staff were kind and caring and always listened to them and they could make their own choices. The manager said that mail is received unopened. Service users have access to a telephone should they wish. Evidence of postal votes being applied for were seen within service users case files. The menu seen offered a wholesome and appealing varied diet. There was evidence seen to show that service users are offered choices and alternatives as required. Specialist diets are also catered for. Relevant records such as cleaning rotas and temperature control was seen. The kitchen was clean and tidy and there was evidence of good stock control. Service users spoken with spoke highly of food received and confirmed that choices were offered. There was evidence seen within one service users plan of care to show that a specialist diet was offered. Millington Springs DS0000057365.V306665.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The quality rating for this outcome area is good. This judgement was made using evidence available including a visit to the service. Service users and relevant others may be confident that their complaints will be listened to taken seriously and acted upon. Service users are protected from abuse. EVIDENCE: Relevant policies and procedures are in place for dealing with complaints. Staff spoken with were able to discuss how complaints would be dealt with should they be received. One issue had been referred to the protection of vulnerable adults since the previous inspection, this was resolved; the manager said that systems and procedures have been readdressed in response to this issue. Service users and the two relatives spoken with expressed no complaints. All staff employed have relevant Criminal Record Bureau checks in place, staff spoken with confirmed this. Staff underwent training in the protection of vulnerable adults in August of this year and were able to discuss relevant issues. Two questions as part of the thematic pilot were asked in this outcome area. Service users responses were as follows: 1) Have you received any written information that tells you how you can make a complaint? Two service users said yes and two did not know. Millington Springs DS0000057365.V306665.R01.S.doc Version 5.2 Page 15 2) Do you feel you have all the information you need to raise any concerns you have about your care? Three service users said yes and one said no. Millington Springs DS0000057365.V306665.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The quality rating for this outcome area is good. This judgement was made using evidence available including a visit to the service. Service users live in a safe, well-maintained environment. The home is clean, pleasant and hygienic. EVIDENCE: There have been no recent visits from the environmental health officer or the fire officer. A maintenance person is employed and relevant maintenance records were seen. The patio area is unchanged at present however the manager said that there are plans to refurbish this area in the future. The home was clean, pleasant and hygienic in all areas. Millington Springs DS0000057365.V306665.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 The quality rating for this outcome area is good. This judgement was made using evidence available including a visit to the service. The number and skill mix of staff meets service users needs. Service users are in safe hands at all times. Service users are supported and protected by the homes recruitment policies and practices. Staff are working towards ensuring they are trained and competent to do their jobs. EVIDENCE: The staff rotas seen showed that sufficient staff are available to meet service users needs. Staff spoken with confirmed this, however said that they were busy if someone was off sick or on holiday and this had not been covered. Service users and the relatives spoken with had no concerns regarding the staffing levels. A key was available to reflect which shift staff were on. Four members of staff have attained the National Vocational Qualification (a nationally recognised work and theory based qualification) level 2 and one is working towards this qualification. One member of staff is considering starting level 3. There are also two members of staff who are on the adaptation course working towards attaining their registered nurse professional identification number. The induction programme in use is of a recognised standard and the manager said that all new members of staff undertake this. Four staff files were seen, all contained the required documentation. Millington Springs DS0000057365.V306665.R01.S.doc Version 5.2 Page 18 The manager said that nurses registration numbers are checked, however there was no documentation to show that these had been checked recently. The manager is in the process on completing a training matrix to demonstrate that staff have undertaken mandatory training. Staff have undertaken several courses such as fire safety and the protection of vulnerable adults and further training is booked for the near future. Staff spoken with said that they felt supported in their development and training supplied was sufficient. Millington Springs DS0000057365.V306665.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 The quality rating for this outcome area is good. This judgement was made using evidence available including a visit to the service. Service users live in a home which is run and managed by a person who is fit to be in charge. The home is run in the best interests of service users, however further documentary evidence is still required to fully confirm this. Service users financial interests are safeguarded. The health, safety and welfare of service users and staff are promoted and protected. EVIDENCE: The manager has been in post since June 2004 and is registered with the Commission for Social Care Inspection. She is currently undertaking the Registered Managers Award and said that she remains up to date with mandatory training. Staff spoken with said that the manager was supportive Millington Springs DS0000057365.V306665.R01.S.doc Version 5.2 Page 20 and approachable. Service users and the relative spoken with also spoke highly of the manager. The manager said that she had completed a draft questionnaire and this is now being finalised. The operations manager visits the service on a monthly basis and completes a report which is sent to the commission for social care inspection. Four service users personal accounts were checked these corresponded with the account. There was evidence to show that these are checked on a regular basis and receipts were available as required. The service is not responsible for any service users finances. Maintenance and certificate such as the gas, electrics and lift were seen which were up to date. Accident records were completed appropriately, the manager said that these are audited and if necessary any care, practices changes or revisited. Water temperatures were recorded on a weekly basis. The fire logbook showed that staff are attending fire drills as required. Fire alarm systems were checked weekly, there were gaps in the monthly testing of emergency lights. The manager is currently finalising the fire risk assessment. Millington Springs DS0000057365.V306665.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Millington Springs DS0000057365.V306665.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 13(4,c) Requirement To ensure appropriate risk assessments and management are in place for service users with challenging behaviour and/or complex needs. Continue to complete the staff training matrix to demonstrate that staff are fully trained in mandatory areas. Continue to complete the quality monitoring and auditing systems. Timescale for action 20/12/06 2. OP30 17,18 20/12/06 3. OP33 24 20/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP7 OP7 OP29 OP38 Good Practice Recommendations To ensure computerised plans of care are personalised to fully reflect individual needs and choices. Develop service users reviews to ensure these are service user focused to reflect service users current care and condition. Ensure evidence to demonstrate that registered nurses professional identification numbers are check on a periodical basis is available. Emergency lights are tested on a monthly basis. DS0000057365.V306665.R01.S.doc Version 5.2 Page 23 Millington Springs Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 Millington Springs DS0000057365.V306665.R01.S.doc Version 5.2 Page 24 - 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!