Inspection on 20/06/06 for Mostyn Lodge

This inspection was carried out on 20th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Mostyn Lodge 19/07/07

Mostyn Lodge 05/10/05

Mostyn Lodge 01/12/04

Mostyn Lodge 29/06/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Mostyn Lodge 2 Kelston Road Keynsham Bath & N E Somerset BS31 2JF Lead Inspector Jon Clarke Key Unannounced Inspection 20th June 2006 09:30 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 Mostyn Lodge DS0000008156.V301399.R02.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. Mostyn Lodge DS0000008156.V301399.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mostyn Lodge Address 2 Kelston Road Keynsham Bath & N E Somerset BS31 2JF 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) 0117 9864297 0117 9869473 Mr Arthur Gent Mrs Jill Clarke Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Mostyn Lodge DS0000008156.V301399.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 16 persons aged 65 years and over requiring personal care only. 5th October 2005 Date of last inspection Brief Description of the Service: Mostyn Lodge has been a registered care home since 1985 providing care and accommodation for up to 16 older people. It is an adapted property over two floors with stair lift to 1st floor. All rooms are for single occupancy and are of a good size some being over the minimum standard of 10 sq metres. None of the rooms offer en-suite facilities however all room are close to bathrooms and toilets. There are two lounge areas one being a quiet lounge overlooking the rear garden and patio area. There is a separate dining area. The home is situated close to the centre of Keysham but not within walking distance. Mostyn Lodge offers a small, homely environment described by one resident as lovely, couldnt find a happier place and another couldnt find a better home. We at Mostyn Lodge wish to enhance our residents quality of life by making sure that they keep their independence. Privacy and dignity are of the uppermost importance. Mostyn Lodge DS0000008156.V301399.R02.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 over one day. As part of this inspection a number of records and documents were looked at including care plans, daily records, medication and staffing. There was also an opportunity to discuss with residents and staff their experience of living and working in the home. Pre-inspection questionnaires were sent to 10 residents and residents and 10 residents, 9 relatives returned these questionnaires. The responses have been used to inform this inspection about various aspects of the home: availability of staff, activities and meals. What the service does well: What has improved since the last inspection? Following requirements from the previous inspection door restrictors have been fitted to stairwell to improve safety of residents and staff have undertaken the necessary fire drills to make sure they are familiar with the fire evacuation policy and procedures. The building of a extension has greatly improved the communal space and has been welcomed by residents: “its a lot better, more space and choice where I Mostyn Lodge DS0000008156.V301399.R02.S.doc Version 5.2 Page 6 can sit” The additional provision of an outdoor patio and seating area has raised the standard of the home’s environment. 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. Mostyn Lodge DS0000008156.V301399.R02.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 Mostyn Lodge DS0000008156.V301399.R02.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 The Quality rating in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Pre-admission assessments are undertaken to make a decision about the ability of the home to meet the health and social care needs of the prospective resident. EVIDENCE: Pre-admission assessments were seen which gave information about personal care needs, medical condition and social needs. Where the local authority has assessed an individual a copy of their assessment has been obtained. Involvement from the mental health team was included in the pre-admission information where individual had mental health needs such as confusion. Mostyn Lodge DS0000008156.V301399.R02.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 The Quality rating in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Care Planning is generally good though practice needs to be improved to make sure that care plans accurately reflect the needs of residents and full information is available to staff to make sure that the needs of residents are met in a safe manner. The home provides a good service in accessing community health service so the health care needs of residents is fully met. The arrangements for the management and administering of medication need to be more rigorous to make sure the heath of residents is protected. The practice of staff has created an environment in the home where rights to privacy and being treated with respect are upheld. Mostyn Lodge DS0000008156.V301399.R02.S.doc Version 5.2 Page 10 EVIDENCE: A number of care plans were looked at and showed that whilst there is generally good practice there are gaps in the recording of reviews. In one instance there was no evidence of reviewing of care needs since admission of the resident on 22/03/06. Care Plans were not always signed by the individual to evidence their involvement. Moving and Handling assessments are completed, as were risk assessments. Where resident had mental health needs there was additional assessment provided by the local authority mental health team. The home has good practice in discussing end of life care with residents “Thinking Ahead” which gives individuals an opportunity to state their wishes this is to be commended. There are good arrangements in the home so that residents receive community based health services such as chiropody, dental treatment. Relationships with the community nurses are good and residents receive any medical treatment they may need. The inspector was informed that staff are receiving training from the nursing service so that they are able to monitor a resident with diabetes and also administer insulin in a safe way at present this is undertaken by a district nurse who visits the home. Medication records were examined and showed good practice in some aspects: however an individual had regularly been given medication which had only been recorded in the “Day Book”, another had been given paracetamol on number of occasions from stock supply. There was also a stock of medication which had been inappropriately kept by the home for giving to residents. No recording of returned drugs takes place. Storage of drugs was satisfactory however there is no separate controlled drug storage, which needs to be in place in the event a resident is prescribed such drugs (currently there are none). Residents spoke positively of the flexibility of the home and their ability to spend the day as they wish: “I can choose what I do” “don’t feel there are any restrictions on me here” “if I wanted to stay in bed I could”. When asked about how they were treated by staff residents commented: “doing their best for me” “staff all very good” “treat me as would want to be” Staff were observed talking to residents in a respectful way particularly when giving assistance this being done in a sensitive and supportive way. Mostyn Lodge DS0000008156.V301399.R02.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 The Quality rating in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home could improve opportunities for residents to meet their social, religious and recreational needs. The environment of the home is welcoming and contact with family and friends is seen as an important part of the life of the home. There are good arrangements in the home to make sure that the dietary needs of residents are met and meals are balanced and wholesome. The home’s practice protects the resident’s ability to exercise choice over their lives. EVIDENCE: Recreational activities are not provided in a structured way and are dependent on staff availability. Activities arranged included quizzes, games and bingo. Outside entertainers are also invited into the home and residents welcomed this. When asked about activities residents said “theres enough for me” “I am pleased with the entertainment we have here”, “do what they can to entertain Mostyn Lodge DS0000008156.V301399.R02.S.doc Version 5.2 Page 12 me”. Questionnaire response to “Are there activities arranged by the home which you can take part in?” was mixed: 6 Always,2 Usually,2 Sometimes. When asked about what goes on in the home in the way of entertainment one resident commented “staff are always so busy”. In observing staff on the day of this inspection there was little social interaction with residents other then when undertaking specific tasks. Monthly religious services are held in the home. A relative in response to the pre-inspection questionnaire commented, “activities might be increased in frequency” another “boredom is my main concern”. A strength of the home is the efforts by staff to involve family and relatives in the life of the home with regular social events. Residents said that their family and friends are always “welcomed” “staff are always friendly”. Of the returned relatives questionnaire all stated that they felt welcomed in the home and were kept in informed about the care of their relative. There were very positive comments from residents about the choice and quality of meals provided in the home: “excellent meals” “always good food” “they know what I like” “the food we receive is always very good” “if I didn’t like it they would change it”. One resident said how she had spoken to the manager about the food: “I had a chat with them and it has improved”. Another resident who was a vegetarian said how at first the choice available had not been good but this had again improved. In reply to the pre-inspection questionnaire all respondents said how they always liked the meals provided in the home. On the day of the inspection the inspector joined the residents for a meal which was well presented and looked appetising. There was a comfortable and unhurried atmosphere and staff were observed giving assistance to residents in a helpful and sensitive way. Menus were examined and showed that the home provides well-balanced variety of meals. Mostyn Lodge DS0000008156.V301399.R02.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The Quality rating in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The policies and practice of the home help protect residents as far as possible from abuse and residents feel able to say if they are dissatisfied or have a complaint about the quality of the care they receive. EVIDENCE: Residents when asked were aware of their ability to make a complaint a number of residents said they felt the manager and staff were always “there if we are unhappy about anything” “I can always speak to someone” “I would tell Jill (manager) if unhappy and she would do something about it”. The home’s complaint procedure is available to residents and all of the residents spoken with on the day of the inspection were aware of how to make a complaint. There have been no complaints made since the last inspection though in talking to residents some had been unhappy about particular aspects of their care and had spoken to either staff or the manager and action had been taken to address their worry or concern. When asked all residents said how they felt they were “listened to” “something always done”. The home has a procedure in place in the event an allegation of abuse is made. Staff have undertaken Adult Protection training and at a previous inspection when speaking to staff they had a good understanding of the nature Mostyn Lodge DS0000008156.V301399.R02.S.doc Version 5.2 Page 14 of abuse and how to respond if a resident made an allegation or they had any concerns about possible abusive behaviour towards a resident of the home. Mostyn Lodge DS0000008156.V301399.R02.S.doc Version 5.2 Page 15 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, 26 The Quality rating in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The practices of the home provide a safe, well-maintained and hygienic environment for the residents and staff of the home. EVIDENCE: In reply to the pre-inspection questionnaire all respondents said how the home is “always” fresh and clean. A relative said how the home is “always nice and clean”. There are procedures in place to make sure that the health and welfare of residents is protected, staff are provided with protective clothing and some staff have undertaken infection control training. At the time of this inspection the home was clean and free from offensive odours. Mostyn Lodge DS0000008156.V301399.R02.S.doc Version 5.2 Page 16 As stated elsewhere in this report improvements have been made to the environment of the home with the building of an extension and with good level access to outside seating and patio area. The manager advised the inspector that the owner of the home is considering further changes by making the dining room larger this would be a definite improvement in that at present it is rather a dark and cramped room. Mostyn Lodge DS0000008156.V301399.R02.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, 30 The Quality rating in this outcome is adequate. This judgement has been made using available evidence including a visit to the service. The staffing arrangements of the home are at the necessary level to make sure that the needs of residents are met. Failure to ensure references are obtained as part of the recruitment arrangements potentially places residents at risk. Staff are generally trained and competent to fulfil their role and responsibilities. EVIDENCE: Staffing rotas were looked at and showed that there are normally 2 members of staff on at all times with waking night staff. The home has a good history of retaining staff and the manager has been able to avoid using agency staff. When asked residents confirmed that staff are “always available” “always enough staff around” “I have always received the care and attention I need”. One new member of staff (domestic) had been recruited since the last inspection. Whilst this individual’s application form provided the necessary information and a CRB had been obtained no personal or previous employer references had been taken up. Mostyn Lodge DS0000008156.V301399.R02.S.doc Version 5.2 Page 18 Training records were looked at and showed that in the main staff had completed mandatory training such as moving & handling, first aid, fire & safety ( 2 staff have completed Level 2 Occupational Health & Safety), medication administration. Seven out of 10 care staff have successfully completed NVQ Level 2 or 3 this is to be commended. However there were gaps in some of the staff training particularly in relation to night staff. Only one member of night staff had completed medication training, one had no moving and handling training and there was no training record available for one individual. It was noted that there was limited training been undertaken by staff around specific areas: managing continence, dealing with challenging behaviour, caring for individuals who are diabetic, reorganising appropriate social activities, which would provide them with valuable skills and knowledge. In particular considering the number of residents in the home who have a mental health impairment staff would certainly benefit from training in this area. When asked about this staff said they felt it would help them do their job better. Mostyn Lodge DS0000008156.V301399.R02.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, 38 The quality rating in this outcome group is good. This judgement has been made using available evidence including a visit to the service. The manager of the home is qualified and able to discharge her responsibilities in a competent and responsible way and makes a good effort to run the home in the best interests of residents. Improvements need to be made in getting the views of residents and others, in a more structured way, about the care provided in the home and to inform the manager and staff of any changes that need to be made to improve the quality of care. The practices of the home help to make sure the financial interests of residents are safeguarded and their health and welfare are protected. Mostyn Lodge DS0000008156.V301399.R02.S.doc Version 5.2 Page 20 EVIDENCE: The manager Mrs J.Clarke (no relation to inspector) has extensive experience of working with older people and has been the manager of Mostyn Lodge for a number of years. From observations and discussion with residents and staff she is respected as someone who works hard to act in the best interests of residents and staff. Residents describe her as a good listener and approachable. Staff also spoke warmly of her who again is honest in her approach and “there for the residents” Mrs Clarke has Care In Community Care Practice certificate, NVQ 4 Registered Managers Award and had undertake mandatory training including Adult Protection “Investigators” course. It is the practice of the home not to manage the financial affairs of residents other then holding small amounts on their behalf. Receipts are obtained for any items purchased, records were seen which confirmed this good practice. Wherever possible residents are positively encouraged to manage their own affairs and staff will offer assistance if this is necessary. There is limited quality assurance and no structured way of looking at the quality of care provided to residents of the home. Whilst on occasion questionnaires have been issued to residents these were only given to a very small number and not all of those able to complete such a survey have been asked to do so. Again with relatives there is no full and extensive survey of relatives views of the care received. Residents meetings are not held which would provide an opportunity for residents to express their views in a formal way to make suggestions, be informed and consulted ie about the activities they would like to see in the home. There is an open atmosphere in the home where residents are able to express their views, such meetings and fuller surveys would add positively to this ethos. Records relating to health & safety practice in the home were looked at and showed that regular checks of the fire system are undertaken; staff receive the necessary fire drills; and equipment is maintained and serviced at a minimum yearly intervals. Mostyn Lodge DS0000008156.V301399.R02.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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 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 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Mostyn Lodge DS0000008156.V301399.R02.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 (2) Requirement Ensure all elements of an individual’s care plan are reviewed at regular intervals and where individual has completed their “trial” period. Ensure the involvement of resident in the completion of their care plan to be evidenced by individual’s signature. If resident unable their representative. Prescribed medication must not be used for anyone other than the person for whom they are prescribed. Ensure the use of “homely” remedies is fully recorded and not used on a regular or frequent basis without referring to the individual’s G.P. for such medication to be prescribed or advised that it is safe and appropriate to use. Ensure that medication returned to the pharmacist is signed as being received by themselves or their representative. DS0000008156.V301399.R02.S.doc Timescale for action 20/06/06 2 OP7 15 (1) 20/06/06 3 OP9 12 (1), 13 (2) 12 (1), 13 (2) 20/06/06 4 OP9 20/06/06 5 OP9 13 (2) 20/06/06 Mostyn Lodge Version 5.2 Page 23 6 7 8 OP29 OP30 OP30 19 (4) 18 (1a,c) 18 (1a,c) 9 10 OP12 OP33 16 (2)(n) 24 11 OP33 24 Ensure two written references are obtained relating to any prospective employee. Ensure all staff undertake mandatory training e.g. moving & handling. Ensure any staff that have responsibility to handle/administer medication undertaken medication training. Consult residents about activities arranged in the home. Establish a system for reviewing and improving the quality of care provided in the home to include formal consultation with residents and their relatives or representatives. Provide to the CSCI a report in respect of Requirement 10 giving the outcome and any actions taken. A report must be made available to residents and their representatives. 20/06/06 30/09/06 30/09/06 30/09/06 30/09/06 30/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP12 OP30 Good Practice Recommendations Identify a member of staff who has responsibility for the organising of activities in the home. Staff to receive training specifically related to the needs of residents in the home in particularly mental health. Mostyn Lodge DS0000008156.V301399.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Mostyn Lodge DS0000008156.V301399.R02.S.doc Version 5.2 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!