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Inspection on 27/04/05 for Newlands Nursing & Residential Home

Also see our care home review for Newlands Nursing & Residential Home for more information

This inspection was carried out on 27th April 2005.

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.

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

The home offers a wide and varied activities programme. A planned programme of activities was displayed in the home and residents were encouraged to join in although individual wishes were respected. Residents that wished to join in said they enjoyed themselves at the various events. One visitor to the home said the activities programme was "exceptional" and commented on the `VE` Day discussion that had taken place while residents had their nails manicured. The home has recently been tastefully redecorated and refurbished and provides comfortable private and shared spaces.Residents and visitors were complimentary about the staff and about the food provided in the home.

What has improved since the last inspection?

Staff were motivated and enthusiastic about working at the home although concerns were expressed about the potential effects of reducing staffing levels in the home. Staff have received some training including moving and handling and training in how to recognise and report suspected abuse. Care planning documentation in relation to wound care and the use of bed safety rails has improved. The vetting procedures for new staff complied with the regulations.

What the care home could do better:

The home has had three changes in management since November 2004. The person in charge had only been at the home for two weeks and was not permanent. This has resulted in hardly any improvement in many aspects of the service provided at the home. The acting manager did state a new manager was being sought. Proper assessments and care plans were not in place for all the assessed needs of residents. Residents whose main care needs had changed had not had professional assessment. The management of medication practices had not improved since the last inspection. Induction training, staff supervision and NVQ assessment had not been put into practice and concerns around maintaining satisfactory staffing levels in the home continue to be an issue. Criminal record checks for `long term` staff were not at enhanced level. Communication with residents and relatives about the changes in the home had not been managed particularly well which has led to relatives becoming worried and dependent on staff gossip.

CARE HOMES FOR OLDER PEOPLE Newlands 122 Heaton Moor Road Stockport Cheshire SK4 4JY Lead Inspector Tracey Rasmussen Unannounced 27th April 2005 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. Newlands F54-F04 S41583 v222292 270405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Newlands Nursing & Residential Home Address 122 Heaton Moor Road Heaton Moor Stockport Cheshire SK4 4JY 0161 432 2236 0161 282 3333 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) Highfield Home Properties Ltd, Wellfield Hse (1st Floor) Wingate Lane, Wheatley Hill Durham, DH6 3LP CRH - Care Home N - Care Home with Nursing 72 Category(ies) of OP Old Age Number 72 registration, with number PD Physical disability Number 40 Years - 65 of places years PD(E) Physical dis over 65 Number 4 TI Terminally ill Number 2 TI(E) Terminally ill Number 2 Newlands F54-F04 S41583 v222292 270405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. No more than 63 places for nursing care. 2. No service user may be received in the home who is less than 45yrs. 3. 2 qualified nurses to be on duty 24 hrs per day. 4. The Registered Manager to be supermumery to the above stated qualified nurses. Date of last inspection 6th Novembr 2004 Brief Description of the Service: Newlands Care Centre provides care and accommodation for 72 residents, 63 of whom may receive nursing care. The home is registered to provide services to people over the age of 45 years with physical disabilities, end of life care and old age. The home provides services over four floors. Two floors provide nursing care and two floors provide personal care. Each floor has its own lounge and dining area. The home was owned by Highfield Home Properties Ltd but this company has amalgamated with Southern Cross plc. The home is situated in the Heaton Moor area of Stockport. Local amenities such as shops, pubs and GP surgeries are close by. Bus services are also available. The home is located close to Stockport town centre. Newlands Care Centre has car parking facilities at the side and rear of the home. Bedrooms are spacious. All but three rooms are single and all (except four rooms) provide en-suite facilities, many with bath or shower. A communal bathroom is also available on each floor. There are two passenger lifts. The home has its own hairdressing room. There are garden areas where residents can sit out weather permitting. Newlands F54-F04 S41583 v222292 270405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A number of requirements were made at the last inspection but little improvement was seen at this visit. A tour of three of the floors in the home took place and care and staff records were seen. Eight of the seventy-two residents and three close relatives (visitors) and eight staff were spoken to. Twelve resident and twelve visitors questionnaires were left at the home. None had been returned at the time of writing this report. Verbal feedback of the findings from the inspection was given to the acting manager of the home at the end of the visit. The unannounced inspection took place over almost ten hours. Since the last inspection in November 2004, two further inspections have been made; one to investigate two complaints and the second following a serious incident. In all there have been three complaints sent to the Commission since the last inspection. Complaints in January 2005 included poor staffing at weekends, residents having to wait lengthy period of time for assistance, poor moving and handling practice and inadequate care planning. All parts of the complaints were upheld and improvements in these areas have been noted as part of this inspection. At this visit, a complaint was also investigated regarding the reduction of staffing levels on the ground floor of the home and the movement of experienced staff in the home. The outcome of the investigation showed that staffing had not been reduced on the ground floor, however a staff skill mix had been carried out and the more experienced staff had been moved to other floors in the home to improve newer staff’s skills and abilities. What the service does well: The home offers a wide and varied activities programme. A planned programme of activities was displayed in the home and residents were encouraged to join in although individual wishes were respected. Residents that wished to join in said they enjoyed themselves at the various events. One visitor to the home said the activities programme was “exceptional” and commented on the ‘VE’ Day discussion that had taken place while residents had their nails manicured. The home has recently been tastefully redecorated and refurbished and provides comfortable private and shared spaces. Newlands F54-F04 S41583 v222292 270405 Stage 4.doc Version 1.30 Page 6 Residents and visitors were complimentary about the staff and about the food provided in the home. What has improved since the last inspection? 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. Newlands F54-F04 S41583 v222292 270405 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 Newlands F54-F04 S41583 v222292 270405 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) 3,4 Residents are not consistently assessed and so the home cannot confirm they can meet the needs of the resident on admission. EVIDENCE: A range of care records were inspected these contained pre admission assessments. These had not been fully completed in some cases with sections of information left out particularly those sections relating to psychological well being. Community care assessments and nursing assessments had been obtained but again the quality of information provided did not always enable care to be observed fully. One community care assessment provided by the local authority had minimal reference to the mental health needs of the resident yet other information indicated that the resident did have mental health needs. The home’s assessment did not contain much information either about the resident’s specific needs. The resident, however said she was happy with the care she received and said that the home were trying to sort out her problems. Newlands F54-F04 S41583 v222292 270405 Stage 4.doc Version 1.30 Page 9 Two recent admissions to the home did have detailed assessments, however some of the care needs identified such as ‘seizures’ did not have corresponding care plans. The home was trying to obtain a mental health assessment for one resident but reported that they were struggling to obtain a full psychiatric assessment. Newlands F54-F04 S41583 v222292 270405 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 The care planning documentation was insufficient to meet the health, personal and social care needs of residents. Medication practices did pose a potential risk to residents and staff. EVIDENCE: Residents and visitors spoken with said that they were happy with the quality of care provided. Care plans for some residents had been recently reviewed and up dated. One relative had signed her family member’s care plans and added further comments regarding aspects of physical care that had not been included. One relative said she was kept informed about any problems or concerns regarding her family member. Care plans in response to risks and identified from assessments and for eye care; mouth care, mental health and physical needs were not always recorded. Residents were nicely dressed and co-ordinated and attention had been paid to nails and hair. Residents said that they felt that their rights to privacy were respected in the home. One visitor stated she “could only say good things about the home” and residents said it was “lovely” Newlands F54-F04 S41583 v222292 270405 Stage 4.doc Version 1.30 Page 11 Records of visits from GPs, tissue viability nurse and podiatry were recorded Medication was inspected and details of matters that needed attention were passed on to the acting manager. A number of these issues had been identified at previous inspections. These included unsafe record keeping for receipt and returns of meds; the unsafe recording of administration and controlled drug records and handwritten entries not signed or dated. Oxygen was also being used without a risk assessment and without staff training in the safe use of oxygen. Newlands F54-F04 S41583 v222292 270405 Stage 4.doc Version 1.30 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 standard(s) 12,13,14,15 Residents were able to chose what activities, interests, visits they wished to be involved in. The quality of food provided to residents was good. EVIDENCE: One visitor stated, that the home had “exceptional provision of activities and entertainment”. The visitor also said that she had been sat in the lounge with a group of residents who were having manicures and discussing what celebrations, they could do to commemorate ‘VE’ day. The home has dedicated staff to deliver and encourage residents to join in the activities. Information about future activities was displayed prominently in the home and many residents said they enjoyed joining in the different activities. Other residents said they preferred to stay in their room and watch television. Visitors were seen coming and going all day and one relative said he was always made welcome by the home. Residents bedrooms had been made uniquely personal with possessions and mementoes. The meals served appeared appetising and plentiful. Residents, relatives and visitors to the home were complimentary about the meals provided. Comments included “the food’s good quality and there is a good variety”, “the foods lovely” and “foods good”. Dining rooms are available on each of the Newlands F54-F04 S41583 v222292 270405 Stage 4.doc Version 1.30 Page 13 floors and dining tables are dressed with linen tablecloths and napkins. are displayed and residents are offered choices. Menus Newlands F54-F04 S41583 v222292 270405 Stage 4.doc Version 1.30 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 standard(s) 18 Despite some training, residents are not fully protected from potential abuse. EVIDENCE: Training in abuse awareness had been provided to some staff. Two care staff from different floors said they had not received training, one had been employed for three years and one for four months. This training need has been consistently identified. Newlands F54-F04 S41583 v222292 270405 Stage 4.doc Version 1.30 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 standard(s) 19,20,21,22,24,25,26 Residents live in a clean, smartly decorated, well-maintained and comfortable home which has aids and adaptations to meet their needs. EVIDENCE: The home has recently been refurbished and re-decorated and so provides pleasant communal and private living spaces. Residents were complimentary about the quality of the furnishings and fittings and two residents were proud to show off their bedrooms. Toileting and bathing facilities are accessible and numerous. Outdoors the home has a small garden where residents can sit out. Equipment including hoists was available on all floors in the home, however one staff member said she thought a second “stand aid” would be of benefit to the residents. Newlands F54-F04 S41583 v222292 270405 Stage 4.doc Version 1.30 Page 16 The home was clean and a domestic was working on each floor. One domestic explained what health and safety training she had received. The home employs a maintenance person and he had various records of the health and safety monitoring he did in the home. One relative did request a nurse call button in the dining room on the ground floor. The acting manager said she had been made aware of this and would take action to remedy the situation. Newlands F54-F04 S41583 v222292 270405 Stage 4.doc Version 1.30 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 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) 27,28,29,30 The care provided is not always delivered by well trained and correctly vetted staff and resident’s needs are not consistently met in a timely manner. EVIDENCE: The home has been through a period of instability, whereby a permanent manager has not been in post for a period. An acting manager was in post, and had undertaken a skill mix review of the staff teams in the home, which had resulted in a change in the staff teams on each floor. Residents, relatives and staff on the ground floor all expressed concerns about these changes. The main cause of worry being that the residents would lose out by the loss of experienced team members. The acting manager and senior nurses said that the purpose of the skill mix review was to ensure that all residents and newer staff received the benefit provided by the experienced staff members. Two resident’s relatives had also complained to the commission regarding a reduction in staffing levels in the home. A visitor to the home also said he was concerned about the reduction in staffing and the effect that this would have on the quality of care his wife received. He also stated that the staff had been so busy that residents did not get their mid morning drink until 11.40am which left no time to assist residents to the toilet before lunch. All three relatives stated that the home had increased its fees and were upset because of the reduction in staffing. Rotas indicated that staffing levels had not been reduced except on the top floor which provided high dependency residential care, however the level was within the minimum staff required. The acting manager was advised to ensure that these residents are re-assessed so that the right Newlands F54-F04 S41583 v222292 270405 Stage 4.doc Version 1.30 Page 18 care is provided. Advice was also given with regards holding a residents and relatives meeting so the purpose of the staff changes could be explained. The files of 3 three new members of staff were inspected. Criminal Records Bureau checks and 2 written references had been obtained before employment commenced. These were in place on the files. However, some of the home’s long term employees still had only standard Criminal checks held on file. The home was required to update these to enhanced disclosures at the last inspection. The care staff on duty demonstrated a knowledgeable insight to the needs of the residents and some training in health and safety had been provided. However, induction training and NVQ assessment had not been consistently provided. Newlands F54-F04 S41583 v222292 270405 Stage 4.doc Version 1.30 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 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) 31,32,36,38 The service lacks stable leadership and management and staff are not supervised to ensure resident’s needs are met. Residents have not had a say in how the home is run, but health and safety practices do promote the resident’s welfare. EVIDENCE: The acting manager (proper title Project Manager) had only been in post a couple weeks at the time of this visit. She had undertaken an audit of the service provided and was clearly aware of the shortcomings. She had developed an action plan to address these issues and had redeployed the staff skill mix in the home (as detailed in the previous section of this report). The home does need a permanent manager Residents, relatives and staff all talked about their anxieties around the recent changes in the home particularly around the management, staffing and recent Newlands F54-F04 S41583 v222292 270405 Stage 4.doc Version 1.30 Page 20 corporate change that had occurred. Opportunities for residents and relatives to discuss their concerns openly in the form of a meeting had not been provided. Staff supervision or one-to-one support sessions had not started so practice, corporate and training issues still required more development. Residents were complimentary about the staff. One relative stated, that the staff “worked hard within the resources they had to hand” Not all aspects of Standard 38 were assessed but the home has provided training in moving and handling which was a requirement at previous inspections. Training in other health and safety topics had been provided and the home’s maintenance person had records of all health and safety monitoring he undertook. Newlands F54-F04 S41583 v222292 270405 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 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 3 3 3 3 x 3 3 3 STAFFING Standard No Score 27 2 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 2 1 x x x 2 x 3 Newlands F54-F04 S41583 v222292 270405 Stage 4.doc Version 1.30 Page 22 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 3 Regulation 14,15 Requirement The registered person must ensure that pre-admission assessments are undertaken to a consistent standard. The registered person must ensure that a reassessment is undertaken, were residents primary care need changes. The registered person must ensure that all resident assessments undertaken which identify a risk must detail the interventions required to reduce the identified risks or have corresponding plan of care. The registered person must ensure that each resident has care plans to meet all identified needs including physical, psychological and social needs. The registered person must ensure that that hand written amendments to the medicine administration record are signed and dated by the person making those amendments. The registered person must ensure all medications entering and leaving the home are recorded. The registered person must Timescale for action 31/5/05 2. 4 12,14,15 31/5/05 3. 7 13, 14,15 31/5/05 4. 8 12, 14,15 31/5/05 5. 9 13,17 31/5/05 6. 9 13,17 31/5/05 7. Newlands 9 13,17 31/5/05 Page 23 F54-F04 S41583 v222292 270405 Stage 4.doc Version 1.30 8. 9 13 9. 18 18 10. 29 19 11. 30, 28 18 12. 32 12 13. 36 18 14. 27 18 ensure that all controlled drug medications are recorded accurately and contemporaneously The registered person must ensure that staff are trained in the safe use of Oxygen and that appropriate risk assessments are recorded. The registered person must ensure all staff receive training in the home’s policies and procedures for abuse and the protection of vulnerable adults. (Timescale of the 06/12/04 was not met) The registered person must ensure all employees employed at the home since 1/10/03 who provide personal care have enhanced CRB disclosures. (Timescale of the 06/12/04 was not met) The registered person must ensure that all staff receive induction training and that care staff are assisted to attain NVQ accreditation. The registered person must ensure that residents, relatives and staff are provided with opportunities to meet formally as a group to discuss the running of the home. The registered person must ensure that all staff receive regular planned supervision. The registered person must ensure staffing levels are maintained at a level which is appropriate to the dependency needs of the residents to ensure care and support is provided in a timely manner. 31/5/05 15/6/05 30/6/05 31/5/05 15/6/05 15/6/05 31/5/05 Newlands F54-F04 S41583 v222292 270405 Stage 4.doc Version 1.30 Page 24 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. Refer to Standard 22 22 27 Good Practice Recommendations The registered person should consider supplying a second stand aid hoist to assist residents to move swiftly and safely. The registered person should ensure a nurse call button is fitted in the ground floor dining room The registered person should review the needs of all the service users accommodated in the home and deploy staff appropriately to ensure that the service provided in the home promotes the health, welfare and safety of service users. Newlands F54-F04 S41583 v222292 270405 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection 2nd Floor Heritage Wharf Portland Place Ashton under Lyne OL7 0QD 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 Newlands F54-F04 S41583 v222292 270405 Stage 4.doc Version 1.30 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!