CARE HOMES FOR OLDER PEOPLE
Norton House 10 Arneway Street London SW1P 2BG Lead Inspector
Jacqueline Derbyshire Key Unannounced Inspection 15th January 2008 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 Norton House DS0000010862.V357736.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. Norton House DS0000010862.V357736.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Norton House Address 10 Arneway Street London SW1P 2BG 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) 020 7976 7681 www.anchor.org.uk Anchor Trust Manager post vacant Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39) of places Norton House DS0000010862.V357736.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 39 26th April 2007 Date of last inspection Brief Description of the Service: Norton House is registered to provide care and accommodation for 39 older people. The home is situated in a quiet cul de sac, off Horseferry Road, in Victoria and is close to local shops. The service is operated by the Anchor Trust, with all placements being made by Westminster Council. Norton House DS0000010862.V357736.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 on Tuesday 15th January 2008. Tony Lawrence and Jackie Derbyshire, CSCI Regulation Inspectors carried out the Inspection. The Inspectors spent a total of 6 hours talking with residents, the home’s new Deputy Manager, the activities coordinator and staff, inspecting care records, staff records and touring the premises. One Inspector spent time on all of the floors looking at the medication records. The Inspectors looked at financial records for residents, there are new accounts for all however the interest was not shown on any of the residents statements looked at. The Inspectors were pleased with the progress that has been made in ensuring care records and other information kept by the home have been up dated and are relevant for each resident living there. Residents spoken to were positive about living at Norton House and had no issues. The CSCI was sent 4 residents surveys and 1 staff survey, the information from the surveys will be included throughout this report. The 11 requirements set on 24/04/07, 6 have been met, and 6 new requirements have been set from this Inspection. The weekly cost for a resident is at present £510.00. What the service does well:
The Inspectors looked at three residents care plans and the information was seen to be very informative with all areas of the residents needs linked into the care plans. The Inspectors looked at three residents risk assessments and all of the risk areas identified had a risk action plan in place to show how the home were reducing or minimising any risk identified. The risk assessments and care plans worked in conjunction with each other. The Inspectors spent time on floors 1,3 and 4 and staff were seen to be working closely with residents offering choice and listening to the residents wishes. The activities coordinator now has two staff designated each day to assist in providing a wide range of activities to all residents that want to participate. There is a rehabilitation unit in the home that provides a full intensive package of care. Physiotherapists and occupational therapists are employed to assist in setting up a programme of care that assists an individual in re-establishing themselves back into the community.
Norton House DS0000010862.V357736.R01.S.doc Version 5.2 Page 6 The medication records on floors 1,3 and 4 were seen to be recorded appropriately. What has improved since the last inspection? What they could do better:
The Manager must make sure that all complaints logged have the relevant investigation records in place and show the outcome of the complaint. The Manager must make sure that all staff recruitment references are checked for validity, the Inspectors looked at 4 staff files one being a new recruit with none of the references having been checked. The Manager must also confirm that any documents that have been copied as part of the recruitment procedure state that the original document was seen by whom and when. The Manager must make sure that all staff is up to date with mandatory training. The Inspectors looked at 4 staff files and the home’s latest audit that show not all staff have received the training. Norton House DS0000010862.V357736.R01.S.doc Version 5.2 Page 7 The Manager must make sure that all staff is up to date with supervision meetings. The Inspectors looked at 4 staff files and the frequency of supervision meetings is very low. The Manager must make sure that the weighing chair is repaired or replaced to make sure that residents weight can be monitored accordingly. The organisational procedures for saving residents finances has been changed so that all residents now have their own separate bank accounts. The organisation must make sure that each resident receives the relevant interest rates on their savings. The hot water temperatures in all communal kitchens on floors 1,3 and 4 must be set at a safe temperature as the temperature at present could seriously scorch a resident. There are signs in place to show the water is very hot. The Manager and all catering staff must make sure that all frozen food that has been opened has a date opened and use by date recorded to make sure that the frozen food is safe for residents to eat. The Manager must make sure that the CSCI receives a summary copy of their annual quality assurance. This is a repeat requirement that was original set 24/04/07 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. The summary of this inspection report can be made available in other formats on request. Norton House DS0000010862.V357736.R01.S.doc Version 5.2 Page 8 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 Norton House DS0000010862.V357736.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Hone provides a Statement of Purpose that is specific to the individual home, and the resident group they care for. EVIDENCE: The Inspectors looked at the homes Statement of Purpose that has been updated. The Statement of Purpose now has all relevant information in place that sets out the aims, objectives and philosophy of care that the home will provided to all residents living there and for prospective people. The Inspectors looked at the records of three people living at the home and each resident had a full care needs assessment from the placing local authority that is at present Westminster social services only. The residents care plans were then written in conjunction with the needs assessment. Norton House DS0000010862.V357736.R01.S.doc Version 5.2 Page 10 There is a rehabilitation unit in the home that provides a full intensive package of care. Physiotherapists and occupational therapists are employed to assist in setting up a programme of care that assists an individual in re-establishing themselves back into the community. The Inspectors did not spend time on the rehabilitation floor at this site visit. Norton House DS0000010862.V357736.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have access to healthcare and remedial services, staff make sure that those residents who are fit and well enough are encouraged to be independent, have regular appointments and visit the local health care services. EVIDENCE: Comments made by residents: ‘Staff are very helpful and will assist me when required to do so’ ‘I am happy with the care provided to me, I have no issues or complaints to make, staff are very helpful’ Norton House DS0000010862.V357736.R01.S.doc Version 5.2 Page 12 The Inspectors looked at three care plans of people living at the home; the care plans were very informative. All of the key care plan areas have daily progress sheets that are completed after every shift. All three care plans had comprehensive records in place that informed staff of how to support the individuals in their areas of care. Risk assessment records were also in place that worked in conjunction with the care plan and identified risks had an action plan in place. The care plans in Norton House have improved and in talking with staff they stated that they are now familiar with the recording procedures. The health care records looked at for the three residents had a lot of information including professional contact including GP’s, Occupational therapists and District nurse’s visits to the individual. In discussion with the Deputy Manager the Inspectors were told that no residents had any pressure sores, Waterlow records looked at had been reviewed on a regular basis to check the residents tissue viability. The medication records of residents were looked at on 3 floors, the medication recording and safe storage procedures was seen to be good with no errors on any of the MAR sheets looked at. The inspectors were told that the medication records are monitored on a regular basis. The Inspectors spent time on 3 of the floors and observed staff working closely with all residents. Personal care was provided to all residents in the privacy of their own rooms or in bathrooms. Norton House DS0000010862.V357736.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service are given the opportunity to take part in a variety of activities both within the home and in the community. EVIDENCE: Comments from residents: ‘The food is good especially the Sunday roast and the monthly chef’s special’ ‘The meals are nice and I can have the option of jacket potatoes or something different if I don’t want what is on the menu’ Residents who spoke with the Inspectors said that they are able to make choices about their daily lives. Examples included choices at meal times, daily routines and choice of clothes. Norton House DS0000010862.V357736.R01.S.doc Version 5.2 Page 14 The three care plans looked at had information relating to each person’s hobbies and interests. The Activities co-ordinator now has two staff daily designated to assisting him in providing activities on all floors. The Inspectors were shown a weekly activity plan with an annual plan of special occasions including resident’s birthdays where a celebration will be held at the home. The Activities coordinator showed photographs of group activities including all of the residents assisting to make the Christmas cakes for the home. Other activities are day trips the last being to Brighton, there is two trips booked for this year already for residents to enjoy. Relatives and visitors were seen coming into the home throughout this inspection. On the day of this site visit there was a catholic service and Church of England service being provided to residents that wanted to attend. In discussion with the Activities coordinator the Inspectors were told that there are no other religious services at present as there are no other residents with a different religion, the activities coordinator told the Inspectors that all religious or cultural observance would be met for any residents living at Norton House. The Inspectors looked at the finance documentation of three residents, there is a central bank account that is used for all residents’ savings; all residents now have their own account number linked to the account. The Inspectors were not able to ascertain why none of the resident’s accounts had any interest payments, in discussion with the Deputy Manager the Inspector request that this be checked. The Inspectors looked at the financial transactions of three residents and all receipts were seen to be in place. A secure lockable cupboard or draw has now been supplied to every resident living at Norton House to keep any items they wish keep secure and safe. The Deputy Manager told the Inspectors that meals are now provided to all residents in the main dining room on the ground floor rather that in the separate kitchen/dinning rooms on all floors. When speaking to residents the Inspectors were told that this was a positive thing and the residents enjoyed spending time if they wished with other residents in the dinning room. One of the residents spoken to told the Inspectors that they preferred to eat out or in their room even though staff had tried to encourage the person to have their meal in the main dinning room. Residents spoken to told the Inspectors that they like the food and there are always different options for them to choose. The Inspectors looked at the dry food storage areas and all food was seen to be in date and stored appropriately. The Inspectors found frozen food that had been taken out of the original packaging including chicken and sausages. There was no information stating when the use by date was or when the frozen food had been opened. In discussion with the Deputy Manager and Catering Manager the Inspectors discussed that this was a health and safety issue and this was an area that had been found at previous inspections and should not still be happening. Norton House DS0000010862.V357736.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints from individuals are not always fully recorded. When they are logged, the records looked at were incomplete with timescales, outcomes and actions not being properly logged. EVIDENCE: The Inspectors looked at the complaints logged at the home for the last 12 months of which there are 8. The complaints in some areas did not have the full investigation records in place and it was difficult to ascertain whether the complaint had been fully investigated and what was the outcome. On one of the residents surveys returned to the CSCI a resident stated they did not know the complaints procedure but would talk to a member of staff. The inspectors looked at all notice boards on all three floors visited and there were no complaints policy displayed, there should be a copy of the complaints procedure on notice boards on each floor. The home follows the local authority’s protection of vulnerable adults procedures informing the CSCI and other relevant professional bodies of any incidents, and these are available in the home for reference. Norton House DS0000010862.V357736.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in private. EVIDENCE: The Inspectors visited all areas of the home except for the second floor the rehabilitation unit. The Inspectors saw all communal parts of the home and some resident’s bedrooms, with their permission. Each resident has a single room with ensuite facilities. All f the residents are encouraged to personalise their rooms with photos and other personal items. All residents who spoke with the Inspectors said that they are happy with the accommodation at Norton House. All areas of the home were seen to be clean and tidy on this Inspection Norton House DS0000010862.V357736.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28 and 29. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The recruitment procedure at the home must recognise the need to check references to make sure that all of the residents are protected under safeguarding vulnerable adults. EVIDENCE: The Inspectors checked the home’s staffing rota’s for the months of November, December and part of January, staffing was seen to be adequate with vacancies being met with Anchor Bank staff. The Deputy Manager told the Inspectors that they have four new staff starting 16th January 2008 leaving a post of 28hours vacant. The times of each shift are now included on the rotas. The Inspectors looked at four staff recruitment files; all relevant documents were seen to be in place including a CRB Enhanced disclosure for all staff. There is a requirement that all references are checked for validity, the Inspectors looked at the documents for a member of staff that was recently employed and the references had also not been checked. Copies of original documents taken by the organisation must be signed and dated to show that the original documents were seen. The Inspectors looked at staff training and records did show that some staff is out of date with mandatory training including moving and handling, food hygiene and first aid. In discussion with the Deputy Manager the Inspectors were told that this was being looked at and all staff will be up dated ASAP.
Norton House DS0000010862.V357736.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Supervision is inconsistent, the Manager is aware that supervision meetings for all staff are not taking place and has highlighted a plan to make sure this happens. EVIDENCE: The home’s Manager has 20 years experience in the caring profession and is a qualified and experienced manager. She is at present applying to be registered by the Commission as a ‘fit person’ to manage the home. The Manager was not available on the day of this site visit however staff commented very positively about the new leadership provided by the Manager and Deputy Manager. Norton House DS0000010862.V357736.R01.S.doc Version 5.2 Page 19 The Inspectors looked at the records of three residents living at Norton House and each file had a quality review questionnaire in place that had been completed at the end of 2006. The Inspectors were also given a copy of the last in house audit dated 19th November 2007; there are issues that require action including staff training. In discussion with the Deputy Manager the Inspectors discussed the changes that had happened with the management in the past 12-18 months and that a quality assurance summary had been requested to be sent to the CSCI on two occasions. The organisation must collate all information and send a copy to the CSCI and it must also be made available to any stakeholders. The Inspectors looked at four staff files and each file contained supervision records. The records show that supervision is not happening frequently enough for all staff, as one staff member had not had supervision since April 2007. The Deputy manager did show the Inspectors a plan for supervision and agreed that this was something they are working at. With all of the changes that have occurred at the home the Deputy Manger agreed that supervision and training would be looked at straight away. The fire risk assessment review also needs to be completed and a copy sent to the CSCI. There is a need to make sure that hot water temperatures in the home are set at a safe temperature as the communal kitchen’s all had the hot water temperature set for over 50 degrees, this would scald a resident if used. There were signs above each sink stating caution hot water however the risk is significant and the temperatures must be lowered to a safe temperature. The home’s maintenance person and staff record water temperatures throughout the home each week. All frozen food must be stored correctly with open packets being re-sealed, with the date the package was opened and use by dates recorded on each item. Norton House DS0000010862.V357736.R01.S.doc Version 5.2 Page 20 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 3 x 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x x 2 x 2 Norton House DS0000010862.V357736.R01.S.doc Version 5.2 Page 21 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 OP8 Regulation 12 Requirement The Manager must make sure that the weighing chair is repaired or replaced to make sure that residents weight can be monitored accordingly. The organisational procedures for saving residents finances must be changed so that all residents having their own separate bank accounts and also receive the relevant amount of interest. The Manager must make sure that all complaints received have the full investigation records in place and the outcome of the complaint. The complaints procedure should be displayed on all floors so that people have got the information if required to make a complaint. The Manager must make sure that all recruitment references are checked for validity to make sure all residents are protected appropriately. Timescale for action 15/02/08 2 OP14 16 15/04/08 3 OP16 22 15/04/08 4 OP29 19 15/04/08 Norton House DS0000010862.V357736.R01.S.doc Version 5.2 Page 22 5 OP29 19 6 OP30 18 7 OP33 24 The Manager must make sure 15/04/08 that all original documentation copied as part of the recruitment procedure has confirmation that the originals were seen when and by whom. The Manager must make sure 15/05/08 that all staff is up to date with mandatory training to make sure all residents are assisted safely. The organisation to provide a 15/04/08 summary of the homes annual Quality Assurance document for the CSCI and any other stakeholders. This is a repeat requirement that was original set 24/04/07 The Manager must make sure that all staff receive regular supervision to make sure that staff are up to date with the home’s aims and objectives and their own. The Manager and maintenance person to get all of the hot water outlets checked to provide water at the correct temperature in all communal kitchens on all floors. This is a repeat requirement that was original set 24/04/07 The Manager and all catering assistance must make sure that all frozen food after being opened has the date opened and use by date recorded. The Manager to review the homes fire risk assessment. A copy to be sent to the CSCI. 15/04/08 8 OP36 18 9 OP38 23 18/01/08 10 OP38 16 18/01/08 11 OP38 23 15/02/08 Norton House DS0000010862.V357736.R01.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Norton House DS0000010862.V357736.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Norton House DS0000010862.V357736.R01.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!
