Inspection on 18/11/05 for Orchard House (Sawston)

This inspection was carried out on 18th November 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Orchard House (Sawston) 03/06/08

Orchard House (Sawston) 20/07/06

Orchard House (Sawston) 12/04/06

Orchard House (Sawston) 20/07/05

Orchard House (Sawston) 28/02/05

Orchard House (Sawston) 28/07/04

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

CARE HOMES FOR OLDER PEOPLE Orchard House (Sawston) 191 High Street Sawston Cambridgeshire CB2 4HJ Lead Inspector Shirley Christopher Unannounced Inspection 19 November 2005 8:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Orchard House (Sawston) DS0000015174.V266657.R01.S.doc Version 5.0 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. Orchard House (Sawston) DS0000015174.V266657.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Orchard House (Sawston) Address 191 High Street Sawston Cambridgeshire CB2 4HJ 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) 01223 712050 01223 712052 Methodist Homes for the Aged Alison Mary Baggaley Care Home 35 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (13), Old age, not falling within any other of places category (20) Orchard House (Sawston) DS0000015174.V266657.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The minimum daytime staff to resident ratio will be 1:10 for those residents in OP category and 1:5 for those residents in DE(E) category 20th July 2005 Date of last inspection Brief Description of the Service: Orchard House is situated in the village of Sawston, with easy access to local facilities, and road and rail links to the City of Cambridge, Linton and Haverhill. Orchard House provides residential accommodation for up to thirty-five service users over sixty-five. Their current registration certificate enables them to provide accommodation for up to fifteen people with dementia. There is a purpose built unit on the ground floor. The first floor is for service users who need residential care. There is a third unit offering respite care. On the same site there is a purpose built day centre, which can be used by the home, and by older people from the local community. The home has transport for the benefit of the day service. On the same site is a sheltered housing unit, which provides independent accommodation to more able service users. Accommodation is managed by a housing society and care needs are met by Methodist Homes for the aged. This service is managed separately from Orchard House and is subject to separate registration with the CSCI as a domiciliary care provider. The home provides accommodation, which meets the National Minimum Standards in terms of room sizes. The home has thirty-five single bedrooms, some of which on the first floor offer en-suite accommodation. The home has accommodation on two floors, which is accessed by stairs of a lift. Keypads are fitted on the internal doors of the dementia care unit to provide some security. Orchard House (Sawston) DS0000015174.V266657.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was undertaken by two inspectors on Saturday the 19 November at 8.00 am. Five care staff; one domestic, the deputy manager and the manager were spoken to as part of this inspection. In addition to this, nine service users were spoken to and three relatives. A relatives meeting was taking place at the home on the day of the inspection and one of the inspectors joined in the meeting and listened to some relatives concerns following the meeting. A tour of the building was conducted and a number of records were inspected including, the homes registration certificate, the complaints book, the statement of purpose, four service user care plans, regulation 26 visits and the accident records. The menus were displayed around the home and a list of social activities provided in the home was also displayed. Two areas of serious concern were identified in relation to medication, which for one person had been signed as administered when it was in fact still in the blister pack and medication was left unlocked and unattended during the inspection. An immediate requirement notice was left at the home and this will be followed up by an unannounced pharmacy inspection to ensure compliance with all areas relating to the safe administration and storage of medication. A second area of concern related to staff records. Two records were inspected and showed mainly comprehensive pre employment checks. However one staff member was employed on the strength of one written reference. A second written reference was received six weeks after employment. Concerns re staffing records was a previous requirement, so has been made an immediate requirement. What the service does well: The home is fully staffed at the moment and the staffing records inspected generally indicated that the home has thorough recruitment procedures and staff have a good induction and initial training. Supervision records seen were comprehensive. Of the service users spoken to most stated that they were satisfied with the home and felt the staff were good at their jobs. Orchard House (Sawston) DS0000015174.V266657.R01.S.doc Version 5.0 Page 6 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. Orchard House (Sawston) DS0000015174.V266657.R01.S.doc Version 5.0 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 Orchard House (Sawston) DS0000015174.V266657.R01.S.doc Version 5.0 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): 1,3,4 The statement of purpose must clearly establish what services the home are able to offer and to what client group. EVIDENCE: The home must revise its statement of purpose to ensure it accurately reflects the number of places provided, including the age and needs of service users accommodated. The format could be revised to make the document more service specific and user friendly. A number of service users spoken to had knowledge of the home before their admission either thought attendance at the day centre or through a period of respite care. Pre admission assessments were on file and care plans gave a good indication to how service users needs were to be met. Evidence through direct observation and through talking with the manager, care staff, relatives and service users suggested that even when minimum staffing levels are being maintained this is insufficient in meeting the existing Orchard House (Sawston) DS0000015174.V266657.R01.S.doc Version 5.0 Page 9 needs of service users. This potentially puts service users at risk and is subject to separate correspondence to the organisation. Staff spoken to had received basic training, induction and support appropriate to their job roles, but at least one member of staff had not covered basic training in the protection of vulnerable adults and manual handling in the first few months of their employment. Concern was expressed by relatives about care staff being asked to do domestic duties and assist with meal preparation as well as doing personal care and supervisory tasks. Orchard House (Sawston) DS0000015174.V266657.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 Clear improvements have been made to the care plans which give a clear illustration of service users needs. More attention must be placed on the prevention of falls. EVIDENCE: Four care plans were inspected and generally set out service users needs in respect of their health, personal care and social needs. These were kept under review and information was mainly comprehensive. Some health care records are kept separately from the main care plan and these were not inspected on this occasion. Service users had not signed care plans seen. The homes accident book was not up to date and some of the accident records lacked detail about the specific nature of the injury or the follow up action taken. The manager was written to on the 1 November 2005 regarding reporting accidents to the CSCI under regulation 37, in which she was asked to ensure adequate information was completed. Orchard House (Sawston) DS0000015174.V266657.R01.S.doc Version 5.0 Page 11 One relative felt that the health care needs of her mother were not being met and gave a specific example. She also stated that her mother had fallen frequently in the last few months. Her care plan was not inspected. The manager must ensure that there are adequate risk assessments in place addressing the needs of service users at risk of falling. Frequent fallers should be referred to the falls prevention team and other primary care services. A full audit of the homes medication was not undertaken, but a number of errors were observed including medication signed as administered when it was in fact still in the blister pack and medication lefty unattended. An immediate requirement was left in respect of this. The manager and a number of care staff spoken to stated that training in the administration of medication is provided in the home to all staff. The CSCI will request a full pharmacy inspection to be undertaken on its behalf. This visit will be unannounced. Orchard House (Sawston) DS0000015174.V266657.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Evidence of social activity was provided, but the numbers of staff on duty and the inaccessibility of the outside space restricted the type of activity that could be provided. EVIDENCE: The home has staff with an overall responsibility for providing activities. On the day of inspection there was an autumn fair taking place at 12.00 pm and there was also a relatives meeting, which are held every three months. A plan of weekly activities was seen in various areas of the home. A number of service users confirmed that activities take place and relatives and friends visit them. Of the care plans seen, a brief social history was recorded. Daily notes inspected did not indicate what service users had done throughout the day, other than having their personal care and dietary needs met. A number of relatives were concerned that the homes gardens, was largely inaccessible to the service users on the dementia care unit. Plans to create a sensory garden had been discussed at previous inspections. Although monies have been raised and discussions taken place, work on the gardens had not started and relatives stated that this has been ongoing for more than two years. Relatives commented that all throughout the summer their relatives Orchard House (Sawston) DS0000015174.V266657.R01.S.doc Version 5.0 Page 13 were unable to get out. It was agreed that a working party should be set up to get the project off the ground and that opportunities without limits (OWL) and Scottsdale’s garden centre be approached for their support. A number of service users spoken to made positive comments about different aspects of the home. One service user commented on the fact that they have a cooked breakfast on a Saturday and he would like it more often. Another lady commented that she had to wait for over an hour for staff to assist her with a bath. Other service users stated that the staff were very good and they had no complaints. Several attended the day centre downstairs. Menus were on display on the individual units and a cooked breakfast was being served. Some service users were given their breakfast by 8.30, others were still waiting by 9.30 am. One service user asked for her breakfast, concerned that she would faint if she did not eat regularly. The domestic staff stated that she would support care staff in assisting service users with their meals. One relative felt that the home was sometimes short staffed and she had assisted with feeding also. The home must ensure the appropriate supervision of service users at all times, but specifically around meal times which should as far as possible be at a time of residents choosing. Orchard House (Sawston) DS0000015174.V266657.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The home has adequate procedures in place for the protection of vulnerable adults but all staff must receive training in this area. EVIDENCE: The manager stated she had received a complaint since the last inspection, which was appropriately recorded. Policies and procedures in relation to complaints and the protection of vulnerable adults were not inspected. Some staff spoken to had not as yet received training on the protection of vulnerable adults. A recent meeting has been held under the protection of vulnerable adults to discuss a number of concerns re practice issues at the home. The manager has asked to complete an action plan to identify areas for improvement. A copy of this plan must be submitted to the CSCI office and used to monitor the performance of the manager. Orchard House (Sawston) DS0000015174.V266657.R01.S.doc Version 5.0 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): 19,20,21,22,24,26 The environment was generally satisfactory, and accommodation is provided in small homely units. The odour in the dementia care unit was of serious concern. EVIDENCE: A tour of the home was conducted and was generally satisfactory. Bathrooms were fit for purpose, although the lack of storage was identified in a few areas. The maintenance of equipment has been identified as a concern, but no evidence of poorly maintained equipment was found. Individual service user rooms were fine. One relative said the standard of cleanliness in the home was a concern and specific reference was made to one bedroom, which despite attempts to eradicate odours smelt strongly of urine. This door had been propped open, which poses an even greater risk to health and safety. The manager was asked to replace the carpet immediately. There was one domestic on duty and this was discussed with the manager in relation to the comments made. The manager stated she had recruited another domestic to Orchard House (Sawston) DS0000015174.V266657.R01.S.doc Version 5.0 Page 16 work on a Sunday and was just waiting for references. This appointment would mean that the home has domestic staff every day. A further concern raised in the relatives meeting concerned service users going into each other’s bedrooms, particularly on the dementia care unit where they had become disorientated. The manager suggested locking bedroom doors and where consent could be obtained service users to have keys. This was to be tried for a month. The manager must ensure that service users rights are preserved and any such decision is recorded and signed by the service user and, or relative as part of a risk assessment framework. Orchard House (Sawston) DS0000015174.V266657.R01.S.doc Version 5.0 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): 27,29,30 Staff induction, training and supervision records were mainly satisfactory, but the numbers of staff on shift was deemed to be inadequate to meet the needs of the existing service users. EVIDENCE: The inspectors felt that the level of staffing was insufficient to meet the needs of the service users. This was evidenced through direct observation of care practices, and through discussion with care staff, the manager, service users and relatives. One relative said staffing levels were most acute in the morning and staff struggled to get people up in a timely fashion. The home was fully occupied and there were no staffing vacancies, although the rotas showed some use of agency staff. The staffing rotas must include the surnames of agency staff. Staff records were mainly satisfactory and provided evidence that staff recruitment is done on the basis of good employment practices. Interview notes are kept and staff are supported through an initial induction programme and then shadowed by more senior staff. Evidence of supervision showed thorough notes being kept, but did not indicate the frequency of supervision in the case of the files inspected, because they were newly appointed. New staff are subject to a probationary period and have a number of performance Orchard House (Sawston) DS0000015174.V266657.R01.S.doc Version 5.0 Page 18 reviews. Training records in the main indicated that staff have the necessary training, but some staff had not completed training in the protection of vulnerable adults. Care staff were busy throughout the inspection and were spoken to briefly, but did indicate that they were stretched to full capacity. Relatives commented on the high turnover of staff. Orchard House (Sawston) DS0000015174.V266657.R01.S.doc Version 5.0 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): 31,33,36,37,38 The health and welfare of service users is compromised by inadequate levels of staffing and poor record keeping in some areas of practice. EVIDENCE: The manager has considerable experience and had run a previous home for people with dementia. She has completed a qualification in management and an NVQ 4 in care. She is supported by a number of assistant team managers. A number of concerns have been raised in relation to the management of the home and the Methodist Homes for the Aged are committed to improving the level of care at the home. They have brought in a more senior manager to support the existing manager and to help her take the service forward in a number of key areas where room for improvement have been identified. Two immediate requirements were left following this inspection regarding the safe administration and storage of medication and keeping appropriate staffing records. Other records inspected were mainly satisfactory and included four Orchard House (Sawston) DS0000015174.V266657.R01.S.doc Version 5.0 Page 20 service users care plans and daily notes, two staff files including induction records, menus, activities, staffing rotas, complaints book, accident record, evidence of regulation 26 visits, which require a monthly audit of the service, regulation 37 forms which require the home to notify the CSCI of any serious illness, accident, incident or occurrence as laid out by the regulation and the statement of purpose. The latter needs adapting to specifically reflect the service. Accident records need to be completed in more detail and evidence provided of preventive measures taken. Orchard House (Sawston) DS0000015174.V266657.R01.S.doc Version 5.0 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 2 X 3 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 X 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 2 2 3 3 3 X 2 X 2 STAFFING Standard No Score 27 2 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 X X 3 2 X Orchard House (Sawston) DS0000015174.V266657.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 Requirement The statement of purpose must be kept under review and revised accordingly. This was a previous requirement. The timescale of the 31/08/05 has not been met. The registered person must ensure that unnecessary risks to service users are identified and where possible eliminated. Particular attention must be given to the prevention of falls. The registered person must ensure that there are adequate arrangements in place for the safe administration and storage of medication. (An immediate requirement was made in respect of this.) The registered person must ensure that all staff receive adequate training in the protection of vulnerable adults The registered person must ensure the layout of the home is suitable to meet the needs of service users. The physical design of the building makes the appropriate supervision of DS0000015174.V266657.R01.S.doc Timescale for action 30/12/05 2 OP8 13 (4)(c) 30/11/05 3 OP9 13 (1)(2) 19/11/05 4 OP18 13(6) 30/12/05 5 OP19 23(2)(a) (o) 30/11/05 Orchard House (Sawston) Version 5.0 Page 23 service users more difficult. This must be considered before admission and kept under review. The external grounds must also be accessible The registered person must ensure that rooms occupied by service users are fit for purpose. Adequate floor covering must be provided. This requirement should be read in conjunction with the requirement made in number 7 The premises must be kept clean and free from offensive odours. This was a previous requirement. The timescale of the 31/08/05 has not been met. The registered person must ensure that the home is conducted so as to promote and make proper provision for the health and welfare of service users. The staffing levels must be appropriate to meet the needs of existing service users and the home must continue to demonstrate how the supervision given to service users is adequate. The full name of each member of permanent and agency staff must be kept at the home. This was a previous requirement. The timescale of the 31/08/05 has not been met. Staffing ratios must be kept under review according to the assessed needs of the service users and the skills mix of staff must be appropriate to their needs. This was a previous requirement. The timescale of the 31/08/05 has not been met. DS0000015174.V266657.R01.S.doc 6 OP24 16 (c) 30/12/05 7 OP26 16(2)(k) 30/12/05 8 OP27 12 (1) (a)(b) 30/11/05 9 OP27 17(2) Sch4 30/12/05 10 OP27 18 (1) (a) 30/11/05 Orchard House (Sawston) Version 5.0 Page 24 11 OP29 19(4)(i) 12 OP33 24(2) 13 OP37 17(1) Staff files must include two written references. An immediate requirement was made in respect of this regulation. This was a previous requirement and the timescale of 31/08/05 has not been met. The registered person must supply a copy of any review it undertakes with regards to improving the services provided at the home to the CSCI. The registered person must ensure adequate records are kept in accordance with schedule 3 and 4 of the Care home regulations 2001. Regulation 37 forms sent to the CSCI must be completed in full, as must accident records kept in the home. 19/11/05 30/12/05 30/11/05 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 Orchard House (Sawston) DS0000015174.V266657.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB1 5XE 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 Orchard House (Sawston) DS0000015174.V266657.R01.S.doc Version 5.0 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!