Inspection on 03/11/06 for Park House

This inspection was carried out on 3rd November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Park House 06/02/06

Park House 19/04/05

Park House 07/10/04

Park House 01/04/04

Similar services:

Carentan House

Ravensworth Lodge

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

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

CARE HOMES FOR OLDER PEOPLE Park House Worsbrough Road Worsbrough Village Barnsley South Yorkshire S70 5LW Lead Inspector Mrs Sue Stephens Key Unannounced Inspection 3rd November 2006 12:15p 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 Park House DS0000018273.V312466.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. Park House DS0000018273.V312466.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Park House Address Worsbrough Road Worsbrough Village Barnsley South Yorkshire S70 5LW 01226 281228 F/P 01226 281228 none 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) Mr Paul Crabtree Mrs Gloria Crabtree Mrs Gloria Crabtree Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Park House DS0000018273.V312466.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th February 2006 Brief Description of the Service: Park House is a stone built property, which was originally the schoolhouse to the village school. The home has been adapted and extended while maintaining many of its original features in order to create a personal care home with accommodation for 20 elderly persons. It occupies a central position in the conservation village of Worsborough and there is one acre of well-maintained gardens, including a small orchard. The home is adjacent to Worsborough Country Park and is in close proximity to the Parish Church of Saint Marys and the local pub. Main bus routes are close by and the home is about three miles from Barnsley town centre and two miles from junction 36 of the M1 motorway. Accommodation is on two floors, serviced by a passenger lift. There are 12 single and four double bedrooms, two lounges and one dining room. The home has a car park at the rear and side of the building. The manager gave the Commission for Social Care Inspection information about the home’s fees and charges on 3 November 2006. The fees range from £255 to £355 per week. This depends on the size of the room and the residents’ individual needs. Their charges include hairdressing, chiropodist, toiletries and transport. These charges are variable; the manager can provide more information about this. People who are interested in Park House can get information by contacting the manager. The home will also provide a copy of the statement of purpose and the latest inspection report. Park House DS0000018273.V312466.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was unannounced; it took place between 12:15pm and 17:30pm. The inspector sought the views of five residents, one relative, a care worker and one clinical professional who visited the home. The manager, Mrs Crabtree, and the administrator, assisted with the inspection. During the visit the inspector looked at the environment, and made observations on the staffs’ manner and attitude towards the residents. She checked samples of documents that related to the resident’s care and safety. These included three assessments and care plans, three medication records, and three staff recruitment files. The inspector looked at other information before visiting the home. This included the pre-inspection questionnaire, which the Commission for Social Care Inspection (CSCI) had requested and 15 questionnaires from residents at the home. This was a key inspection and the inspector checked all the key standards. The inspector would like to thank the residents, relative, and staff for their welcome, help and contribution to this inspection. What the service does well: Park House gives people good information before they move in to the home. The residents say the care is excellent. They say Park House is a “Good place to live” and it is “Highly recommended”. The manager and staff treat the residents with dignity and respect. And the manager takes a lot of time to observe care to make sure the staff look after the residents well. Park House is very focussed on the care and comfort of the residents. The residents have excellent opportunities to join in interesting activities. For example the home makes a lot of effort to celebrate birthdays and special events. The home arranged for a historian to present a Victorian experience, which the residents enjoyed. The residents described the meals as “Very good” and said they have “good meals all the time”. Staff prepared and served the meals to a very high standard. The food was fresh and nutritious, and the mealtimes were relaxed and a sociable event. Park House DS0000018273.V312466.R01.S.doc Version 5.2 Page 6 The residents said they could talk to staff or the manager if they had any concerns. Park House took a lot of effort to make sure the environment was comfortable and pleasing. Pictures and ornaments were on display in a way that created interest for the residents and made the place feel warm and inviting. Residents said their rooms and beds were warm and comfortable. More than half the care staff had a National Vocational Qualification in care, which meant they understood about how to give good care. And Park House followed recruitment procedures to make sure they chose the right people to work at the home. The manager closely supervised the staff to make sure they met the residents’ needs. And a resident said they were “Happy with Mrs Crabtree, the staff and cooks. The home states it follows Christian values within their principles of care; and the manager said she considers peoples diversity needs through their assessments and reviews. What has improved since the last inspection? What they could do better: Park house need to improve how they do the residents assessments and care plans because they do not have enough information in them. They need to be more clear and tell staff what the residents needs are and what action they must take to meet the residents needs. The home needs to be able to identify staff signatures, in case they need to check who administered the medication. And the staff need to have medication guidelines to refer to and know if it is safe to give residents homely remedies. Park House DS0000018273.V312466.R01.S.doc Version 5.2 Page 7 It is important that staff start to get regular training, which will keep them up to date with safe working practices. They also need training related to the care of older people to make sure they continue to give residents safe and consistent care. 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. Park House DS0000018273.V312466.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 Park House DS0000018273.V312466.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 did not apply. The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Park House gives future residents (and their representatives) the information they need to decide if the home can meet their needs. And the residents have their needs assessed before they come to the home. Park House needs to improve their assessment records, to make sure staff understand the residents’ needs. EVIDENCE: The manager always assessed people before they were offered a place at Park House. The manager carried out the assessment herself and kept the records in the residents care plans. The assessments looked at people’s health and social needs. The assessments were basic and did not include all the information recommended in the National Minimum Standards. The plans of care did not reflect peoples assessed needs. Park House DS0000018273.V312466.R01.S.doc Version 5.2 Page 10 However, the residents and the relative said the home understood each persons needs well and Mrs Crabtree took thorough information about people before they moved in. Park House DS0000018273.V312466.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care, which a resident receives, is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: The care plans did not contain enough information about the residents. There was no plan of care that told staff the action they must take to meet people’s needs. Some of the information in the records was not easy to find and the records were not clear and consistent. Each resident said they were very satisfied with their care. The relative agreed with this and said she was “Well satisfied”, “staff are all very caring” and “Mrs Crabtree is strict about the general care”. The residents made the following comments: Park House DS0000018273.V312466.R01.S.doc Version 5.2 Page 12 “We are very well looked after here”, “I am fine here”, “Its as good as home from home”, “It is like a first class hotel”. The residents also made very positive comments in the questionnaires, and these included: “This is the nearest to home from home” “Park House is a good place to live in” “I am happy with Park House, Mrs Crabtree and all the staff”. “Highly recommended” “I’m quite happy here at Park House”. The standard of care was very high. Staff were very attentive to the residents they spoke to them with dignity and respect, and the manager was very keen that staff dealt with the residents with patience and good manners. The manager spent a lot of time with the residents observing the care and making sure residents needs were met. Staff understood the residents personal needs, they gave them independence and dignity, and helped the residents in a way the residents preferred. For example undressing alone and persevering with a walking frame. The staff and manager were mindful about people’s personal possessions. This meant that residents could have their own possessions around them, for example purses, handbags and books, without the fear of losing or misplacing them. A clinical professional who visited the home said the home always welcomed her. Staff were “very helpful”, and understood the residents conditions. They asked appropriate advice about the residents health needs, listened and carried out the professional’s advice. In the main Park House managed residents’ medication well. However the home had not met the previous requirement to make sure they could identify staff signatures and have pharmaceutical guidelines available for staff to refer to. The home had a stock of homely remedies; the remedies did not have residents’ names on or a list of safe remedies to use. This could put people at risk of using a remedy that did not go with their medication. Park House DS0000018273.V312466.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. The quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are able to keep in contact with family and friends. The residents have activities that they enjoy, find interesting and stimulating. Park House makes an exceptional effort to do this. Park House provide residents with a very high quality diet. They put a lot of effort into making mealtimes and celebrations enjoyable and dignified. EVIDENCE: The residents and relative spoke very highly about the activities they were involved in at Park House. The manager took great pride in making sure days at the home were interesting. The home goes to great lengths to celebrate any event that is interesting for the residents. For example, they enjoy national annual events and residents’ birthdays. The residents had recently enjoyed a Halloween night and they had joined in a Victorian experience day. The home hired a historian who presented the event. Park House DS0000018273.V312466.R01.S.doc Version 5.2 Page 14 The residents and staff said the manager made birthdays very special. The resident would choose the homes menu for the day and could have “absolutely anything they want”. The residents also receive a present from the home. The relative said the home makes Christmas very special. They plan the day with treats, Christmas music and poems and a grand meal. The home invites the relatives and friends, and the relative said the day is “very touching”. One resident said, “I go to all the concerts, I enjoy them very much”. The staff offer residents a walk on most days, they can visit the gardens or go round the village. If residents want to go shopping staff will escort them. The residents made a lot of positive comments about meals at Park House. These included: “I like the meals very much so”. “The meals here are very good, we always get the food we like” “Very adequate to what we need”. “I have very good meals” “Good food all the time”. The manager, cook and staff made a lot of effort to make sure the quality of the food was good and the meal time was pleasant. They cooked all the food fresh; there was a lot of choice with fresh vegetables, meat and fruit. And the residents enjoyed home-baked cakes. Staff set the tables to look very appealing. And each table had an easy to read menu. The staff were very observant and made sure people had enough to eat and drink. The mealtime was sociable and relaxed with soft music playing in the background. Park House DS0000018273.V312466.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can tell the home if they have any concerns. People at the home will listen and take action. The manager and staff need to understand adult protection procedures better so that they continue to keep people safe. EVIDENCE: The home had a complaints procedure and this was on display for people to see in the entrance hall. The residents said they could raise concerns and the manager and staff would listen. The relative, and feedback from residents in the questionnaires, also confirmed this. The manager took action to safeguard residents when there was an incident at the home. The manager contacted the Commission for Social Care Inspection, and social services. Social services began adult protection procedures and the manager followed their advice and guidance. The administrator also assisted in the procedures. However the manager and administrator did not have sufficient understanding of the adult protection procedures. They did not have the local authority procedure manual to refer to and the administrator had not had adult protection training. Park House DS0000018273.V312466.R01.S.doc Version 5.2 Page 16 The manager said staff at the home had been on adult protection training in the past. However the home could not demonstrate this for all staff and there was no training plan to secure future training. Staff did not have access to the homes and local authorities procedures. Park House DS0000018273.V312466.R01.S.doc Version 5.2 Page 17 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, 24 and 26. The quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. The residents live in a very comfortable home. The home makes a lot of effort to make the environment pleasing for the residents. This promotes the residents’ dignity, respect and welfare. EVIDENCE: The residents said they were very pleased with their environment. They said they were comfortable and warm. One resident said the manager had bought all the residents a ‘snugly’ blanket each, which they were ‘delighted’ about. Park House decorated the home to a high standard. Each room had ornaments, pictures and soft lighting; this gave the place an inviting and homely feel. Park House DS0000018273.V312466.R01.S.doc Version 5.2 Page 18 Staff said the manager changed some of the pictures and ornament displays from time to time to create interest for the residents. There were a variety of comfortable places to sit. Each area had a focal point with comfy chairs or settees. Residents could personalise their own rooms, they said their rooms were pleasant and their beds were comfortable. The relative said the manager went to a lot of effort to make sure the home looked nice, for example she makes sure bedding and curtains match and she asks people if they have everything they need. The home was clean, tidy and had no offensive odours; the carers were involved in cleaning the home. The home laundered the residents’ clothes well. Park House DS0000018273.V312466.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff look after the residents well, however they have not had sufficient training to make sure their practices are up to date and safe. EVIDENCE: Over 50 of the care staff had a National Vocational Qualification in care. This was good practice because it meant staff understood the values of good care practices. The residents were very positive about the staff; they said they felt well looked after by staff, they said this in the questionnaire and to the inspector. One resident said the staff availability was “very good”. A staff member said there was enough staff to support residents and do their other duties. For example doing the laundry and cleaning. The home had improved its recruitment records. These had information in them to show that the home had made careful checks before recruiting staff at the home. This helped to safeguard the residents and make sure they employed the right people to care for the residents. Park House DS0000018273.V312466.R01.S.doc Version 5.2 Page 20 The administrator said she was aware that new employees would need a declaration of health statement and statement of any employment gaps. (This was because the information was not in some of the original staff records). Park House did not have a training programme for staff. The home could not demonstrate that staff had an induction that met the Skills for Care standards, (the national training standards). The amount of training the home had provided for staff to maintain their care and safe practice skills was not sufficient to make sure their practices were consistent, up to date and safe. The home did not have a plan to provide the training in the future. Park House DS0000018273.V312466.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration is open and respects the residents. The quality assurance systems have improved, this improves the residents’ safety and welfare. The staff need to update on safe practice training to continue to keep people safe. EVIDENCE: The residents said they were happy with the way the manager ran the home. They said they could talk to her and she was “always” around. One resident said they were “Happy with Mrs Crabtree, and all the staff and cooks”. Park House DS0000018273.V312466.R01.S.doc Version 5.2 Page 22 The home had improved its administration. The administrator had put in new systems, which helped to protect the residents’ welfare. For example they had neat and orderly finance systems, where the information was easy to find. The new systems allowed the home to do better quality audits. The home had introduced improved resident finance systems. This gave the home a clear audit and information was easy to find and understand. Staff had very good supervision. The manager made regular observations of the staff, consulted with residents and followed up if any concerns were raised about staff practice. Staff said the manager was a good a ‘listener’ and they could approach her with ideas and concerns. Some staff were not up to date with safe working practice training. For example it was a long time since they had training about moving and handling people safely, understanding health and safety and food hygiene. The home did not have any plans to update the training, (although staff did have fire training). This was not good practice because the home could not be confident that staff understood how to carry out safe practices. This could put the residents’ safety and welfare at risk. Park House DS0000018273.V312466.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 4 9 2 10 4 11 x 1DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 4 X X X X 4 X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Park House DS0000018273.V312466.R01.S.doc Version 5.2 Page 24 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 OP3 Regulation 14 Requirement Plans of care must be based on the outcomes of residents’ needs assessments. The homes assessments must include all the details as set out in standard 3. Previous action dates 30/05/05 and 30/04/06 Residents’ records must include all the information in schedule 3 of the Care Homes Regulations 2001, and the home must be regularly review them to reflect the changing needs of the residents. Previous action date 30/06/05 and 30/04/06 Each resident must have a plan of care that identifies their needs and outlines the action staff must take to meet those needs. 3 OP9 13 Staff signatures must be identified for the medication records. DS0000018273.V312466.R01.S.doc Timescale for action 31/01/07 2. OP7 15,17 31/01/07 31/01/07 Park House Version 5.2 Page 25 The Royal Pharmaceutical guidelines must be available for staff. Previous action date 30/04/06 The home must have a record of the purpose of the residents’ medication. The home must check with the pharmacist what homely remedies are safe for each resident. 4. OP30 17,18 All staff must receive training appropriate to their work. Previous action date 31/05/05 and 30/04/06 Staff inductions must meet sector skills council requirements. A training programme must be devised that covers training in line with resident care needs and staff development needs. 31/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Park House DS0000018273.V312466.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Doncaster Area Office 1st Floor, Barclay Court Heavens Walk Doncaster Carr Doncaster DN4 5HZ 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 Park House DS0000018273.V312466.R01.S.doc Version 5.2 Page 27 - 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!