Inspection on 03/05/06 for Park Lodge

This inspection was carried out on 3rd May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 Lodge 29/06/07

Park Lodge 12/12/05

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Park Lodge 11-15 Park Road Berrylands Surbiton Surrey KT5 8QA Lead Inspector Margaret Lynes Unannounced Inspection 2nd May 2006 10.15 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 Lodge DS0000065224.V289663.R01.S.doc Version 5.1 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 Lodge DS0000065224.V289663.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Park Lodge Address 11-15 Park Road Berrylands Surbiton Surrey KT5 8QA 020 8390 7712 020 8547 1580 parklodge@supanet.com 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) CHD (Care Homes) Ltd Mrs Paulene Rogers Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35), Physical disability (35), Physical disability of places over 65 years of age (35) Park Lodge DS0000065224.V289663.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th December 2005 Brief Description of the Service: Park Lodge is a care home with nursing that provides care for older people. It is situated in a residential area of Surbiton close to the main A3 road, and is on a bus route that serves the local rail station. The home has limited parking facilities, but benefits from a large garden. Accommodation is provided over three floors, which are serviced, by a passenger lift and chair lifts. The accommodation comprises of shared and single rooms. All rooms have a wash hand basin. The home has a large lounge area. The home is owned by Care Homes of Distinction. This company also has several other care homes in the Croydon/Sutton/Kingston geographical area. The current weekly fees, as given at this inspection, range from £355.67 to £640. Park Lodge DS0000065224.V289663.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The last inspection visit, carried out in December 2005, found that the vast majority (12) of the 15 requirements that were made at the main inspection earlier on in the year were unmet. In addition, the December visit resulted in an additional five requirements being made. Because of this, the home received a further visit in January 2006 to assess what progress had been made. A meeting with the proprietors was also held to outline the Commission’s concerns. At the January inspection it was found that of the seventeen outstanding requirements six had been met, while action had been taken to partially meet another five. Four had not been dealt with while it was not possible to determine if the remaining two had been actioned. This visit, therefore, while focussing on assessing all of the key Standards, also looked at those outstanding requirements to see what action had been taken. The resignation of the Registered Manager at the end of March has added to the issues that the proprietors need to address, although it must be noted that they have already recruited a new manager. This inspection had resulted in ten new requirements being made, while of those outstanding requirements detailed above some nine are still to be dealt with – a clear indication, therefore, that there remains a lot of work to be done to bring this home up to an acceptable standard. Evidence to support the comments below was gathered from a range of sources – the service users themselves, members of staff and inspection records. What the service does well: As was stated in the December report, and was re-confirmed on this visit, the service users who kindly gave up some of their time to talk with the Inspector said that they were that they were satisfied with the service being provided. It is, of course, of paramount importance that the service users feel happy with their home, and it could be said that all else is secondary to this. To a great extent this is true, however if the proprietors, and now the new manager, take the steps needed to meet the requirements, then the service could be so much better, thus improving the quality of life for the residents. Park Lodge DS0000065224.V289663.R01.S.doc Version 5.1 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. Park Lodge DS0000065224.V289663.R01.S.doc Version 5.1 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 Park Lodge DS0000065224.V289663.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (6 is not applicable) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. It was felt that the home met the minimum Standard with regard to preadmission assessments. This means that service users should be assured that their needs can and will be met by the home. EVIDENCE: The files of four service users were examined. All contained an assessment from the Placing Authority. Some of these were supplemented by a partially completed in-house assessment. The presence of the placing Authority assessments means that the home should have sufficient information upon which to determine if it can offer a placement. It would be good practice, however, to ensure that if the home is going to complete its own assessment then this is done to a satisfactory standard. The previous three inspection visits identified that the home had (historically) admitted clients who fell outside its registration categories. This led to a Park Lodge DS0000065224.V289663.R01.S.doc Version 5.1 Page 9 requirement that the proprietors apply for a variation for any such resident that still lived at the home. This application has not, to date, been forthcoming. It was of further concern to see that a recently admitted service user had a diagnosis that also fell outside the home’s registration categories. A requirement will be made in this report to the effect that the home cannot agree to such admissions until a variation application has been made to the Commission, and the Commission has given written agreement to it. The proprietors will also be written to under separate cover, and asked to provide an explanation of this apparent breach of Regulations. The Commission will then determine what, if any further action is required. Park Lodge DS0000065224.V289663.R01.S.doc Version 5.1 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 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There were a number of areas relating to the above key issues where the Standards were not met – which has led to 3 outstanding requirements being repeated. This means that there was insufficient attention being paid to both recording and meeting service users needs, to reviewing service user plans and to health care records. This can have a detrimental effect on the overall care being provided. EVIDENCE: While all of the service user files examined contained a service user plan, the thoroughness of these varied, and none had been reviewed on a regular basis. The recording system in use in the home (Standex) has specific proforma for each area of care. These would be more than adequate if they were actually fully completed by staff. For example, not all of the risk assessment or manual handling assessments had been completed. Some of the plans included social care needs, others did Park Lodge DS0000065224.V289663.R01.S.doc Version 5.1 Page 11 not. The specific record sheet for diabetic service users had been completed for one such resident but not for another. The new manager has already identified the shortcomings in this area and has started to have teaching sessions with the qualified staff. Very few of the service users had wounds that needed to be dressed however it was noted that in once case, although the manager stated that a dressing was to be done twice daily, the record indicated that it was only being done once, and on occasion not even then. Nowhere on the wound treatment record was it actually written how often the dressing was to be changed – which could account for it not being done as the manager wished. The medication charts were examined and it was pleasing to see that staff had improved their recording. Two minor issues were noted – these related to the need for staff to ensure that they correctly dated entries on the ‘reason medication not given’ section of the chart, and also that they were diligent in ensuring that the dosage/frequency of medication was always clearly stated. Park Lodge DS0000065224.V289663.R01.S.doc Version 5.1 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 and 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There was little evidence to suggest that the home offered sufficient social, cultural, religious or recreational activities to meet service users interests and needs. More positively, visitors are encouraged to call, and the lunchtime meal appeared well prepared and appetising. Service users said that they found the food to be satisfactory. EVIDENCE: The Inspector sat in the main service user lounge for the morning of the inspection and saw very very little in the way of activities or stimulation for the service users. The TV music channel was turned on, and one resident was given a puzzle to complete. It was a similar scenario in the afternoon. The new manager has carried out a quality assurance survey of the service users and relatives. While the majority of responses were positive, almost all of the residents who replied said that they would like more activities. Relatives and other visitors are welcomed, however at the time of this visit there were not any such guests at the home for the Inspector to meet with. Park Lodge DS0000065224.V289663.R01.S.doc Version 5.1 Page 13 The food, although not sampled, was well prepared, well presented and looked appetizing. On the aforementioned quality assurance surveys several residents had asked if they could occasionally be offered a cooked breakfast. The manager said that these requests had been acted upon. Park Lodge DS0000065224.V289663.R01.S.doc Version 5.1 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 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Both the complaints and adult protection procedures were adequate so as to provide both a means of addressing concerns and sufficient protection to service users. EVIDENCE: The outstanding requirement regarding amendments that were needed to the adult protection procedure has now been met. There have not been any adult protection issues in the home, and neither have there been any recent (recorded) complaints. Park Lodge DS0000065224.V289663.R01.S.doc Version 5.1 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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although there were still two outstanding requirements, action had been taken to progress both of them. It was felt, therefore, that service users were enabled to live in a safe and generally adequately-maintained environment. EVIDENCE: A tour was made of the communal areas and some of the bedrooms. At the previous two inspections there was a noticeable odour on entry into the home. This has improved as on this visit there was just a slight odour detected in the small lounge area. Although the home was generally adequately kept, there were a number of issues that the Inspector raised with the manager. These related to the need to re-hang the curtains in one bedroom; to ensure that all bedroom doors fully closed; to ensure that all call bells were untied and within easy reach and to Park Lodge DS0000065224.V289663.R01.S.doc Version 5.1 Page 16 ensure that the door giving access to the lift mechanism was kept locked. The extractor fan in the kitchen still needs to be fitted however the manager gave assurances that this was in hand. The manager was asked to remind cleaning staff that all existing extractor fans need to be cleaned on a regular basis. While examining the risk assessment records it was noted that the (previous) manager had deemed that a number of wardrobes presented a risk to service users because they were not anchored to the wall. It was pleasing to note that this had been rectified as the proprietors had purchased better quality furniture that was highly unlikely to topple. The home is served by one main lift and by two stair lifts. At present one of the latter is out of order, which means the adjacent bedroom cannot be used. Staff commented upon frequent breakdown of the main lift. Indeed there was a problem with it during the inspection. The proprietors need to give consideration, therefore, to the replacement of the main lift, and a resolution to the problem with the stair lift. Park Lodge DS0000065224.V289663.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. From the rota provided it was not felt that service user needs could be fully met by the number of staff on duty. From the documents available for inspection it was not felt that service users were either supported or protected by the home’s recruitment policy and practices. At the last visit a requirement was made for staff to be enabled to attend more training, including accessing NVQ courses. It was disappointing to find that carers have not, as yet, enrolled on NVQ training. This means that it is possible that staff skills are not as comprehensive as they could and should be. EVIDENCE: Following the last inspection visit concerns were expressed to the proprietors regarding staffing levels. From the information provided it appeared that the manager was expected to work as part of the rota, and the number of qualified staff on duty (excluding the manager) had been cut to just one. This reduction in qualified staff was not acceptable to the Commission, and the proprietors were asked to rectify it. On this visit, it appeared that no action had been taken to increase the number of qualified staff on duty, albeit on most shifts the number of carers was satisfactory. It will again be required, therefore, that Park Lodge DS0000065224.V289663.R01.S.doc Version 5.1 Page 18 the number of qualified staff is increased, but not at the expense of a carer. The carer levels must be maintained as they are, as from observation the staff team was stretched, with service users having to wait some time before their needs could be attended to. At the aforementioned inspection visit it was not possible to access the staff recruitment documentation, and unfortunately this was yet again the case on this visit – with the exception of the file of one of the new members of staff. This was incomplete, as it did not contain a CRB disclosure. The manager explained that almost all of the staff records had been taken to the proprietors’ head office to be sorted. While the wish to ensure that these files are up to date is commendable, it would have been more appropriate to have them sorted while in the home, so that they were available for inspection. The requirement re recruitment has, therefore, been repeated. The unavailability of the staff files meant that it was not possible to inspect the training records. From discussion with staff however it transpired that they were still waiting to commence NVQ courses. It was stressed following the last inspection that this was a priority, and it is of concern that no progress has been made. Park Lodge DS0000065224.V289663.R01.S.doc Version 5.1 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, 35 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A number of concerns regarding fire safety, quality assurance and the lack of a registered manager means that the health safety and welfare of both service users and staff is neither promoted or protected. EVIDENCE: While the proprietors have taken action to recruit a new manager, until that individual has actually been registered it is difficult to evidence that that the new recruit has the necessary management skills and leadership to successfully run this home in the best interests of the service users. This having been said, the new incumbent has identified that there are a considerable number of areas which need to be improved, and has started to work through these to find acceptable solutions. Park Lodge DS0000065224.V289663.R01.S.doc Version 5.1 Page 20 One of the areas that the new manager has worked on is quality assurance – and surveys of both service users and relatives have recently been carried out. While this is commendable, further work needs to be done on quality assurance in general, including paying sufficient attention to equality and diversity. The home needs to have in place systems that will measure the quality of the service provided against the Statement of Purpose. The manager maintains both the monies and the records relating to them, which belong to the service users. Generally these are small amounts, and are used for things such as newspapers, confectionary and hairdressing. These records were inspected and appeared to be in order. While most of the home was satisfactorily maintained it was of concern to find that the fire alarms were not being tested on a weekly basis, and that in spite of the last inspection visit highlighting that it was not acceptable to wedge open bedroom doors, a number of doors were again found to be held open in this way. Park Lodge DS0000065224.V289663.R01.S.doc Version 5.1 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 1 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 1 Park Lodge DS0000065224.V289663.R01.S.doc Version 5.1 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 OP3 Regulation 10 Requirement The Registered Provider must submit a variation to ensure that current service users are reflected in the category of care. The previously set timescale for this requirement has again not been met. The manager must ensure that the action taken to meet the identified needs of service users is documented and thus can be evidenced. The previously set timescale has not been met. The service user plans (and accompanying assessments) must be reviewed on a regular basis. The previously set timescale has not been met. The manager must ensure that documentation relating to specific nursing tasks (i.e. wound care) is correctly maintained. The previously set timescale has not been met. Steps must be taken to eradicate the odour. The previously set timescale has not been met. The extractor fan in the kitchen must be repaired as a matter of DS0000065224.V289663.R01.S.doc Timescale for action 30/06/06 2. OP7 15 03/05/06 3. OP7 15 30/06/06 4. OP8 12 03/05/06 5. 6. OP26 OP19 16 23 03/05/06 30/05/06 Park Lodge Version 5.1 Page 23 7. OP29 19 8. OP30 18 9. OP27 18 10. 11. OP3 OP12 14 16 12. 13. 14. 15. 16. 17. OP19 OP19 OP19 OP19 OP31 OP33 23 13 13 23 8 24 urgency. The previously set timescale has not been met. The manager must ensure that all new staff supply the documentation listed in the Regulations before commencing work. The previously set timescale has not been fully met. The Registered Provider must ensure that staff have access to relevant training, including NVQ awards. The previously set timescale has not been fully met. The proprietors must ensure that the staffing levels are increased forthwith (and as outlined in this report), and in future do not fall below the minimum numbers. The previously set timescale has not been met. The home must not admit clients who fall outside its registration category. The registered person must ensure that sufficient activities are provided for service users, and that these are based on their identified needs and wishes. The registered person must ensure that all bedroom doors fully close. The registered person must ensure that all call bells are untied and within reach. Staff must ensure that the door to the lift mechanism is always locked. The curtain rail in bedroom 11 must be re-fitted. The registered person must submit an application for their new manager to be registered. The registered person must ensure that the home has in place quality assurance systems that can measure the service DS0000065224.V289663.R01.S.doc 03/05/06 30/06/06 03/05/06 03/05/06 31/05/06 31/05/06 03/05/06 03/05/06 05/05/06 30/05/06 30/06/06 Park Lodge Version 5.1 Page 24 18. 19. OP38 OP38 23 23 being provided against the home’s Statement of Purpose. The registered person must 03/05/06 ensure that fire alarms are tested on a weekly basis. The registered person must 30/06/06 ensure that appropriate fire safety door closures are fitted to any (fire) door that is required to be open during the day. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard OP3 OP7 OP19 OP19 OP33 Good Practice Recommendations It would be good practice for the in-house pre-admission assessments to be fully completed. It would be good practice for the manager to discuss keyworking with staff, to ensure that they fully understand what is needed, and how this is evidenced. It is strongly recommended that consideration be given to replacing the main lift. It is strongly recommended that all extractor fans should be cleaned on a regular basis. It would be good practice to have the most recent CSCI inspection report on display. Park Lodge DS0000065224.V289663.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Lodge DS0000065224.V289663.R01.S.doc Version 5.1 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!