Inspection on 11/05/05 for Philiphaugh

This inspection was carried out on 11th May 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

Philiphaugh 06/07/09

Philiphaugh 29/08/07

Philiphaugh 10/10/06

Philiphaugh 09/05/06

Philiphaugh 24/11/05

Philiphaugh 10/11/04

Philiphaugh 06/07/04

Similar services:

2 Perhaver Park

The Vicarage

Fairfields Country Rest Home

St George`s

5 Seafield Road

Credence House

Poldhu

Queensmount

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

CARE HOMES FOR OLDER PEOPLE Philiphaugh Station Road St Columb Major Cornwall TR9 6BX Lead Inspector Elaine Bruce Mathias Foundling-Miah Unannounced 11th and 12th May 2005 9:00 a.m. The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Philiphaugh D52-D04 S9249 Philiphaugh V220347 110505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Philiphaugh Address Station Road St Columb Major Cornwall TR9 6BX 01637 880520 01637 880520 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Stephen Michael Hendy Mrs Susan Laithwaite Care Home 32 Category(ies) of Dementia - over 65 years of age (19) registration, with number Learning disability over 65 years of age (6) of places Mental Disorder, excluding learning disability or dementia - over 65 years of age (19) Old age, not falling within any other category (12) Philiphaugh D52-D04 S9249 Philiphaugh V220347 110505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 10 November 2004 Brief Description of the Service: Philiphaugh provides care for up to thirty two service users in need of care by reason of old age, dementia, mental disorder and a learning disability. Respite care is available at the home in addition to long stay care (when a bed is available). The home also provides a day care service. The home is situated close to the town of St Columb Major enabling the more mobile service user to visit the shops and facilities independently. The home is set in attractive grounds and is a listed building. Car parking is available in the grounds of the home. The building has been extended with two wings. There are several communal rooms including an activities room and a smoking lounge. Access to the first floor in the main house is by a staircase, which is provided with a stair lift. Bedrooms are available on the ground and first floor of the home. Many of the bedrooms have en suite facilities. Philiphaugh D52-D04 S9249 Philiphaugh V220347 110505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 11th and 12th May 2005 over 12 hours, with a lead inspector and a pharmacy inspector. The inspection was carried out as an unannounced inspection. A tour of the premises took place and service users and staff were spoken to. Care records, staff files, policies and procedures and the medication system were inspected. Some of the service users who are able to give an opinion expressed positive comments on the standard of the care that they are receiving at the home. The registered provider and the recently registered manager were present during the course of the inspection. What the service does well: What has improved since the last inspection? The home now has a registered manager in place which has had a direct positive impact on most of the delivery of care in the home. Care planning and the organising of the files has improved considerably since the last inspection. Staff have spent time improving the system to ensure information on care needs is now readily available. Philiphaugh D52-D04 S9249 Philiphaugh V220347 110505 Stage 4.doc Version 1.30 Page 6 Recruitment procedures are now robust and provide the safeguards to offer protection to the service users living in the home. Excessive stocks of medicines including Controlled Drugs are now not held. Medicines to be disposed were regularly recorded and disposed of accordingly. 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. Philiphaugh D52-D04 S9249 Philiphaugh V220347 110505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Philiphaugh D52-D04 S9249 Philiphaugh V220347 110505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2 and 4 The home’s statement of purpose and service user guide documentation require updating to provide prospective service users with details of what the home provides helping an informed decision about admission to the home. The registered manager assesses all service users prior to admission to the home to establish that care needs can be met. Recent admissions have been on a respite basis only. EVIDENCE: The home has in place a statement of purpose document but information in the document is out of date, for example the name of the NCSC requires changing to the CSCI and there are references to legislation that is out of date. This is also the case for the service user guide documentation. The inspection report of the 10th November 2004 also identified that this documentation was not up to date. Service users have not yet been issued with contracts of care that detail the terms and conditions of their placement. This statutory requirement was Philiphaugh D52-D04 S9249 Philiphaugh V220347 110505 Stage 4.doc Version 1.30 Page 9 identified in the inspection report of the 22nd January 2004 and the 10th November 2004. The registered manager is involved in the assessment process prior to service user being admitted to the home. A pre admission assessment document is in place at the home and this has recently been used for respite care admissions to the home only. Philiphaugh D52-D04 S9249 Philiphaugh V220347 110505 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 and 9 Considerable progress has been made in improving care planning documentation and daily recording to ensure that the health, social and personal care needs of the service users are being met. There were though serious shortfalls identified by the pharmacy inspector in the recording, handling and administering of medication. This potentially places service users at risk of harm. EVIDENCE: Each service user has in place a problem based plan of care which is supported by daily day and night recording. Staff have worked very hard recently to organise and improve the care planning system and this has been achieved so information on care needs and how they are to be met is easily identifiable. The care plans are being reviewed monthly and include risk assessment information which is essential as some of the service users have high care needs. Behaviour charts are also in place for some of the service users. One recommendation is made for care planning and that is to ensure that all staff sign their entries in the daily diary that is used for the handover of shifts. Philiphaugh D52-D04 S9249 Philiphaugh V220347 110505 Stage 4.doc Version 1.30 Page 11 The care plans evidence that the service users have access to specialist health care services to meet care needs as required, for example medical, nursing and dental services. All the service users are registered with a general practitioner and written evidence is in place of all health care consultations. Service users are weighed regularly and information is included in care planning on dietary needs. All accidents in the home are being recorded as required by legislation. The medicine audits undertaken demonstrated that medicines were probably not administered as prescribed. The number of signed entries and the remaining quantity of medicine left in stock did not balance. Some medicines dispensed from the pharmacy and the commencement of administering to the service user indicated medicines were not administered in a timely manner and at specified times as instructed by the GP. The date of medicines received into the home or balances carried over from previous Medicine Administration Record (MAR) charts were not recorded on the MAR charts. Care Staff signed a MAR Chart then administered medication and transported the medicine insecurely. Several medicines were labelled without full directions. Eye preparations did not state which eye and there was no date of opening when they were first used. MAR charts indicated two services had no allergies when both were allergic to certain medication. The receipt, administration and disposal of Controlled Drugs (CD) were not adequately recorded in the CD register. Philiphaugh D52-D04 S9249 Philiphaugh V220347 110505 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 and 15 Social activities in the home (and externally) are well managed providing stimulation and interest for the service users. The dietary needs of the service users are well catered for with a balanced and varied menu that meets service users tastes and choices. EVIDENCE: The service user’s social care needs and interests are identified in care planning. Daily records evidence how the service users are spending their time in the home and separate sheets are kept of when the service user joins in any activities. On every afternoon from a Monday to a Friday there is an activity organised by the staff on duty. On day one of the inspection bingo was taking place which appeared to be very popular and well thought out by the staff to include the giving of prizes. On day two of the inspection the home’s mini bus was being used to take the service users to Newquay Zoo where they were also going to have a picnic. Considerable time and effort had gone into planning this day out and the service users spoken to were very excited about the day. Positive comments were also given to the inspector on the activities that regularly happen in the home. Philiphaugh D52-D04 S9249 Philiphaugh V220347 110505 Stage 4.doc Version 1.30 Page 13 The daily records evidence when the service users have received visitors. A notice on the door of the home indicates that visitors are very welcome to the home. All visitors are asked to sign in the visitors’ book on arrival at the home. All the service users expressed very positive comments on the standard of the meals that the home provides. The meal of the day is displayed on a board in the communal sitting/activity room. A new cook has recently been employed by the home and he is in the process of getting to know the service users likes and dislikes with a view to changing some of the menu dishes in consultation with the service users. The menu rotates over a four week period and is mainly traditional to include two roasts in the week and fish and chips on a Friday. A choice is meal is always available. On day one of the inspection the main meal of the day was roast pork with cauliflower and green beans and roast potatoes, with smoked haddock and bread and butter for tea. An inspection of the kitchen by the district council environmental health officer took place on the 26th July 2004 with requirements from that inspection having been addressed. The cook is qualified to the basic food hygiene certificate level. Philiphaugh D52-D04 S9249 Philiphaugh V220347 110505 Stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The home has a complaints policy and procedure in place that has been provided to the service users but the document requires updating to ensure that the service users have the correct information. The home has adult protection policies and procedures but staff have not received training in this area. Training is essential to provide staff with the knowledge and understanding of adult protection issues to protect service users from abuse. EVIDENCE: The home has a complaints policy and procedure in place which now requires updating to include changing the name of the NCSC to the CSCI. It is important that the service users have the correct information should they or their representatives wish to complain. There appears to be a number of policies and procedures in the home on adult protection. These should now be brought into one robust policy and procedure and the staff then given the opportunity to read this very important documentation. This was recommended in the inspection report of the 6th July 2004. In addition to this staff must be provided with adult protection training which is presently available from the local social services department. Philiphaugh D52-D04 S9249 Philiphaugh V220347 110505 Stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20 and 26 Maintenance of the premises is taking place with further improvements required. Limited fire safety precautions place the service users at risk. EVIDENCE: The home is well placed for service users to access St Columb Major and all it’s facilities. Grounds are spacious and seating is provided for the service users. Ongoing maintenance externally and internally is taking place which has included recent improvements to the entrance hall. A maintenance staff member is employed. Further improvements required were discussed at the time of the inspection and this will include replacing some bedroom carpets. This will result in improved odour control in the relevant bedrooms. It was noted that due to wheelchair damage the décor of the corridors (in the annex) is in need of improvement. Communal areas in the home are spacious and include a smoking lounge, television lounge, dining room and activity room/lounge. Philiphaugh D52-D04 S9249 Philiphaugh V220347 110505 Stage 4.doc Version 1.30 Page 16 The evidence for the regular testing of the fire alarm system is not in place as recommended by Cornwall County Council Fire Brigade. In addition evidence is not in place that staff are receiving regular fire drill training as recommended by Cornwall County Council Fire Brigade. The last inspection of the premises by the fire Brigade (31/03/04) noted breaches in regulations. The registered manager informed the inspector that fire drill training is booked for the staff and a discussion took place on the option of the maintenance staff member being given the responsibility of the testing of the alarm system. The laundry is provided with industrial machines for washing and drying of the service users clothes. Gloves and aprons are freely available for the staff for infection control. Policies and procedures are in place to guide staff on safe working practices. Cleaning and laundry staff are employed by the home on every day of the week. Philiphaugh D52-D04 S9249 Philiphaugh V220347 110505 Stage 4.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 and 30 Staffing levels are appropriate to meet the needs of the service users. The procedures for the recruitment of staff have improved. Some areas of statutory staff training are not being met. EVIDENCE: The home employs four care staff on duty in the morning and the afternoon in addition to the registered manager who is in the home throughout the week. In addition to the care staff, housekeeping, cooking, cleaning and maintenance staff are employed. Two waking night staff are also employed by the home. Two new staff members have recently been recruited to include a new cook and a carer. Two written references are taken up prior to employment following a satisfactorily completed application form. Criminal records bureau checks are now in place for all staff members employed in the home. Staff are issued with contracts of employment and a job description. As already identified in this inspection report fire drill training for staff is not up to date. Moving and handling training is due to take place and some additional first aid training must be provided to ensure that a staff member on each shift is trained to deal with any emergencies. Some staff are due to receive updated basic food hygiene certificate training. Dementia training is being provided in the home by a local college. Philiphaugh D52-D04 S9249 Philiphaugh V220347 110505 Stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,35 and 36 The registered manager runs and manages the home on a day to day basis to ensure that the service users receive consistent, quality care. The medication findings unfortunately deflect negatively from this judgement. There is no leadership, ethos, guidance and direction to staff from the registered provider. This results in some practices that do not promote the health, safety and welfare of the service users. EVIDENCE: The registered manager has demonstrated to the Commission for Social Care Inspection that she is a competent and capable manager during the recent difficult period at the home. The medication findings unfortunately deflect on her competency in not thoroughly checking the administration of the system by staff employed in the home. Philiphaugh D52-D04 S9249 Philiphaugh V220347 110505 Stage 4.doc Version 1.30 Page 19 Inspection reports evidence that the registered provider is regularly in breach of statutory requirements and only increased his presence in the home during late 2004 when he eventually realised that the home was experiencing severe difficulties. Some of these difficulties are still not resolved with a number of staff members suspended and police investigations continuing in relation to the service users finances and medication irregularities. The registered manager is involving the staff in the running of the home to include having minuted staff meetings. Records are in place to evidence the incoming and outing of the personal finances of the service users and an audit trail can be carried out. Social services are involved in legal procedures for the Court of Protection for two service users and appointeeship arrangements are presently being changed for a number of the service users by the Benefits Agency. These temporary arrangements have resulted in a build up of finances in the home and the registered provider has been written to to make safe immediately the service users finances by opening a bank account. There are no formal supervision arrangements by management for the staff. This is identified as a statutory requirement in this inspection report and was identified in the inspection report of the 10th November 2004. Philiphaugh D52-D04 S9249 Philiphaugh V220347 110505 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 1 x 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 1 3 x x x x x 2 STAFFING Standard No Score 27 3 28 x 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 1 3 1 x x 2 1 x x Philiphaugh D52-D04 S9249 Philiphaugh V220347 110505 Stage 4.doc Version 1.30 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 5(1)(b) Requirement The registered provider must ensure that each service user is provided with documentation on the terms and conditions of their placement including the amount and method of payment of fees The registered provider must make arrangements, by training staff to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. The registered provider shall after consultation with the fire authority take adequate precautions against the risk of fire. The registered provider shall ensure that the staff employed receive training appropriate to the work they are to perform. The registered provider must ensure that the staff employed at the home are regularly supervised. MAR charts must be properly signed as administered only after the medicine has been given and the number of signed entries and the remaining quantity of medicine left in stock must Timescale for action 31/08/05 2. 18 13(6) 31/08/05 3. 19 23(4) Immediate 4. 30 18(1) 31/08/05 5. 36 18(2) 31/08/05 6. 9 13(2)17 (1)(a) schedule 3 Immediate and ongoing Philiphaugh D52-D04 S9249 Philiphaugh V220347 110505 Stage 4.doc Version 1.30 Page 22 balance. 7. 9 13(2) The home must order and receive medicines in a timely manner and liase with the supplying pharmacy to allow medicines to be available and administered correctly at all times as specified by the GP. The date of medicines received into the home or balances carried over from previous MAR charts must be in all instances be recorded on the MAR charts. The home must order and receive medicines to allow medicines to be available in a timely manner. Medicines must be administered correctly at all times as specified by the GP. Care staff administering the medicine must sign the MAR chart immediately after the medicine has been given and the medicine transported in a lidded pot. The GP must be asked to include full directions, including which eye(s) to be treated for eye preparations. Staff must enter the starting date on opening or the last date of use when medicines with short shelf are first used. Any known allergies must be recorded on the MAR sheet or ‘nil known’ where appropriate. The standard of record keeping must ensure that the CD register is properly maintained and provides a complete audit trail. Immediate and ongoing 8. 9 13(2)17 (1)(a) schedule 3 13(2) Immediate and ongoing Immediate and ongoing 9. 9 10. 9 13(2) Immediate and ongoing 11. 9 13(2) Immediate and ongoing 12. 9 13. 9 13(2)17 (1)(a) schedule 3 13(2)17 (1)(a) schedule 3 Immediate and ongoing Immediate and ongoing 14. Philiphaugh D52-D04 S9249 Philiphaugh V220347 110505 Stage 4.doc Version 1.30 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard 1 7 9 16 19 35 Good Practice Recommendations To update the statement of purpose document and service user guide. For staff to consistently sign all their entries re care delivery particularly in the hand over diary. It strongly recommended that the home obtain patient Information leaflets preferably kept in one file for the provision of up to date information on medicines. To update the complaints policy and procedure with correct information. To continue to improve the environment for the service users. To open a bank account on behalf of a number of the service users to safeguard their finances Philiphaugh D52-D04 S9249 Philiphaugh V220347 110505 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell, Cornwall PL25 4AD 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 Philiphaugh D52-D04 S9249 Philiphaugh V220347 110505 Stage 4.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!