Inspection on 14/02/08 for Pine Croft

This inspection was carried out on 14th February 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Pine Croft 23/08/06

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Pine Croft Gloucester Road Alveston Thornbury South Glos BS35 3RG Lead Inspector Melanie Edwards Key Unannounced Inspection 14th February 2008 09:30 Pine Croft DS0000065367.V359655.R01.S.doc Version 5.2 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 Pine Croft DS0000065367.V359655.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 Adults 18-65. 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. Pine Croft DS0000065367.V359655.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pine Croft Address Gloucester Road Alveston Thornbury South Glos BS35 3RG 01454 417658 01454 417658 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) The National Autistic Society Gwyneth Rodman Care Home 4 Category(ies) of Learning disability (4), Mental disorder, registration, with number excluding learning disability or dementia (4) of places Pine Croft DS0000065367.V359655.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd August 2006 Brief Description of the Service: Pinecroft Care Home is operated by The National Autistic Society and is registered to provide personal care and accommodation for up to four people with mental health needs who have been sectioned under the mental health act and are between 18 and 65 years of age. At present there are three men in the Home who have lived there since April 2006 when the service opened. It is a large residential house, which blends in with the local surroundings. It is built on two floors. It is close to small local facilities and amenities, including shops and public houses. It is also close to a main bus route and near to the market town of Thornbury. The fees charged for staying at the Home are £3631.31 a week. Pine Croft DS0000065367.V359655.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The inspection was carried out over one day. The occupants have selected the term that they wish to be known by while staying at the Home. We (the Commission) met the three occupants living at the Home. We met the registered manager, the deputy manager and three support workers. We talked to them about their roles, responsibilities, training needs, and how they assist occupants. Staff were observed assisting occupants with their needs. A number of records relating to the running and management of the Home were looked at. A number of resident’s care records and care plans were checked and inspected. These included staff training files, staff recruitment files, staff duty rotas, maintenance records, menus, and medication records The majority of the environment was seen and the only areas that were not checked were a small number of bedrooms. The ‘AQAA’ (an annual quality assessment document that all Homes are required to complete) has been used to help form the judgments in the report. The Home was operating within the required conditions of registration set down by the Commission. The conditions of registration detail the type of care and the needs of occupants, and the numbers of occupants who may stay at the Home. What the service does well: The occupants receive a supportive and caring service from Ms Rodman and the team. The staff team are highly motivated and committed to the work that they do. The occupants benefit from a safe, supportive and enabling environment. Pine Croft DS0000065367.V359655.R01.S.doc Version 5.2 Page 6 Care plans and risk assessment records are detailed and informative and show well how to meet the occupants’ needs. The staff do a good range of training to help them support occupants who have Aspergers Syndrome, to live a varied and fulfilled life. One occupant said of the service, `I’m quite happy here’, another occupant said, ‘ the home is well organised and caters for the needs of the occupants ’. 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. The summary of this inspection report can be made available in other formats on request. Pine Croft DS0000065367.V359655.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Pine Croft DS0000065367.V359655.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Occupants’ needs are assessed and their needs are well met. Occupants can make an informed choice about whether the Home is right for them. EVIDENCE: To find out how the prospective occupants were helped to find out about the Home a copy of the occupants guide was read. Each occupant was given a copy of the document when they moved in. The guide has information about the service provided, the qualifications of the staff employed, and the accommodation. The philosophy of the Home and how the service aim to meet occupants needs was also included. The complaints procedure was also in the document. The guide includes pictures of the Home. To find out how well occupants needs are assessed one occupant’s assessment record was read. There was a very detailed assessment of the physical, mental health and social needs of each occupant. There was also information showing the occupant’s views had been fully taken into account. Pine Croft DS0000065367.V359655.R01.S.doc Version 5.2 Page 9 The staff we met have a very good understanding of the complex mental heath needs of the occupants. Staff talked to occupants in a warm, and very calm way. This helps to show how occupants are being well supported by staff. Pine Croft DS0000065367.V359655.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The occupants’ needs are very well met, and care plans effectively support how to meet them. The occupants are well supported to make decisions and to take risks in their daily lives. EVIDENCE: To find out how effectively the occupants are helped to meet their needs one care plan was read. There was a detailed personal profile, completed for each person. This explained about the personal history of the occupant, information about their physical and mental health history, as well as a record of the important people such as family and friends. There was also a very detailed and informative plan of care for the occupant, which addressed the physical, mental, and social needs of the person. Pine Croft DS0000065367.V359655.R01.S.doc Version 5.2 Page 11 The information in the care plan helps promote the independence of the person in their daily lives. There was evidence written in the records that occupants had been consulted in the care planning process. There was evidence that the care plans had been evaluated and updated on a regular basis with the involvement of the occupant. There was helpful information included in the care plan seen about risks the person may face, and how to support them to stay safe. The risk assessment records and the plans of care set out the preferred approaches staff should take. The staff demonstrated a very good understanding of the occupants, and the skills that are needed to support them to be able to live a fulfilling and independent life. There was information written in records that showed staff were aiming to support the person to stay independent in their day lives. The Home has guidelines for responding to challenging behaviours, and the staff had signed to verify they had read this document. Occupants were observed leaving the Home with the support of staff to go to the shops. This is good evidence that occupants are being supported and encouraged to take some risks as part of an independent life style. From discussion with occupants and staff it is evident that one of the main aims of the Home is to actively promote occupants’ rights and independence. As referred to already the occupants have selected the term that they wish to be known by, while staying at the Home. There was good evidence that occupants are actively involved in the choice of meals served in the Home. There are regular `occupants meetings’ where occupants are being encouraged and supported to set their own agenda for these meetings. The occupants have also been involved in setting their own visitors policy. These are good examples of how the occupants are being well supported to take an active role in the day-to-day running of the Home. Pine Croft DS0000065367.V359655.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The occupants are well supported to take part in a range of social and therapeutic activities, and to be a part of the local community. The occupants are well supported to be a part of the community and to have personal relationships. EVIDENCE: Occupants left the Home with staff support, to go to the community for social and therapeutic activities. One occupant has been on a day trips to London with staff. One aim of the Home is to support the occupants to be able to use community facilities independently. This is also written in the statement of purpose document about the Home. Pine Croft DS0000065367.V359655.R01.S.doc Version 5.2 Page 13 The occupants go to regular training classes at a local training and resource centre, during the week. This evidence demonstrates how occupants are being well supported to take part in a range of community-based activities. The Home has a visiting policy that the occupants themselves helped to write. Families and friends are supported and encouraged to visit the occupants at Home. A copy of the current menu was looked at to see if occupants have a varied and well balanced diet. There was a range of dishes available for each day. The occupants’ likes and dislikes are included when menus are planned, and the staff ask them what food they would like to on the menu. There was a choice of meal options available for the occupants. Evening meal options included a range of traditional, nutritional meals. The lunchtime meal options included a range of well-balanced meals and snacks. Two of the occupants said the food was ‘ really good ’, and ‘ healthy ’. Pine Croft DS0000065367.V359655.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The occupants are being supported to meet their needs in the ways they prefer. The occupants physical and mental health needs are well met. The occupants’ medication is stored administered and disposed of safely. EVIDENCE: The occupants’ psychiatrist meets with them and the staff on a regular basis to support them with their mental health needs. There is also a psychologist who comes to the Home regularly and meets with the occupants, to help them with psychological needs. Staff talked and helped occupants in a relaxed manner. The occupant and staff looked as if they have built up close trusting relationships. Pine Croft DS0000065367.V359655.R01.S.doc Version 5.2 Page 15 There is information in care records about the preferred day-to-day routine of the occupants and their likes and dislikes. This helps to demonstrate how occupants are being involved in the planning of their care. The plan of care set out the preferred manner in which to assist the occupant to meet their mental health and social needs. The procedures for the administration storage and disposal of medication were checked to see if the systems are safe. Medication is kept in the office in a locked cabinet. All staff who give out medication do a three-day training course to make sure they can do this safely. The medication administration charts of three occupants were read. There was a recent photograph of each occupant kept with the administration charts. The charts were legible and up to date, they had the signatures of the dispensing member of staff, and the reasons for any omissions had also been recorded. There was evidence recorded on a selection of the drug administration charts that stock checks are being carried out. Pine Croft DS0000065367.V359655.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The occupants’ views are listened to, and acted on by Ms Rodman and the staff. The occupants are protected from the risk of abuse or harm by systems and staff training. EVIDENCE: The complaints book record was looked at to see how Ms Rodman responds to occupants’ complaints. The complaints book showed that there had been no complaints received since the Home opened. The record did include the details of how the complaint would be dealt with. Each occupant has been given a copy of the procedure to make a complaint and this includes the contact details for the National Autistic Society and The Commission for Social Care Inspection. This gives occupants the information they need to complain about the service. There are regular ‘occupants meetings’ held in the Home. The occupants are encouraged to set the agenda for the meetings. This is a good opportunity for occupants to complain if they need to. One occupant also confirmed that they had been given a copy of the Home’s complaints procedure, which helps to demonstrate occupants are well supported to complain about the service if they so wish. Pine Croft DS0000065367.V359655.R01.S.doc Version 5.2 Page 17 There is a `protection of vulnerable adults’ procedure to protect occupants and to guide and support staff in the event of an allegation of abuse. The staff have been on training on issues related to abuse within the last twelve months. This helps to demonstrate how occupants are protected form the risk of harm or abuse in the Home. Pine Croft DS0000065367.V359655.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,28,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The occupants Home is domestic in style and provides a comfortable environment that is suitable for them and meets their needs. EVIDENCE: Pine croft is an older house in a residential area near to the market town of Thornbury. There are local shops, a church, pubs, and coffee shops nearby. The occupants use the local amenities most days. The Home has two main lounges, and a smaller lounge. This helps ensure occupants can keep some privacy and `personal space’ if they so wish. The two occupants looked to be relaxed and comfortable in their surroundings. The Home looked very clean tidy and well maintained. Pine Croft DS0000065367.V359655.R01.S.doc Version 5.2 Page 19 The bedrooms are personalised with personal possessions. There is furniture and fittings provided, including a wardrobe a comfortable chair a bedside cabinet and a chest of drawers in each room. There are also photographs, and pictures displayed in some rooms that help to create a ‘personal’ feel to the rooms. One occupant kindly showed us their bedroom. The bedrooms were clean and tidy .The bedrooms do not have en-suite facilities, however there are toilets, and a shower or bathroom facilities located on each floor. The kitchen is on the ground floor, leading onto a dining area. The kitchen is a domestic style. The occupants use the kitchen to prepare drinks and snacks with the support of staff if needed. There is a laundry room on the ground floor with a washing machine and tumble dryer. The occupants use the laundry to wash their own clothes with staff support if needed. This is another example of how they are supported to maintain independence in their daily living activities. Pine Croft DS0000065367.V359655.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The occupants are supported by a sufficient number of competent, qualified staff. The occupants benefit from being cared for by staff who are well trained and have a very good understanding of their needs. EVIDENCE: The staff on duty discussed with us recent training that they had attended. Staff from the Home go on a variety of training from the National Autistic Society’s nearby Independent Hospital. All the staff had done a variety of relevant courses. The staff said they had attended a range of training that related to the mental health needs of the occupants. There was information on display in the office that demonstrated staff are booked to attend forthcoming training in food hygiene, first aid and fire safety. Pine Croft DS0000065367.V359655.R01.S.doc Version 5.2 Page 21 The staff duty rota for February 2008 was looked at to check on how many staff are on duty to support the occupants. There had been no sickness recorded on the rota for February. The Home covers shifts with staff that the occupants know which helps ensure they are given continuity of care. There are at least two staff on duty during the core hours of 9am to 5pm, to provide occupants with support during the day. There is one member of staff on duty at night, and one member of staff who does a `sleeping in’ shift and is available for support. There is an on call support system to support staff and occupants out of hours and at weekends. Based on the evidence seen during the inspection, the number of staff on duty is sufficient to meet occupants’ needs. The staff demonstrated they communicate and support occupants in a sensitive, and very skilled manner. All of the staff talked about training principals called ‘low arousal’ training. This training emphasises working with the occupants in an extremely calm, and non-confrontational way. The staff meetings minutes record showed that staff meetings take place on a regular basis and staff are consulted about a range of relevant matters related to the day-to-day running of the Home. Ms Rodman and the deputy manager supervise the staff. The supervision records of staff were not looked at on this occasion. Based on the discussions with the staff on duty it is clear staff are very well supported and well motivated. The recruitment practises and procedures were not inspected on this occasion. The National Autistic Society keep the staff record of staff who work at Pine croft at the head office at the Hayes Independent Hospital. We will request that these records be made available to us so that we can inspect the recruitment practises and procedures for the Home. Pine Croft DS0000065367.V359655.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The occupants benefit from a well run Home and their views will be listened to and represented. The occupants and staff health and safety is being protected. EVIDENCE: Ms Rodman has a number of years of experience working with occupants who have very complex mental health disorders. She is registered with the Commission for Social Care Inspection as the manager of the Home. This demonstrates Ms Rodman is considered suitable and qualified to fulfil the role of registered manager. Pine Croft DS0000065367.V359655.R01.S.doc Version 5.2 Page 23 The staff on duty said that Miss Rodman was supportive and encourages them to develop their skills. The Home ensures the occupants’ records are kept in a locked metal cabinet in the office. The occupants care records, and the records that were seen relating to the running of the Home were satisfactorily written, legible, up to date, and well maintained. This helps to demonstrate occupants’ confidentiality is being protected, and that legal records required for the effective running of the Home are being kept in order. The monthly monitoring visits of the Home that must be carried out by a representative of The National Autistic Society undertaken as required by law. There are records of these visits kept in the Home. The records that have been seen show that the designated person responsible for the visits spends time consulting with occupants and their representatives and observing staff. Ms Rodman and the team carry out detailed regular quality audits of the service at the Home .A copy of recent audit records were seen during the inspection. These records demonstrated that the overall quality of the Home is being monitored on a regular basis. The environment looked safe and satisfactorily maintained in all areas viewed. Staff are provided with regular training in health and safety matters including first aid, and moving and handling practices. This should help protect occupants’ health and safety if staff are knowledgeable and well trained in health and safety principles and practices. All staff and one of the occupants have done food hygiene training. Pine Croft DS0000065367.V359655.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 N/A 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 4 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Pine Croft DS0000065367.V359655.R01.S.doc Version 5.2 Page 25 NO 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. Standard Regulation Requirement Timescale for action 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 Pine Croft DS0000065367.V359655.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Pine Croft DS0000065367.V359655.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!