Inspection on 26/11/05 for Prince Alfred

This inspection was carried out on 26th November 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Prince Alfred 27/09/07

Prince Alfred 07/12/06

Prince Alfred 03/03/06

Prince Alfred 06/01/05

Prince Alfred 03/09/04

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

CARE HOMES FOR OLDER PEOPLE Prince Alfred Prince Alfred Road Liverpool Merseyside L15 8HH Lead Inspector Beate Roth Unannounced Inspection 26th November 2005 09:50 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 Prince Alfred DS0000059310.V269097.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Prince Alfred DS0000059310.V269097.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Prince Alfred Address Prince Alfred Road Liverpool Merseyside L15 8HH 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) 0151 734 2587 0151 734 5998 European Wellcare Homes Ltd Cheryl Marie Dobie Care Home 50 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (3), Old age, of places not falling within any other category (38), Physical disability over 65 years of age (9) Prince Alfred DS0000059310.V269097.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 50 Nursing and 50 Personal Care in the overall total of 50 This service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection OP Old age - to include one named service user under the age of 65 years in an overall total of 50 6th January 2005 Date of last inspection Brief Description of the Service: Prince Alfred is situated in the Wavertree area of Liverpool, within easy walking distance to Wavertree High Street and is close to local bus and rail routes, shops and amenities. The home has fifty single rooms, each with a hand-wash basin. The bedrooms are situated on the first and second floors. The first and second floors can be reached by stairs or by a passenger lift. Bathrooms are located on the first and second floors and toilet facilities are available on each of the three floors. Bathing aids are available. On the ground floor there are two dining rooms, a conservatory and two lounges, one lounge being available for service users who wish to smoke. There is also a lounge on both the first and second floors. The home has a hydrotherapy pool and a hair salon. A garden with a seating area is provided. There is a car park at the front of the home. Prince Alfred DS0000059310.V269097.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over six hours. During the inspection time was spent in the office examining records and policies and procedures and talking to the person in charge. A tour of the home was undertaken. Staff were observed delivering care to service users. Service users and staff were spoken with. A telephone discussion took place with the manager. What the service does well: What has improved since the last inspection? What they could do better: A risk assessment around the prevention of falls needs some further information in order to ensure that the service user concerned is fully supported. Improvements need to be made to the homes system for the management of medication, as one type of medication that is prescribed for a service user could not be located. Improvements need to be made to the record keeping around medication in order to ensure that the directions for the administration of medication on the medication container, correspond to the directions on the medication administration record sheet. Improvements need to be made to the appearance of the home in order to better meet the needs of service users. The health and safety of service users must be promoted at all times. At this inspection it was necessary to make an immediate requirement for the conservatory to be made inaccessible to service users due Prince Alfred DS0000059310.V269097.R01.S.doc Version 5.0 Page 6 to damage to this room as a result of a leaking roof. The records of tests of the fire alarm and the emergency lighting systems must be recorded and indicate that they are being tested at the frequencies recommended by the fire service. 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. Prince Alfred DS0000059310.V269097.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Prince Alfred DS0000059310.V269097.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5 Service users are provided with opportunities and information on which to decide if the home is suitable. An appropriate assessment of whether the home is suitable for new service users takes place. EVIDENCE: The home has a detailed and informative statement of purpose and service user guide that would provide prospective service users with the information needed to assist them in making a decision as to whether the home is suitable. Both documents are available on request in the office. The date of review is unclear and should be recorded. In addition, service users and their families are encouraged to undertake trial visits to the home. Prince Alfred DS0000059310.V269097.R01.S.doc Version 5.0 Page 9 A discussion took place with the manager around the current registration categories for the service. The manager is to prepare a report for CSCI detailing whether the current categories of registration for service users over 65 with mental disorder (excluding learning disability or dementia) and physical disability continue to be accurate. The statement of purpose and service user guide will need to reflect any changes to the registration for the home. The records of three service users who have come to live at the home since the last inspection were seen. A pre-admission assessment that would form the basis for care planning was available. The home undertakes assessments in relation to pressure sores, dependency levels, moving and handling, activities of daily living and a social care assessment. Each of the service users had a written care plan in place. The home routinely receives transfer information if a service user is admitted from a hospital. Copies of social work assessments were found on the files inspected where applicable. A copy of the contract/statement of terms and conditions between the home and service users is available in the service user guide. This covered the information that is needed. Access to completed contracts was not possible. A sample of these documents will be seen at the next inspection. Prince Alfred DS0000059310.V269097.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9 The health, personal and social care needs of service users are in general well supported by the care planning processes in place at the home. The welfare of service users is not fully promoted by the procedures around the management of medication. EVIDENCE: A sample of service users care planning records were seen and indicated that service users have an up to date care plan that is reviewed monthly. Care plans were shown to contain the required detail in order for service users needs to be fully met. Each service user has a night care plan in place. Service user’s who are able are given the opportunity to be involved in the care planning and review process. Service users spoken with said that they receive a good standard of care and support from the staff although there are times when the staff are busy. Observations of staff indicated that staff promote the privacy and dignity of service users. The records at the home and a discussion with staff indicated that referrals are made to health professionals in accordance with the needs of service users. A Prince Alfred DS0000059310.V269097.R01.S.doc Version 5.0 Page 11 record is made of visits by health professionals and the outcome is documented. A record of accidents were examined and were satisfactorily maintained. The records for one service user indicated that they had had a number of falls. There was a risk assessment in place to minimise the risk of falls however this needs to contain further information in order to better support this service user. The home has policies and procedures in place in relation to the receipt, recording, storage, administration and disposal of medicines. The home provides secure medicine storage facilities. The home benefits from having a separate medication room that also contains a medication fridge. There are up to date photographs of service users for staff to refer to when administrating medication. Staff responsible for the administration of medication have completed medication training. A sample of medication administration records and corresponding medication were inspected and were in general appropriately maintained. An inhaler that was recorded as being prescribed for a service user was not available. The reason for this could not be identified during the inspection. The medication administration record sheets refer to two types of medication to be given as and when required. This does not correspond to the instructions on the container for this medication that indicates that a daily dosage is to be given. Prince Alfred DS0000059310.V269097.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 and 15 The home promotes the social and emotional needs of service users by maintaining community links and encouraging visitors. The meals in the home offer service users both choice and variety and cater for any special dietary needs. EVIDENCE: The service user guide states that visiting can take place at any reasonable time and that service users have the right to refuse to see any visitor. The home has a written policy relating to maintaining relatives and friends involvements with service users. Service users who were spoken with said they felt their visitors are made to feel welcome. Visitors were observed visiting the home during the inspection. Service users that spoke with the inspector indicated that they are able to go out independently, or assisted by staff to visit local shops and community facilities as staffing allows. The home has a written policy in relation to advocacy. Addresses and contact numbers of advocacy services, which are appropriate for older people are available in the front foyer near the main entrance. Service users are able to bring personal possessions to the home. Prince Alfred DS0000059310.V269097.R01.S.doc Version 5.0 Page 13 Dining room tables were nicely laid and presented with attractive table cloths, napkins and various condiments. There is a varied menu, which is reviewed regularly. The menu contains a number of choices for each meal and an alternative can be offered if necessary. Service users are made aware by staff of the meals provided during the day and a written menu is provided on the notice board near the main dining room. A menu is provided in large print. Hot and cold drinks are offered to service users throughout the day. The home is able to provide special and cultural diets where necessary. Service users spoken with confirmed that they are able to have their meals in their rooms according to their wishes. In general, the service users spoken with commented positively on the food provided. A couple of comments were made about the varying standards of the meals. The manager was asked to look at this issue further. Information regarding service users having diabetes or needing a soft diet was displayed in the dining room, next to the serving hatch. An alternative way of providing this information to staff that promotes the privacy of service users needs to be considered. Prince Alfred DS0000059310.V269097.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The home has a satisfactory complaints system which service users know how to access. The adult protection procedures at the home safeguard service users. EVIDENCE: The home has a written complaints procedure that states complaints will be responded to within 7 days. Service users reported that if they wished to raise any issues about the standards of the service provided they would speak to the manager or a member of staff. Records show that no complaints have been made directly to the home. A copy of the complaint procedure is contained in the service user guide and is displayed on the wall in the foyer. A complaint about the home was made to CSCI in February 2005. This was upheld and appropriate action has been taken by the home. The home has a copy of the Liverpool City Council’s guidance in relation to adult protection and the home also has its own whistle-blowing policy. A discussion with two staff members indicated that they have undertaken training in elder abuse. This training is provided to new staff as part of their induction. The records relating to a recent adult protection concern indicated that the adult protection procedure is being followed appropriately. The home has a written policy precluding staff involvement in assisting in the making of or benefiting from service users wills. Prince Alfred DS0000059310.V269097.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Improvements need to be made to the appearance of the home in order to better meet the needs of service users. EVIDENCE: The location and layout of the home is suitable for its stated purpose. A tour of the home was undertaken during which the communal areas and a sample of bedrooms were seen. The home was in general observed to be clean and free from any malodours. The carpet in the lounges had some stains. Records show that the carpet cleaner for the home had broken and a request to the facilities manager for European Wellcare Homes Ltd, for a new carpet cleaner was made 2 weeks ago but a replacement had not been received. Prince Alfred DS0000059310.V269097.R01.S.doc Version 5.0 Page 16 A number of areas at the home are satisfactorily maintained. Records and a discussion with a member of staff indicated that decorative and maintenance works have taken place since the last inspection. There are areas where improvements need to be made to the appearance of the home: A requirement was made at the last inspection to attend to the number of bedroom doors that have marked paintwork and to replace the damaged conservatory roof blinds, these requirements have not been addressed. At this inspection, some of the roof blinds in the smoking area off the main lounge appeared worn with evidence of damage. The damaged blinds are to be replaced. The wall covering in this room was showing signs of wear. The corridor carpets on the first and second floor are marked in places were there is heavy usage. These must be satisfactorily cleaned or replaced. The decoration to the first floor corridor is damaged in a number of areas and requires attention. The handle rest to the window in bedroom 53 is loose and needs to be secured so that the window can be easily opened and closed. The conservatory was not safe for use as the roof had been leaking. There was evidence of a serious leak, which had damaged the flooring and wall coverings. The flooring in the conservatory was uneven in one small area and there may have been further unseen damage that may have presented a hazard. An immediate requirement was made that the registered persons take immediate action to ensure that the conservatory is not accessible to service users until it has been made safe for use. A discussion with the manager indicated that the conservatory had not been in use for 9 weeks and it was only recently that quotes to repair the roof and redecorate had been obtained. This is not acceptable. The manager reported that requests are made to the facilities department of European Wellcare Homes Ltd for maintenance and decorative works to be undertaken but that there are delays in attending to the works requested. Prince Alfred DS0000059310.V269097.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 28 The needs of service users are met by having a number of appropriately qualified staff. In general, service users are supported by the number of staff available. EVIDENCE: 44 service users were living at the home at the time of the inspection. The staff rota indicates that there are 5 carers and a senior on duty during the morning periods and 4 carers and a senior on duty during the afternoon. The manager or a senior carer in the manager’s absence works supernumerary. During the night time there are 3 carers and a senior on duty. Some service users raised the issue of having to wait for an unacceptable length of time for attention from staff. They said that this occurs around lunch and teatime. Staff spoken with considered that there are sufficient staff available to meet the needs of service users but that meal times are very busy. This was discussed with the manager for the service who reported that the staffing levels are regularly reviewed in accordance with the needs of the service users. The manager reported that an assessment of the staffing levels at meal times will be assessed. In order to provide evidence and demonstrate that the current staffing levels meet the needs of the service users the registered person should provide CSCI with a current assessment of the home’s staffing levels, taking into account the needs of the service users, layout of the home and the home’s statement of purpose. Prince Alfred DS0000059310.V269097.R01.S.doc Version 5.0 Page 18 The records showed that over 50 of staff hold an NVQ in care of the elderly. Further staff are currently working towards this qualification. Prince Alfred DS0000059310.V269097.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 34 and 38 Service users are in general, supported by the management and administrative systems at the home. EVIDENCE: The manager is currently undertaking an NVQ level 4 in management and care. The manager has managed the home for over two years and undertakes periodic training in accordance with her training needs. Valid insurance cover is in place. It is anticipated that details in relation to the business and financial planning for the home would be made available to CSCI upon request. A sample of safety check records were seen. Certificates of safety checks for the gas and electricity were available and up to date. The fire alarm and emergency lighting systems had been serviced following the last inspection. Prince Alfred DS0000059310.V269097.R01.S.doc Version 5.0 Page 20 Bath hoists had been serviced. A test for legionella had been recently completed. Records inspected in relation to the testing of the fire alarm and emergency lighting indicated that these checks have not been occurring within the recommended frequencies. The records showed that the fire alarm was last tested in June 2005. The manager reported that these tests have occurred but have not been recorded. These records must be kept up to date. Comprehensive health and safety risk assessments are in place and these are kept under review. A fire risk assessment has been undertaken in relation to the premises. Prince Alfred DS0000059310.V269097.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X 3 X X X 2 Prince Alfred DS0000059310.V269097.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4 Requirement The registered person must prepare a report for CSCI detailing whether the current categories of registration for service users over 65 with mental disorder, excluding learning disability or dementia and physical disability continue to be accurate. The registered person must ensure that risk assessments to prevent falls contain adequate information around measures staff are to take to minimise this risk. The registered person must ensure that the directions for the administration of medication on the medication container correspond to the directions on the medication administration record sheet. The registered person must ensure that all prescribed medication is readily available for service users to take. The registered persons must take immediate action to ensure that the conservatory is not DS0000059310.V269097.R01.S.doc Timescale for action 26/12/05 2 OP8 13 26/11/05 3 OP9 13 26/11/05 4 OP9 13 26/11/05 5 OP19 13 03/12/05 Prince Alfred Version 5.0 Page 23 accessible to service users until it has been made safe for use. 6 OP19 23 The registered person must ensure that adequate action is taken in relation to the following issues: Attention is needed to a number of bedroom doors which have marked paintwork. • The damaged conservatory roof blinds are to be replaced. (previous timescale of 06/04/05 not met) • The damaged roof blinds in the smoking area off the main lounge are to be replaced. • The corridor carpets on the first and second floor are to be satisfactorily cleaned or replaced. • The decoration to the first floor corridor is damaged in a number of areas and requires attention. The handle rest to the window in bedroom 53 is loose and must be secured so that the window can be easily opened and closed. The works needed to make the conservatory suitable for use must be attended to. All areas of the home must be kept clean at all times. Tests of the fire alarm and emergency lighting must be recorded. The fire alarm system must be tested weekly and the emergency lighting tested monthly in accordance with guidance from the fire service. • 26/02/06 7 OP19 23 26/12/05 8 9 10 OP19 OP26 OP38 13 23 23 26/12/05 26/11/05 26/11/05 Prince Alfred DS0000059310.V269097.R01.S.doc Version 5.0 Page 24 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 Refer to Standard OP15 Good Practice Recommendations Records concerning service users dietary needs should not be displayed in the dining area a more suitable way of ensuring staff have access to this information needs to be considered. In order to provide evidence and demonstrate that the current staffing levels meet the needs of the service users the registered person should provide CSCI with a current assessment of the home’s staffing levels, taking into account the needs of the service users, layout of the home and the home’s statement of purpose. The manager is to obtain an NVQ Level 4 (or equivalent) in care and management. 2 OP27 3 OP31 Prince Alfred DS0000059310.V269097.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Prince Alfred DS0000059310.V269097.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!