Inspection on 03/03/06 for Queen Elizabeth Walk (57)

This inspection was carried out on 3rd March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Queen Elizabeth Walk (57) 27/08/08

Queen Elizabeth Walk (57) 19/12/07

Queen Elizabeth Walk (57) 20/03/07

Queen Elizabeth Walk (57) 10/01/06

Queen Elizabeth Walk (57) 02/12/04

Queen Elizabeth Walk (57) 20/09/04

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Edenvale

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Chatsworth Care - Dawson House

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Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Queen Elizabeth Walk (57) 57 Queen Elizabeth Walk Hackney London N16 5UQ Lead Inspector Kristen Judd Unannounced Inspection 3 March 2006 11:55 rd Queen Elizabeth Walk (57) DS0000010281.V282516.R01.S.doc Version 5.1 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 Queen Elizabeth Walk (57) DS0000010281.V282516.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Queen Elizabeth Walk (57) DS0000010281.V282516.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Queen Elizabeth Walk (57) Address 57 Queen Elizabeth Walk Hackney London N16 5UQ 020 8809 3817 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) yadvoezer@btconnect.com Yad Voezer Mrs Jacqui Biren Care Home 8 Category(ies) of Learning disability (7), Mental disorder, registration, with number excluding learning disability or dementia (1) of places Queen Elizabeth Walk (57) DS0000010281.V282516.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Agreed room may be used for respite care. Agreed residents may have relatives/friends to stay overnight in respite room and not in their own bedr Agreed room may be used for respite care. Agreed residents may have relatives/friends to stay overnight in respite room and not in their own bedrooms One Service user with Mental Health needs may be accommodated for a period of six months from the date of this certificate and thereafter reviewed by CSCI on a three monthly basis. 10th January 2006 2. Date of last inspection Brief Description of the Service: 57 Queen Elizabeth Walk is a Jewish Orthodox care home for seven females with a learning disability and one respite bed. The care provider is Yad Voezer (A Helping Hand), an orthodox Jewish charitable organisation, managed in accordance with strict Torah guidelines. All areas of daily life, including food (Kashrus requirements), Shabbos (Sabbath) traditions, festivals, religious rituals etc. are culturally observed. Yad Voezer aims to “ensure that despite a learning disability, people are given the maximum opportunity to enjoy their lives to the full.” A range of activities is offered within and outside of the home. These include opportunities for employment, day care, Hebrew lessons, religious instruction, art therapy, music therapy, keep fit and computer training. Service users independent living skills, spiritual needs and personal development are actively promoted. There are additionally strong links with the local orthodox Jewish community. The home is a large family type property situated in a quiet residential area in Stoke Newington. The home offers access to local amenities, transport and relevant support services, to suit the lifestyle needs of service users and the purpose of the home. Restricted permit parking is in operation. Queen Elizabeth Walk (57) DS0000010281.V282516.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced which started at 11.55am. This inspection followed up the requirements made at the unannounced visit held on 8th December 2005. The inspector spoke with service users, staff and the registered manager during the inspection. A tour of the environment was undertaken and samples of the homes records were examined. There have been four requirements one made following this inspection. The service has also been awarded one commendation. Verbal feedback was given to the registered manager at the end of the inspection. The inspector wishes to thank the staff and service users for facilitating this unannounced inspection and actively contributing to the regulatory process. What the service does well: 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. Queen Elizabeth Walk (57) DS0000010281.V282516.R01.S.doc Version 5.1 Page 6 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 Queen Elizabeth Walk (57) DS0000010281.V282516.R01.S.doc Version 5.1 Page 7 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 & 5 The inspector believes that the home is able to meet service users needs in line with the homes Statement of Purpose. EVIDENCE: The home’s statement of purpose covers the aims and objectives of the home, and the additional aspects as listed in Schedule 1 of The Care Homes Regulations 2001. The service user guide has been developed; the format has been improved and is more suitable for service users with learning disabilities; however requires further amendment as it does not indicate that complaints can made to outside agencies such as social services or to the commission directly. It currently indicates that the complaint must go through the organisational procedure in the first instance. The inspector was informed that all service users are admitted only after a full assessment has been undertaken. Following assessment the service users care plans are developed. The most recent admission to the home had relevant documentation on file. The organisation has developed a written contract / statement of terms and conditions with the home. Contracts cover such aspects as conditions; trail periods, fees, conditions, visitors, health and complaints. Queen Elizabeth Walk (57) DS0000010281.V282516.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6&9 The inspector believes that staff are aware of service users support needs in line with assessed needs. EVIDENCE: A sample of the service user plans were examined during the inspection. Each file examined contained service user basic information that contained all the personal information as stated in Schedule 3 of the Care Homes Regulations. Files contain a photograph of the service user and basic information profiles. Service user individual plans highlight the issues/needs, the aims and actions. Identified needs are highlighted covering daily living skills, personal care, activities, religion and health. The inspector noted a marked improvement and through the tracking of care it was noted plans clearly reflected the individual service users needs. Through cross-referencing the information obtained a recent hospital discharge assessment it had clearly been used as a basis for updating the care plan. For example one plan was very clear about how to provide personal care even Queen Elizabeth Walk (57) DS0000010281.V282516.R01.S.doc Version 5.1 Page 9 indicating what products to be used. The mobility care plan stated what equipment was to used and made reference to the risk assessment in place. Risk assessments were seen on the individual service user files inspected. The assessments highlight the risk which assess whether the activity should be considered and breaks down elements to be considered which are: A positive action in spite of risks listed. A positive action with additional safeguards in place A positive action to be deferred until additional safeguards are in place Not advisable in view of the risks involved. Through discussion with the registered manager the inspector was informed that the process of assessing risk includes consultation with the service user, and other key professionals. The inspector was satisfied that the care plans are developed to minimise risk without imposing inappropriate restrictions on the service users. Queen Elizabeth Walk (57) DS0000010281.V282516.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 17 The inspector observed and was satisfied that staff provide service users with support to make choices and provide them the opportunity to undertake a wide range of activities both inside and outside the home. EVIDENCE: This care home is an orthodox Jewish home and all service users are from orthodox Jewish families. The home is culturally appropriate to the needs of the service users. The inspector was satisfied through observations made during the inspection that staff encourage service users to be involved with many activities and organisations outside the home. This continues to be one of the homes strengths. Queen Elizabeth Walk (57) DS0000010281.V282516.R01.S.doc Version 5.1 Page 11 On the day of inspection service users were attending day services, there was a keep fit session with a qualified physiotherapist, shopping in the local area, art and crafts and food preparation. Staffing was at a level to support all of the activities. Service users were active throughout the inspection and clearly had a very structure day. Each service users is also assisted to complete daily living tasks such as cleaning their own rooms and laundry. Service users’ are fully involved in the day-to-day routines of the home as part of their identified care planning objectives and in relation to their learning disabilities. Service users are offered a key to their own bedroom, which can be locked. The inspector was informed that staff do not enter bedrooms except in emergency or invited by the service user. Through observation and discussion with staff, it was positive to note that daily routines and house rules do promote independence and individual choice for the service users. Staff were observed to communicate in a respectful and sensitive manner. There are three meals offered daily when service users are present in the home, with additional drinks and snacks. Menus are planned with the service users at the house meetings on Sundays. Menus were examined and found to be international, culturally appropriate and nutritious. Service users assist in meal preparation on a rota basis. The inspector saw the food being prepared for ‘Shabbos’, which was being prepared in the home. Fresh ingredients were used. All food purchased whether for the home, clubs, holidays or outing must hold a hescher (certificate of Kashrus) of Kedassia or one of equal standing. Milk and meat sections of the kitchen were clearly separated. Food stores were seen during the inspection. Queen Elizabeth Walk (57) DS0000010281.V282516.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 It is the inspector’s view that service users are well supported by staff to ensure that physical and emotional needs are met. Although there needs to be attention to the recording of medication records. EVIDENCE: The inspector was satisfied through observations made that the service users continue to be supported to maintain their personal identity and choice. Service users’ require a range of support with personal care from just supervision to assistance with all aspects of personal care. One service users personal needs have increased however the needs are clearly recorded on the service users individual plan of care with detailed information as to how those needs are to be met. The inspector was satisfied that the registered manager and staff are fully aware of service users’ needs and makes appropriate referrals when required. Much work was evidence on one service users file regarding liaison with health professional prior to and after discharge from hospital to ensure that the service users needs could be met. Queen Elizabeth Walk (57) DS0000010281.V282516.R01.S.doc Version 5.1 Page 13 The home has implemented Health Action plans for service users. This document provides a very clear picture for the service users health needs, what appointments have been undertaken and any issues that may need following up. The inspector is satisfied that referrals are made to relevant health professional such occupational therapist. The format provides a comprehensive overview service users health needs. Staff were observed interacting with all of the service users throughout the inspection. The interaction was positive and there is clearly good relationships between staff and service users. Service users were seen to move around the home without any restrictions. The medication storage was in good order. Service users medication is provided in doset boxes. The home appropriately stores medication in a locked cabinet. The inspector completed seven spot checks on generic package medication. However two errors were found. Additionally one medication administration advice on the box did not correspond with the MAR sheet. The registered manager stated that the change had occurred some week’s prior. It therefore remains an outstanding requirement that the registered manager must ensure that arrangements are in place for the recording, handling, safekeeping and safe administration of all medications in the care home Queen Elizabeth Walk (57) DS0000010281.V282516.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): It is the inspectors view that the service user rights are protected however there must be accurate records maintained in relation to service users income and how that income is spent. EVIDENCE: The inspector saw the home’s complaints procedure/policy. The policy indicated the timescales to be adhered to for the responses. There have been no new complaints since the previous unannounced inspection. As previously stated the service user guide requires further amendment as it does not indicate that complaints can made to outside agencies such as social services or to the commission directly. It currently indicates that the complaint must go through the organisational procedure in the first instance. This has been made a requirement under standard 1. Concerns have been raised at previous inspections regarding to the procedure of the service users Disability Living Allowance being used by the organisation to go towards the funding of the mini bus. The registered manager must forward the end of year account of the benefits and evidence how the funds are spent on accessing the community. The requirement is still within timescale. Queen Elizabeth Walk (57) DS0000010281.V282516.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 &30 The inspector is satisfied that the home is suitable for it purpose and is maintained to a high standard of cleanliness. EVIDENCE: The home is located in a quiet residential road in Stoke Newington. It is a large terraced town house and blends unobtrusively into the neighbourhood. The home offers access to local amenities, transport and relevant support services to suit the personal and lifestyle needs of service users. The ground floor bathroom is being refurbished and the bath is being replaced with a walk in shower by the end of March 2006, as such requirements have not been made at this time. The premises were found to be safe, comfortable, bright, homely, clean and free from offensive odours. There was sufficient lighting, heating and ventilation on the day of inspection. The home has ramps leading to the entrance of the home and at the rear of the building leading to the garden. Service users were found to have the specialist equipment needed to maximise their independence. The home does not however have a passenger lift. Queen Elizabeth Walk (57) DS0000010281.V282516.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 , 34 & 35 It was the inspectors view that the home has a stable, experienced and effective staff team who work well together to provide an excellent level of care to service users. However the staff files must evidence all relevant pre employment checks have been completed appropriately. EVIDENCE: Rotas indicated that staffing levels are satisfactory and there is sufficient staff on duty to meet the needs of the service users. The home always has at least 2 members of staff on duty during the day. At nighttimes there is one waking night. An on call rota is available for staff support. At the time of inspection there were also two students on work experience who were supernumerary. Through observation and discussions with staff they demonstrated a good understanding of their roles and responsibilities, and good knowledge around individual service users needs. Staff assist service users with domestic tasks in the home dependant on their individual assessed need.Staff were observed to interacting with service users in a relaxed and respectful manner, and there was evidence that good relationships have been built up with service users Queen Elizabeth Walk (57) DS0000010281.V282516.R01.S.doc Version 5.1 Page 17 Minutes for staff meetings were seen the content of the meeting was good, items that were discussed such as the previous inspection report. An action plan was recorded clearly stating who was responsible. For example one item was discussed was with regard to the garden, a staff member took the lead with service users to assist planting spring flowers in tubs and flower beds. The inspector observed that this had been actioned. The head office deals with all recruitment and this is where the main personal files are stored. Following the requirements made at the previous inspection the registered manager informed the inspector that staff files have been audited and missing elements have been highlighted which are in the process of being followed through by the head office. It therefore remains an outstanding requirement that the registered manager must ensure that records for all employees comply with Regulation 17 and the accompanying Schedule of The Care Homes Regulations 2001. This matter must be addressed as a matter or urgency. All staff have ‘Personal Development Plans’ in place. Training is provided both by internal and external providers. Four of the current staff team have achieved the NVQL2 award. The registered manager stated that a further eleven staff members commenced the NVQL2 in February. Additionally some staff are undertaking training via distance learning. Staff have achieved a intermediate certificate in the safe handling of medicines. Other distance learning being undertaken in Health and Safety and customer relations. Queen Elizabeth Walk (57) DS0000010281.V282516.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 41 The inspector believes that the home is run by a registered manager who is competent to run the care home in line with its statement of purpose. EVIDENCE: The registered manager has over twenty-two years experience in social care field. Previous work experience includes nursing, care of the elderly and therapeutic work. The registered manager has obtained the level 4 NVQ in Management and Care. The registered manager has a good knowledge and understanding of the cultural needs of the service users and ensures that Kashrut laws are maintained within the home. The registered manager is aware of the National Minimum Standards and as reflected in this report endeavours to exceed them. Through interviewing the registered manager, the inspector continues to be satisfied that the home is managed in an open and positive way. The inspector continues to be satisfied that the registered manager is competent and experienced to run the care home in line with its stated purpose. Queen Elizabeth Walk (57) DS0000010281.V282516.R01.S.doc Version 5.1 Page 19 The monthly-unannounced monitoring visits are untaken; and copies are forwarded to the Commission. Service users and staff meetings are being held and copies of the minutes were available for inspection. The inspector was informed that the inspection visits from the CSCI would assist with monitoring the service provision. Queen Elizabeth Walk (57) DS0000010281.V282516.R01.S.doc Version 5.1 Page 20 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 2 2 3 3 x 4 x 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 x x 3 x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 4 15 x 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 3 x 3 x x Queen Elizabeth Walk (57) DS0000010281.V282516.R01.S.doc Version 5.1 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 YA1 Regulation 22 Requirement Timescale for action 30/04/06 2 YA20 13.2 3 YA23 25.3(c ) 4 YA34 19.1 The registered manager must ensure that the complaints procedure in the service user guide be amended as stated in this report. The registered manager must 30/04/06 ensure that arrangements are in place for the recording, handling, safekeeping and safe administration of all medications in the care home. (Timescale of 31/01/06 not met) The registered manager must 20/05/06 forward the end of year account of the benefits and evidence how the funds are spent on accessing the community. The registered manager must 30/04/06 ensure that records for all employees comply with Regulation 17 and the accompanying Schedule of The Care Homes Regulations 2001. (Timescale of 28/2/05 not met) Queen Elizabeth Walk (57) DS0000010281.V282516.R01.S.doc Version 5.1 Page 22 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 Queen Elizabeth Walk (57) DS0000010281.V282516.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ 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 Queen Elizabeth Walk (57) DS0000010281.V282516.R01.S.doc Version 5.1 Page 24 - 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!