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Inspection on 25/05/05 for Regent House Nursing Home

Also see our care home review for Regent House Nursing Home for more information

This inspection was carried out on 25th May 2005.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides both prospective and existing residents, with a good level of information about what services are provided and what to expect when living at the home. Regent House provides a pleasant and well-maintained environment that is furnished and decorated to a high standard. Staff try to make life in the home as flexible as possible. For instance, meals can be taken in the dining room or in resident`s own rooms, and there are no set times for getting up or going to bed.

What has improved since the last inspection?

The areas of concern noted during previous inspections have been addressed. Action is in place to ensure that those areas not yet fully met are done so in the near future. The home has obtained information for residents regarding advocacy services available in the local area.

What the care home could do better:

Residents must be actively involved in the planning of their care and provided with suitable opportunities for meaningful things to do, in order to improve the quality of life for people living at the home. Although much good care practice is evident, this must be supported by good record keeping to ensure that legislation is complied with, and residents and staff are fully protected. Management strategies must be developed and acted upon to ensure that residents, their relatives and staff feel that they are able to raise concerns and feel that they have been listened to, to ensure that all complaints are handled objectively by the home in the best interests of residents. Whilst health and safety checks are carried out, this must be done on a monthly basis.

CARE HOMES FOR OLDER PEOPLE Regent House 107 - 109 The Drive Hove East Sussex BN3 6GE Lead Inspector Penny Bailey Unannounced 25 May 2005 14:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Regent House H59-H10 S14033 Regent House V221603 080605 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Regent House Address 107 - 109 The Drive Hove East Sussex BN3 6GE 01273 220888 01273 726724 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Shafa Medical Services Limited Care Home with nursing (N) 32 Category(ies) of Old age, not falling within any other category registration, with number (OP) 32 of places Regent House H59-H10 S14033 Regent House V221603 080605 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the home is able to provide care for one named service user under sixty-five (65) years of age. 2. The maximum number of service users to be accomodated is thirty-two (32). 3. The individuals accommodated must be aged sixty-five (65) years and over on admission. Date of last inspection 28 October 2004 Brief Description of the Service: Regent House Nursing Home provides nursing care and accommodation for up to thirty-two older people. The home is owned by Shafa Medical Services Limited, and is situated in a residential area of Hove, East Sussex. Regent House is within walking distance of local bus routes, with both Hove and Brighton town centres a short drive away. A small number of parking spaces are available at the front of the home for visitors. The home is a detached residence converted from two houses. Accommodation is provided over three floors, with a basement housing the laundry and kitchens. The home provides a passenger lift that enables residents to access all parts of the building. Regent House has thirty single rooms, all with ensuite facilities. Two of these rooms are registered as shared accommodation if required. There is a large garden at the rear of the property that is accessible to residents, including those in wheelchairs or with mobility problems. There is a large, attractive sitting room, and two dining rooms. There is a further seating area in the hall of the second house. Regent House H59-H10 S14033 Regent House V221603 080605 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced inspection and took place over six hours forming part of the annual inspection programme for this home. This visit was also undertaken in response to an adult protection concern that had been raised. A tour of the home took place and two members of staff out of the seven on duty were spoken with. Fourteen residents and five visitors spoke with the Inspector and visiting health professionals, and staff and care records and documentation relating to health and safety were examined. What the service does well: What has improved since the last inspection? What they could do better: Regent House H59-H10 S14033 Regent House V221603 080605 Stage 4.doc Version 1.20 Page 6 Residents must be actively involved in the planning of their care and provided with suitable opportunities for meaningful things to do, in order to improve the quality of life for people living at the home. Although much good care practice is evident, this must be supported by good record keeping to ensure that legislation is complied with, and residents and staff are fully protected. Management strategies must be developed and acted upon to ensure that residents, their relatives and staff feel that they are able to raise concerns and feel that they have been listened to, to ensure that all complaints are handled objectively by the home in the best interests of residents. Whilst health and safety checks are carried out, this must be done on a monthly basis. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Regent House H59-H10 S14033 Regent House V221603 080605 Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Regent House H59-H10 S14033 Regent House V221603 080605 Stage 4.doc Version 1.20 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3 & 5. The home provides both prospective and existing residents, with a good level of information about services at the home. This supports prospective residents and their representatives to make informed decisions about Regent House. However, the home must ensure that the Statement of Purpose and Service User Guide are reviewed to ensure that the information provided is up-to-date, clear and consistent. Prospective residents needs are assessed before they move in to ensure that the home is able to offer the care needed. EVIDENCE: Documents seen for recent admissions showed that resident’s are only accommodated following an assessment of their needs by the Manager or a senior nurse. Information about their needs is gathered from a variety of sources including the resident, their representative and health care professionals. This needs assessment then forms the basis of the resident’s care plan. Residents or their relatives are able to visit Regent House and talk to people living in the home before deciding whether they wish to live there, and are Regent House H59-H10 S14033 Regent House V221603 080605 Stage 4.doc Version 1.20 Page 9 admitted for one months trial period. On admission all residents receive a ‘Service Users Guide’ and a Contract of terms and conditions, that provides information on what they may wish to know about the home, including the amount of fees they will need to pay. These documents require review to ensure that the information provided is up-to-date. For example, the Service Users Guide was developed in 2002 by a previous Manager, and refers to the National Care Standards Commission which became the Commission for Social Care Inspection (CSCI) in April 2004. Trial visits and an initial trial period of one month are referred to in the Service User Guide, but not in the Contract of terms and conditions. Regent House H59-H10 S14033 Regent House V221603 080605 Stage 4.doc Version 1.20 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 The staff at the home are knowledgeable about the care of the residents, however, residents records do not always identify this. The home must ensure that each residents physical, social and psychological care needs are fully assessed, and a care plan put in place for each assessed need. Care plans must be reviewed at least once a month, and updated to provide clear guidance for staff on meeting the residents current care needs. Evidence must also be provided that care plans are completed with the involvement of the resident or their representative, and ensure that their preferences regarding the way their care needs are to be met are recorded. EVIDENCE: Four individual plans of care were inspected. These comprised of many documents including risk and needs assessments, basic information, daily notes and care plans. Three of the care plans seen had not been reviewed or updated regularly to provide clear guidance for staff on each residents current needs and how these should be addressed. Examples of this were that the care plan had not been reviewed and updated following a residents return from hospital, and for a resident who was receiving treatment for a pressure sore the pressure area risk assessment tool had not been reviewed for several months. Staff must ensure that every time a change of care is identified that Regent House H59-H10 S14033 Regent House V221603 080605 Stage 4.doc Version 1.20 Page 11 this is written in the care plan. Where care plans had been updated, they were not signed and dated by the member of staff who had recorded the change, in line with professional guidelines on recording. Clear guidance was provided that one resident should have their weight monitored and recorded on a weekly basis, there was no evidence that this had been done. Residents had not all received weight monitoring and recording on admission. This would be considered to be good practice to ensure that any future changes can be fully assessed. Records showed that advice is sought from General Practitioners and specialist health professionals when required. There was little evidence that residents and their representatives had been consulted when completing care plans, or that their preferences regarding the way care was to be provided were recorded. Staff must ensure that care plans are drawn up with the involvement of the resident or their representative, and complete care plans that provide clear guidance for staff to follow on all of the residents assessed needs, which are reviewed and updated at least once a month or more often if required. Medication charts were seen to be up-to-date and signed by staff each time a medication was administered. Staff must ensure that where medicines are prescribed “as required” that this is clearly recorded on the medication chart. All but one of the residents spoken with stated that staff treat them with courtesy and respect their dignity, and those residents who were ill appeared to be comfortable. Regent House H59-H10 S14033 Regent House V221603 080605 Stage 4.doc Version 1.20 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 14 Flexible routines are part of daily practice at the home. There is more work needed to ensure that opportunities for occupation and stimulation are improved. EVIDENCE: The home is in the process of recruiting an Activities Coordinator. Activities are currently being provided on a weekly basis by a member of the care staff. A requirement has been made that following consultation with residents, a programme of activities be put in place, and the amount of hours available for activities increased. The Manager reported that outings are generally undertaken on a one-to-one basis, with a carer accompanying a resident to local shops or the sea front. During the inspection the majority of residents remained in their rooms, with only two residents using the lounge. Whilst it is recognised that this may be the residents choice, staff must record residents social preferences in the plan of care. The home has an open visiting policy and welcomes visitors at any reasonable time. Twelve of the residents who spoke with the Inspector or visiting health care professionals commented that they were happy with the care and services provided by the home, and felt that their choices were respected. Residents stated that there is flexibility in daily routines regarding meal times, going to bed, rising and bathing. Four of their relatives reported that they were Regent House H59-H10 S14033 Regent House V221603 080605 Stage 4.doc Version 1.20 Page 13 satisfied with the care provided, and felt that they were made welcome by staff when visiting. The concerns raised by two residents and their relatives are currently being investigated under the protection of vulnerable adults procedures, with the support of the home’s owner. Regent House H59-H10 S14033 Regent House V221603 080605 Stage 4.doc Version 1.20 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 The home must ensure that complaints are handled objectively, and do all that is possible to make sure that residents and their relatives feel comfortable to raise concerns and feel that they are listened to. The home has an adult protection policy but there is no formal training given on this. EVIDENCE: A copy of the home’s complaints procedure is provided in each residents’ room, and contains information about how complaints will be investigated. The contact details of CSCI are also provided, should the resident be unhappy with the home’s response to their complaint. A record of complaints is maintained, and this showed that the home had received and investigated five complaints since the last inspection. The Manager reported that a further complaint was currently being investigated. No formal training has been given in the protection of vulnerable adults, although there are policies and procedures outlining this and staff receive some training whilst they are undergoing induction. An adult protection concern is currently being investigated within the home, during which the relatives of two residents reported that they did not feel that their complaints had been listened to by the Manager or staff, and consequently felt uncomfortable about raising concerns in the future. Regent House H59-H10 S14033 Regent House V221603 080605 Stage 4.doc Version 1.20 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25 & 26 Residents live in a clean and homely environment that is decorated and furnished to a high standard. The home ensures that residents private accommodation is equipped to provide comfort and privacy, and to meet the assessed needs of those residing in the room. EVIDENCE: Bedrooms were observed to have been individualised by residents, and are provided with domestic style furniture and fittings of a good standard, together with bedding, carpeting and curtains. All bedrooms are currently used for single occupancy, but two rooms are available for shared occupancy if required. The majority of rooms have en-suite facilities. Assisted bathing facilities are also provided. Grab rails, and a range of equipment and adaptations are provided to support residents in moving safely around the home. Call bells are provided in each Regent House H59-H10 S14033 Regent House V221603 080605 Stage 4.doc Version 1.20 Page 16 room. A high standard of cleanliness was noted throughout, and the home was free from offensive odours. The home employs sufficient domestic staff to ensure that standards of hygiene and cleanliness are maintained. The home has a good range of infection control policies, and staff were seen to be wearing aprons and gloves where appropriate. Communal space is provided in a large lounge and separate dining area. There is also a small sitting area in the ground floor foyer, and a large garden at the rear of the home that provides a pleasant place for residents to sit outside. Regent House H59-H10 S14033 Regent House V221603 080605 Stage 4.doc Version 1.20 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 28 There are sufficient staff on duty on a daily basis to meet the needs of the residents, and further recruitment of staff is taking place. Care staff must be given the opportunity to undertake the NVQ Level 2 in Care, in order to ensure that Government Guidelines are met with regard to the employment of suitably qualified staff. EVIDENCE: The home was well-staffed on the day of inspection, and rotas demonstrated that there are generally two Registered Nurses and five or six carers during the morning shift, one Registered Nurse and four carers during the afternoon, and one Registered Nurse and three carers during the night. The Manager reported that extra staff are also employed on shift, where the needs of residents require this. A number of agency staff have recently been employed at the home, however, the rota demonstrated that the same members of agency staff regularly work at Regent House to ensure that continuity of care is maintained as much as possible. Only two members of care staff have completed the NVQ Level 2 in care, with one member of staff currently studying for this qualification. Regent House H59-H10 S14033 Regent House V221603 080605 Stage 4.doc Version 1.20 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 37 & 38 Health and safety matters are generally well attended to, however, safety checks of emergency lighting and hot water delivery temperatures must be carried out and recorded on a monthly basis. The Manager must develop strategies to enable staff and visitors to the home to share their views regarding how services are provided. EVIDENCE: The home does not have a Registered Manager, although the Acting Manager has been employed at Regent House for a number of years and has acted as Manager for approximately two years. While residents, their visitors and staff made positive comments about the staff team and the care provided, several people gave examples of poor communication and poor staff discipline. A number of concerns were raised during the ongoing adult protection investigations regarding the management style of the home, with some staff indicating that they felt unsupported when making decisions regarding the way Regent House H59-H10 S14033 Regent House V221603 080605 Stage 4.doc Version 1.20 Page 19 care and services should be provided on a day to day basis. These concerns are currently being investigated and addressed by the home’s owner. Some systems to support fire safety are in place. Fire alarms and emergency lighting checks were recorded, however, the home must ensure that emergency lighting is checked each month, with a record maintained of any repairs required. A number of fire doors were wedged open. Service contracts are in place for the fire detection and fighting equipment. Temperature checks of hot water outlets are recorded, but these did not include communal facilities such as assisted baths. A requirement was made that such checks be carried out and recorded monthly to ensure that hot water delivery remains within safe limits. Safety matters were generally well attended to, but the floor covering in two communal toilets was noted to be wrinkled, and could present a trip hazard. Regent House H59-H10 S14033 Regent House V221603 080605 Stage 4.doc Version 1.20 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 3 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 x COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 1 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 x 2 x 1 x x x x 3 2 Regent House H59-H10 S14033 Regent House V221603 080605 Stage 4.doc Version 1.20 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 1 Regulation 4 (1), 5 (1) 15 (2) Requirement Timescale for action 01/12/05 2. 7 That the homes Statement of Purpose and Service User Guide are reviewed, and updated as required. With That each time a change of care is identified, or a particular need immediate is assessed, that this information effect. is written in the care plan and reflects all of the residents physical, psychological and social needs. That care plans be reviewed at least once a month, or more frequently as required, and updated to provide guidance for care staff on meeting all of the assessed needs of each service user. That evidence is provided within the care plan, that the plan has been drawn up with the involvement of the service user and/or their representative. That each service users weight is monitored and recorded on admission, and regularly thereafter based on the assessed needs identified within the nutritional assessment. That where medications are 3. 7 15 (1) With immediate effect. With immediate effect. 4. 8 14 (1) 5. 9 13 (2) With Page 22 Regent House H59-H10 S14033 Regent House V221603 080605 Stage 4.doc Version 1.20 6. 12 16 (2) (m) 12 (1) (a) 7. 16 8. 18 13 (6) 9. 10. 31 32 8, 12 (1) 12 (1), 12 (5) (a) 11. 38 13 (4) prescribed as PRN, that this information is clearly recorded on the M.A.R. chart. That a programme of activities be developed based on the preferred activities and wishes of service users. That strategies are developed to ensure that all complaints received by the home are handled objectively, and based on the best interests of the service user. That staff receive training on the recognition of abuse and the correct methods of reporting suspected abuse in line with Local Authority Guidelines. That the Registered Provider employs an RGN to take up the position of Registered Manager. That strategies are developed for enabling staff, service users and other stakeholders to inform the way in which the service is delivered. That emergency lighting and hot water delivery temperatures are monitored and recorded at least once a month. That the wrinkled floor covering in the two ground floor communal toilets is risk assessed and repaired or replaced as necessary. immediate effect. With immediate effect. With immediate effect. 01/12/05 With immediate effect. With immediate effect. 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 2 Good Practice Recommendations That the statement of Terms and Conditions includes the information that a one month trial period is offered. H59-H10 S14033 Regent House V221603 080605 Stage 4.doc Version 1.20 Page 23 Regent House 2. 28 That a minimum ratio of fifty per cent trained members of staff (NVQ Level 2 or equivalent) is acheved. Regent House H59-H10 S14033 Regent House V221603 080605 Stage 4.doc Version 1.20 Page 24 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 Regent House H59-H10 S14033 Regent House V221603 080605 Stage 4.doc Version 1.20 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!