Inspection on 15/11/05 for Richmond

This inspection was carried out on 15th 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

Richmond 15/07/08

Richmond 14/08/07

Richmond 05/06/06

Richmond 17/05/05

Richmond 11/01/05

Richmond 17/05/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Richmond Collington Lane East Bexhill-on-sea East Sussex TN39 3RJ Lead Inspector Gwyneth Bryant Unannounced Inspection 15th November 2005 08.30 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 Richmond DS0000021194.V267221.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. Richmond DS0000021194.V267221.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Richmond Address Collington Lane East Bexhill-on-sea East Sussex TN39 3RJ 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) 01424 217688 01424 210424 home.bex@mha.org.uk Methodist Homes for the Aged Mrs Debra Macklin Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Richmond DS0000021194.V267221.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users to be accommodated is forty (40). Service users will be aged sixty five (65) years of age or over on admission. 17th May 2005 Date of last inspection Brief Description of the Service: Richmond is a purpose built home providing personal care and accommodation for forty older people. It is owned and managed by Methodist Homes for the Aged. Service users accommodation consists of forty single rooms all of which have en-suite toilet and hand washing facilities. In addition twelve rooms also have showers as part of the en-suite facilities and four have baths. The building has two floors with nine rooms on the ground floor and thirty-one rooms on the first floor. There are two lounge areas and four small ‘break out’ areas where service users can make hot drinks. The home has seven communal toilets and five bathrooms of which four have assisted baths. Meals are served in the dining room or in individual bedrooms if required. There is a programme of regular activities for service users. Richmond DS0000021194.V267221.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulations 2001 uses the term ‘service users’ to describe those living in care home settings. For the purpose of this report, those living at Richmond will be referred to as ’residents’ at their own request. This was an unannounced inspection and took place over seven hours. The purpose of the inspection was to check compliance with the requirements made at the last inspection and inspect additional standards. There were thirty-nine residents in residence on the day. Residents were spoken with individually and as a group. Two staff, the chef and the Registered Manager were spoken with. A tour of the premises was carried out and a range of documentation was viewed including care plans, personnel and medication records. What the service does well: What has improved since the last inspection? What they could do better: The entire care planning process needs to be reviewed and systems put in place to ensure that National Minimum Standards are met; provide clear direction to staff in the delivery of care to residents and ensure residents’ needs are met. Detailed risk assessments need to be provided for those residents at risk of tissue breakdown and falls. Care plans need to be regularly reviewed to ensure that the home can meet the changing needs of those residents who have become more dependent. Richmond DS0000021194.V267221.R01.S.doc Version 5.0 Page 6 Staff need to be trained in adult protection procedures to promote the protection of residents. An assessment of the premises and facilities needs to be carried out by a suitably, including an Occupational Therapist to ensure the needs of all residents are met. Some bedroom carpets need to be cleaned or replaced and some minor repairs need to be carried out. Arrangements for consulting with residents need to be more regular. Recruitment practices needs to ensure that any gaps in employment history are explored and two references obtained prior to appointment to protect residents. Fire safety training for all staff needs to be provided by a suitably qualified person. 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. Richmond DS0000021194.V267221.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 Richmond DS0000021194.V267221.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, 3, 4 and 5. Standard 6 is not applicable The Statement of Purpose and Service Users Guide provide details of the home that enables residents and their relatives to decide if the home can meet their needs. Satisfactory pre-admission assessments are carried to ensure the home can meet residents needs at the time of admission. Care plan reviews are inadequate therefore the home is unable to ensure it can meet the needs of all residents. EVIDENCE: The home has recently reviewed its Statement of Purpose and a copy was made available for inspection. This document clearly outlines the homes aims and objectives ensuring that prospective residents and their families are clear about the services provided in the home. The manager or senior carers undertake detailed pre-admission assessments for all prospective residents to ensure the home can meet the needs of residents at the time of admission. There is evidence that two residents care needs are such that they appear to be out of the homes’ registration category. (See under Standard 7). Richmond DS0000021194.V267221.R01.S.doc Version 5.0 Page 9 The home has an open visiting policy to encourage relatives and family to visit regularly. Residents confirmed they and their families had the opportunity to visit the home prior to admission. Richmond DS0000021194.V267221.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, 9, 10 and 11 There is no consistent care planning system to ensure staff have the information to meet residents personal and healthcare needs. Residents are protected by satisfactory systems for the recording, handling and storing of medication. To protect residents there are policies and procedures in place in relation to privacy and dignity and appropriate training is provided for staff. EVIDENCE: Six care plans were viewed and those relating to residents who led the most independent lives were satisfactory. However, those plans for the more dependent residents were inadequate and did not provide clear direction to staff in the delivery of care. Basic risk assessments had been carried out but they did not clearly identify the hazards nor include sufficient detail for the management of risks, this is especially true for those who are at risk of falls or tissue breakdown, self medicate or have particular disabilities. Neither care plans nor risk assessments were reviewed monthly. One resident who required two carers for all transfers and whose mobility was severely reduced did not have clear instructions in their care plan in respect of regular turning and management of incontinence although staff had recorded a Richmond DS0000021194.V267221.R01.S.doc Version 5.0 Page 11 reddening of the sacral area which could lead to tissue breakdown. During the lunchtime meal this resident was seated in a sheepskin lined ‘bucket’ chair as she was unable to remain upright in an ordinary chair. This residents’ dependency level is high and therefore she appears to be out of the homes registration category. Not all care plans had evidence that residents or their representatives had been involved in compiling and reviewing the plans. Residents spoken with were not aware of the contents of their care plan none could recall being asked about their care. One resident had been admitted in October 2005 but only the first page of her care plan had been completed. Care staff and the deputy manager spoken with were aware of residents individual care needs but this system relies on good verbal communication and good staff memory. Residents are at risk if these informal systems breakdown. Not all care planning documents were signed and dated making it difficult to ascertain who undertook the reviews and how often they were carried out. The home has policies and procedures in place in respect of the safe handling, storage and administration of medicate and all staff who administer medication have been appropriately trained. Staff were observed to follow the correct procedures when administering medication and medication recording charts were accurate and up to date. Throughout the inspection staff were noted to treat residents with care and respect. Residents spoken with said that staff were very good and they felt they ‘could not get better care’. Richmond DS0000021194.V267221.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): 12, 13, 14 and 15 Residents benefit from a daily programme of varied activities and are encouraged to exercise choice over their daily lives. Visitors are welcome to the home at all reasonable times to ensure residents maintain links with family and friends. The meals in this home are good offering both choice and variety and cater for special dietary needs. EVIDENCE: Armchair exercises are provided each morning in the lounge. The inspector joined residents for this session and it was evident that residents enjoyed this activity and found it entertaining as well as being beneficial to health. During the afternoons, activities are varied including arts and crafts, music and entertainers. Those residents spoken with said they often go out alone into the community or to the local church services and that their friends and families were always made welcome. The ethos of the home is to maximise residents’ independence and ensure they are able to continue with their chosen leisure activities. The inspector joined residents for lunch and the meal on the day was either cottage pie or vegetarian Mexican bake. The meals looked appetising and were attractively presented. All residents spoken with were positive and complementary about the food. Menus were viewed and the chef spoken with. Richmond DS0000021194.V267221.R01.S.doc Version 5.0 Page 13 Meals are varied and a vegetarian option offered each day. The chef said that he frequently puts up a board and asks residents to list any meals they would like to be included in the menus as he felt that they should be given a choice based on their preferences. He confirmed that all meals are homemade and fresh vegetables used whenever possible. Richmond DS0000021194.V267221.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 procedure with evidence that residents feel that their views are listened to and acted upon. Residents would be better protected if staff were trained in adult protection procedures. EVIDENCE: The home has policies and procedures on complaints, a copy of which is in the homes hallway. No complaints had been received since the last inspection. Residents said that they would be happy to speak to the manager or staff if they had any concerns, although all said they had no reason to complain about anything in the home. The home has policies and procedures on adult protection and staff are expected to be familiar with this document. However, all staff need to be trained in recognising abusive practices and in adult protection procedures to ensure residents are protected. The Manager provided evidence that she has undertaken training in adult protection from the local authority and intends to formulate a programme to cascade the training to all staff. Richmond DS0000021194.V267221.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, 22, 24 and 26 The standard of decor within the home is generally good, with most areas homely and comfortable for residents. Resident’s bedrooms are comfortable and they are able to bring in their own possessions. Satisfactory systems of infection control are in place to protect residents and staff. EVIDENCE: A tour of the premises was carried out and most parts of the home are well maintained and décor is generally good. Most residents’ bedrooms were clean, tidy and attractive. Residents are encouraged to personalise their rooms and many have done so with ornaments, photographs and items of furniture. However, the carpet in two bedrooms was badly stained. This was discussed with the manager who explained that she is waiting for a room to become vacant so residents can be accommodated elsewhere while carpets are replaced. Some minor repairs needed to be carried out in bathrooms and communal areas. The manager confirmed she was aware of these shortfalls and plans are in progress to address them. Richmond DS0000021194.V267221.R01.S.doc Version 5.0 Page 16 There are grab rails and toilet riser seats in evidence but these have been fitted to meet the needs of individual service users. An assessment of the premises needs to be carried out by a suitably qualified person to promote residents’ independence. Laundry facilities are clean and hygienic. Systems are in place for the control of infection and all staff have been trained in this area, thereby ensuring the risk of infection to both staff and residents is reduced. Richmond DS0000021194.V267221.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, 28 and 29 Care staffing levels are not always sufficient to ensure that residents’ needs are always appropriately met. Staff received satisfactory training to enable them to meet residents care needs. The recruitment practice is not robust and does not provide sufficient safeguards for the protection of residents. EVIDENCE: Staff rotas showed that there were four care staff on duty during each shift and two waking night staff. In addition there are a chef, domestic, laundry and maintenance staff. The administrative, maintenance and activities staff are shared with Heatherbank, the adjoining home. Residents spoken with said staff are often rushed with little time to sit and chat with them. Care plans showed that one resident needed two carers for all transfers and also needed regular care at night. This raises concerns in respect of staffing levels when there are residents with high dependency. In addition there were other residents whose level of confusion had increased with one spending the day at Heatherbank as there were fears she may leave the home unescorted. The home provides a total of 532 care hours during the working week. The Residential Forum staffing tool recommends a minimum of 896.5 care hours based on current residents dependency levels and taking into consideration the layout of the home. This shortfall indicates that not all residents care needs can be meet with current staffing levels. Richmond DS0000021194.V267221.R01.S.doc Version 5.0 Page 18 The home is committed to comprehensive staff training with eleven staff having achieved NVQ level 2, five in the process of gaining this qualification and two in the process of achieving NVQ level 3. This training is in addition to satisfactory induction and foundation training that all new staff undertake. Evidence was available to demonstrate staff also received additional training in infection control, manual handling and the safe handling of medication. Recruitment records were viewed and it was found that not all new staff had provided the required two written references nor had gaps in employment history been explored and explained. The recruitment practice for overseas staff is to conduct a telephone interview using a standard set of questions. Due to language difficulties this form had not been completed for one member of staff. Subsequently this member of staff could only be deployed for domestic duties in communal areas due to their inability to communicate effectively with residents. However, there remain concerns that this person may not be able to effectively communicate with staff and residents both verbally and in writing. As this person was undertaking domestic tasks she would be using cleaning chemicals so may not be able to familiarise herself with the regulations regarding Control of Substances Hazardous to Health. Recruitment practices need to be reviewed to ensure the requirements of Schedule 2 of the Regulations are met. A letter has been sent to the Responsible Individual in respect of these matters. Richmond DS0000021194.V267221.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, 32, 33, 35 and 38 The Manager is supported well by the staff and her deputy in providing clear leadership throughout the home. The ethos of the home is open and residents would benefit from the opportunity to be consulted more regularly. Formal quality monitoring systems are in place that enables the Provider to evaluate the service. Systems to safeguard residents financial interests are satisfactory. All aspects of residents health, safety and welfare are protected and promoted. EVIDENCE: The Registered Manager is suitably experienced and has the qualifications and skills to effectively run the home and ensure staff are suitably supported Staff meetings are carried out in addition to a ‘hand over’ at the end of each shift. Richmond DS0000021194.V267221.R01.S.doc Version 5.0 Page 20 Residents spoken with said there had been residents meetings but thought that the last one must have been months ago, as they could not recall it. This was discussed with the manager who agreed that residents meetings had not been carried as frequently as she preferred. However, residents spoken with said that they felt comfortable approaching the manager or staff should they wish to raise any matters. During the inspection residents came to speak to the manager and her deputy in the office so it is evident that the home operates an ‘open door’ policy. Regular residents meetings that are minuted could be used as evidence to inform the quality monitoring systems. The assistant manager was in the process of organising the annual audit that is used for quality monitoring purposes. This is in addition to residents’ surveys and the informal day-to-day system for ensuring the home is run in residents best interest. The Registered Provider undertakes checks as required under Regulation 26 and the results made available to the Commission. Service users are responsible for their own finances if appropriate; relatives and solicitors support others, while the home does not handle the financial affairs of service users. When items are purchased on behalf of residents receipts are obtained and satisfactory records maintained. Evidence was available to demonstrate that electrical and gas systems and appliances have been serviced and are safe. Documents relating to safe working practices and Health and Safety were available and found to be satisfactory as were accident records. There were records showing the regular testing of call bells and fire alarms and fire equipment and systems are regularly serviced. The homes maintenance person provides fire safety training to staff however he does not have the required qualification to deliver this. This was discussed with the manager who agreed that she would contact the local fire authority to discuss the training requirements. Richmond DS0000021194.V267221.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 X 2 2 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X 2 X 3 3 3 STAFFING Standard No Score 27 2 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 2 Richmond DS0000021194.V267221.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 OP4 Regulation 12 (1ab) (14)(1d) Requirement The home needs to demonstrate it can meet service users assessed needs by identifying how service users care needs are to be met. Detailed risk assessments need to be undertaken in respect of those service users at risk of falls and for moving and handling. Wherever practicable service users or their representatives should be involved in the preparation and review of their care plans. (timescale of 17/05/05 not met) All parts of service users care plans need to be completed, signed, dated and include clear direction to staff as to how needs will be met. That advice is sought from a continence advisor in respect of the management of incontinence. Detailed risk assessments must be carried out for those service users at risk of tissue breakdown as under Schedule 3 (p). DS0000021194.V267221.R01.S.doc Timescale for action 15/12/05 2 OP7 13(4bc) (c)(5) 15/01/06 2 OP7 15(1)(2) (a) 15/01/06 3 OP7 13(4bc) 15(1) (2bc) 13(1)(b) 15/01/06 4 OP8 15/01/06 5 OP8 13 (4c) 15/01/06 Richmond Version 5.0 Page 23 6 OP9 13(2)(4) (abc) 7 8 9 OP18 OP22 OP27 10 OP38 Risk assessments for those service users who self-medicate need to be more detailed and reviewed monthly. 13(6) Training in Adult Protection must be provided for all staff. (timescale of 17/05/05 not met) 16(1) (2c) That a suitably qualified person 23 (2n) make an assessment of the premises and facilities. 18(1)(a) Staffing levels must be reviewed with a view to providing additional care time. (timescale of 31/07/05 not met) 23 (4) (d) That all staff fire safety training is provided by a suitable qualified person. 15/12/05 15/01/05 15/02/06 15/12/05 15/01/06 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 Richmond DS0000021194.V267221.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection East Sussex Area Office 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 Richmond DS0000021194.V267221.R01.S.doc Version 5.0 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!