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Inspection on 05/11/08 for River Court Residential And Nursing Home

Also see our care home review for River Court Residential And Nursing Home for more information

This inspection was carried out on 5th November 2008.

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

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 care of people on three of the four units was good. However, we had concerns about the care of people on Chess unit. In Hampermill where people who have the highest needs we observed the care to be good. We watched staff provide care and comfort to the people who live there. For example we observed one person get very upset. We saw staff sit with them and hold their hand until they were calm. This happened several times during the morning we observed. People were engaged in gentle activities and staff were observed to smile at the residents and include them in the activities on the unit. During the time we were there all the residents had one to one time with staff. On the other two units Gade and Colne we were aware that staff offered kindness to the people who lived there. The care staff on Chess appeared to be kind but lacked direction on the delivery of good care. The good practice we observed must be spread to the rest of the home.

What has improved since the last inspection?

The care of very vulnerable people continues to be provided on a high level on Hampermill. The home has been re-furbished and looks bright, clean and welcoming. BUPA has introduced a 24 hour menu that offers meals and hot snacks to all the residents as they need or want it.

What the care home could do better:

The care of vulnerable people on the Chess unit was not good. We had concerns about the administration and recording of medication on Chess. We found records that did not appear to be accurate. For instance we found that medication had been signed for as given to a resident when on the previous day a different member of staff had indicated that this medication had run out. Neither staff member had re-ordered the medication. We found that one of the nursing staff was going to order it on the day of the inspection. She was not making this an urgent issue and it would take 48 hours for the Pharmacy to deliver it. The management of the home did not pick up these mistakes and practices. The home must have processes in place to pick up mistakes and poor record keeping. Medication records must be filled out appropriately.

CARE HOMES FOR OLDER PEOPLE River Court Residential And Nursing Home Explorer Drive Watford Hertfordshire WD18 6TQ Lead Inspector Marian Byrne Unannounced Inspection 5th November 2008 09:00 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 River Court Residential And Nursing Home DS0000019511.V372974.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. River Court Residential And Nursing Home DS0000019511.V372974.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service River Court Residential And Nursing Home Address Explorer Drive Watford Hertfordshire WD18 6TQ 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) 01923 800178 01923 230 891 kanes@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Ltd Manager post vacant Care Home 120 Category(ies) of Dementia - over 65 years of age (60), Old age, registration, with number not falling within any other category (60) of places River Court Residential And Nursing Home DS0000019511.V372974.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. This home may accommodate (in Gade House) 30 older people with dementia who require personal care. This home may accommodate (in Colne House) 30 older people who require personal care. This home may accommodate (in Chess house) 30 older people who require nursing care. This home may accommodate (in Hampermill House) 30 older people with dementia who require nursing care. 14th December 2007 Date of last inspection Brief Description of the Service: Rivercourt Residential and Nursing home is a purpose-built care home owned by BUPA Care Homes Limited. It is situated in a residential area close to the town of Watford. There are local shops and transport facilities nearby. The home is registered for 120 residents in the Old Age category, some of whom may require nursing or dementia care. The buildings are set around a central courtyard with parking facilities. Facing the entrance to the courtyard is the central administrative office block; The main kitchen, laundry and hairdressing facilities are in the administrative block. The Residential Units are to the right and the Nursing Units are to the left of the courtyard. Each building has 2 floors served by a lift. The home may accommodate 30 residents who require residential care (Colne House on the first floor), 30 residents with dementia (Gade House on the ground floor), 30 residents who require nursing (Chess House on the first floor) and 30 residents who require nursing and dementia care (Hampermill House). All bedrooms have en-suite toilet facilities and they are all of single occupancy. The surrounding grounds have mature trees and gardens with seating. The grounds are wheelchair-accessible. Further information including fees can be obtained from the Statement of Purpose and the Service User Guide. A copy of the CSCI inspection report should be available in the care home. River Court Residential And Nursing Home DS0000019511.V372974.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is no star. This means people who use the service experience poor quality outcomes. Two inspectors spent one day inspecting Rivercourt. As part of the inspection we conducted a two-hour observation. We call this a Short Observation Framework for Inspection (SOFI). This was conducted on Chess unit. The focus of the observation is to look at what life is like for the people who use the service and the interaction them and staff. We visited all the four units but most of the inspection was carried out on Hampermill and Chess. We chose Hampermill and Chess because the most vulnerable people in the home are cared for on these units. The Manager of the home completed and returned an Annual Quality Assurance Assessment of the home. This is a legal document we use to gather information on how the home sees its own performance focusing on outcomes for service users. We inspected records this included medication records known as MAR charts, care plans and staffing records. No surveys were returned in time to be included in this inspection. Any subsequent information returned to us will be used in planning the next visit to this service. What the service does well: The care of people on three of the four units was good. However, we had concerns about the care of people on Chess unit. In Hampermill where people who have the highest needs we observed the care to be good. We watched staff provide care and comfort to the people who live there. For example we observed one person get very upset. We saw staff sit with them and hold their hand until they were calm. This happened several times during the morning we observed. People were engaged in gentle activities and staff were observed to smile at the residents and include them in the activities on the unit. During the time we were there all the residents had one to one time with staff. On the other two units Gade and Colne we were aware that staff offered kindness to the people who lived there. The care staff on Chess appeared to be kind but lacked direction on the delivery of good care. The good practice we observed must be spread to the rest of the home. River Court Residential And Nursing Home DS0000019511.V372974.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. River Court Residential And Nursing Home DS0000019511.V372974.R01.S.doc Version 5.2 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 River Court Residential And Nursing Home DS0000019511.V372974.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be confident that the home can support them as an accurate assessment of their needs has been carried out. EVIDENCE: Appropriate information regarding the service is included in the Statement of Purpose and service User Guide. This has been recently reviewed. The records we inspected showed us that a full assessment of needs is carried out prior to the resident being admitted to the home. This assessment is ongoing and is reviewed at six weeks. Where possible the resident or their relatives (or representatives) are involved in the process. River Court Residential And Nursing Home DS0000019511.V372974.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Some people living in this home receive the care they need and are treated with dignity and respect at all times. Some people cannot be sure that they will get their prescribed medication or that records of their medication will be accurate. This means that that their health may be adversely affected. EVIDENCE: The people who live in the Hampermill Unit have their needs met. Their care is delivered in a manner that recognises their personalities and staff were able to encourage communication. They took their time and gave residents a chance to think and respond and did not rush them in any way. There was no television on, music was playing and staff were aware of the music and if the residents appeared to find it too loud it was turned down. In Chess where the River Court Residential And Nursing Home DS0000019511.V372974.R01.S.doc Version 5.2 Page 10 SOFI observation was carried out an inspector sat in the sitting room for two hours trying to get a feeling for what is was like for the residents who live in the home. We saw that care provided was task led rather than person centred. Interaction with service users was limited to responding only to tasks for example taking people to the toilet. Whereas on other units excellent interaction was observed between staff and the people that they care for. This would seem to indicate that the staff on Chess Unit lack direction and leadership from the qualified staff on this unit. See comments in Daily Life and Social Activities. Care plans throughout the home were of a good standard, were person centred and if followed would provide very good care. We found the administration and recording of medication on Chess Unit to be inaccurate. We found that due regard was not paid to ensuring the residents were given their prescribed medication. We found this practice to put people at risk and this has also been dealt with under Complaints and Protection. We found one person who had recently been admitted to the Chess Unit had run out of their medication. We found that a staff member had signed that the person had taken it when they had no medication. We found that a staff member had signed to indicate that the medication had run out but had not ordered any more. On the day of the inspection one of the nursing staff was re-ordering this person’s medicines but when we asked how long it would take we were told about 48 hours. They showed no concern for this and when asked if it could be obtained sooner we were told no that how long it takes. It must be noted that when we brought this to the Manager’s attention it was deal with straight away and had arrived before we left the premises. Medication was not being signed as being offered to the resident on when it happened as we observed a staff member filling in the lunchtime medication charts at 14.30 for medication given earlier in the day. When we asked what she was doing she told us that she was checking that there were no mistakes. We then looked at the charts we saw that they were not filled in for the lunchtime medication except for people who lived in rooms one to nine. Therefore the residents were either not given their lunchtime medication or the records were not filled in appropriately. The medication records should be filled in individually at the time the resident is offered their medication then staff must record whether they take it or if they refuse it. If medication is refused this should be appropriately recorded. This practice takes away from the right of the person to be offered medication for their health and the right to be cared for appropriately with dignity and respect. River Court Residential And Nursing Home DS0000019511.V372974.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most of the people who live in this home have will find that their expectations will be met. Visitors are welcomed at all reasonable times. Good quality food is available throughout the day and night to meet people’s needs. EVIDENCE: We found differences in how people were cared for from very well to the incidents with medication. People who are not offered their medication at times prescribed may have control of their lives taken from them. Most of the people we observed have opportunities to live their lives as they choose, staff are aware of people’s needs and abilities. Most staff were observed to be proactive in ensuring people were not left alone and isolated. We saw staff offer comfort to people who were distressed. On the unit where we did the SOFI observation we found that the way staff delivered care was task led. By this we mean that they were more focused on carrying out the tasks they had to do, than on the mood or the effect they were having on the person they were River Court Residential And Nursing Home DS0000019511.V372974.R01.S.doc Version 5.2 Page 12 caring for. An example of this was one person was watching television prior to being taken out of the room when they were returned to the room they told staff that they wanted to watch television However, they were put in a chair where they could not see the television. People were offered drinks but not encouraged to drink them. We saw staff walk on to the floor and not speak to any of the residents or to acknowledge them in any way. We observed staff speak to each other in a very loud voice without any regard for the residents or their visitors. In Hampermill where people with dementia are cared for we observed staff ensuring all people were attended to, were offered occupation and comfort. We observed staff stay with one person who was distressed until they were calm. This happened three times while we were there on one occasion a staff member held their hand for 25 minutes until they were calm. On the day of the inspection there was a constant stream of visitors to the home. People had access to food and snacks at all times. A new menu system has been implemented. Food observed provided to people was of a high standard. The menu is also in picture format so that all people are able to access the choices available to them. River Court Residential And Nursing Home DS0000019511.V372974.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Due to some of the care practices we observed some people who live in this home are not always protected from abuse. People who use the service can be confident that complaints are taken seriously and are investigated. EVIDENCE: Complaints were taken seriously and dealt with according to the services own procedures. We are appropriately informed of any complaints and any action subsequently taken. We saw that there were a number of compliments on file. Safeguarding training has been provided to all staff and staff spoken to be aware of the safeguarding procedures. However, as stated earlier we found that some of the people who live in the home cannot be guaranteed that medication that has been prescribed for their health will be offered to them, which leaves them at risk. We found one person who had recently been admitted to the Chess Unit had run out of medication. We found that a staff member had signed that the person had taken it when they had no medication. We found that a staff member had signed to indicate that the medication had run out but had not ordered any more. This could lead to a serious breakdown River Court Residential And Nursing Home DS0000019511.V372974.R01.S.doc Version 5.2 Page 14 in people’s health where prescribed medication is not administered. Medication was not being signed as being offered to the resident on when it happened we found a staff member filling in the lunchtime medication charts at 14.30 for medication given earlier in the day. The Manager was made aware of the situation and took immediate action. River Court Residential And Nursing Home DS0000019511.V372974.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in this home can be sure that the home is well maintained, clean and fresh and meets their needs. EVIDENCE: The home had recently been re-furbished and the different units were bright, clean and hygienic. The home is offers safe accommodation to the people who live there. Communal rooms are set out in a manner that allows people to pursue different social engagements and entertainment. A new sensory room has recently opened in the area where the people who have the highest needs. River Court Residential And Nursing Home DS0000019511.V372974.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most of the people who live in this home are looked after by staff who are well trained and experienced, all staff members were recruited appropriately which ensures vulnerable people are kept safe. There were sufficient staff members on duty to meet the needs of the residents. EVIDENCE: With the exception of some staff where examples were given earlier in this report we found the staff to be well trained and dedicated. We observed staff provide care with kindness and affection to the residents. It was clear that staff understood the needs of the residents and were able to offer re-assurance to residents when needed and were able to offer them useful occupation. We observed staff ensure the residents had objects that they take comfort from holding. However, the SOFI observation on Chess Unit indicates that staff although kind and caring, lack leadership and direction from the qualified staff on this unit. River Court Residential And Nursing Home DS0000019511.V372974.R01.S.doc Version 5.2 Page 17 Staff are trained in all aspects of service delivery. We looked at the training records of the staff that were responsible for the administration of medication all had attended training in the past year. We looked at the staffing files of the most recently recruited staff they contained all the appropriate paperwork. This includes two written references, a security check and a Criminal Records Bureau clearance. River Court Residential And Nursing Home DS0000019511.V372974.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most of the people who live in this home can be assured that the home is run in their best interests and that their health and safety is promoted. EVIDENCE: The Manger and staff have worked hard to ensure that the people who live in this home have a good quality of life. With the exception of the one unit of the home people are well looked after. However the way medication is administered and recorded has put the residents who live there at risk. We left an immediate requirement to ensure the safety of the residents. The resident who was without medication had their medication delivered before we left the premises and the staff involved were identified and the disciplinary procedure followed. However, this medication error was easy to spot and the qualified River Court Residential And Nursing Home DS0000019511.V372974.R01.S.doc Version 5.2 Page 19 nurse responsible showed no urgency is ensuring the resident got their medication as soon as it was discovered that they had run out. This shows lack of regard for the individual and their health and welfare. The management of the home did not have robust procedures in place to ensure that any medication errors would be picked up. At the last inspection we found that the medication was not recorded appropriately. This requirement was therefore also not met at this inspection. The home had a timescale of 14th January 2008 to meet the requirement otherwise enforcement action will be taken. The Manager has been in post for approximately 18 months and at the time of the inspection had tendered her resignation. She managed River Court through a very difficult period including a time where six members of staff were dismissed for poor performance. The management of this very large home had not had stable management for some years, this is an area that must be explored and addressed by BUPA to ensure the welfare of the people who live there and that future managers of the service are supported in achieving the services aims and objectives. The home does not take responsibility for any resident’s money. River Court Residential And Nursing Home DS0000019511.V372974.R01.S.doc Version 5.2 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. 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 X X 3 X X x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 1 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X X X X 3 River Court Residential And Nursing Home DS0000019511.V372974.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? NO 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 OP9 OP8 OP14 Regulation 13(2) Requirement To ensure the safety of service users any medication prescribed for the residents must be available to them. They must be offered their medication in a timely manner and as prescribed by their GP. Accurate records must be kept of medication offered and medication taken. An immediate requirement was left on this. To ensure that the continued welfare of the service users the home, robust processes must be in place that will highlight any areas of potential harm or neglect to the residents. Timescale for action 05/11/08 2. OP18 OP10 OP33 12(1)(a) 31/12/08 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 River Court Residential And Nursing Home DS0000019511.V372974.R01.S.doc Version 5.2 Page 22 River Court Residential And Nursing Home DS0000019511.V372974.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI River Court Residential And Nursing Home DS0000019511.V372974.R01.S.doc Version 5.2 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!