Inspection on 11/12/08 for Rowland House

This inspection was carried out on 11th December 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rowland House 24/01/07

Rowland House 21/07/05

Rowland House 03/05/05

Rowland House 14/09/04

Rowland House 10/06/04

Similar services:

Thorndene

Sutton Lodge Nursing Home

Wingham Court

Bethany Lodge

17 John Street

Red Oaks

Clare House Nursing Home

Broad Oak Manor Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Rowland House 1a Lime Tree Avenue Weston Green Thames Ditton Surrey KT7 0NY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lesley Garrett     Date: 1 1 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Rowland House 1a Lime Tree Avenue Weston Green Thames Ditton Surrey KT7 0NY 02089729143 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Titleworth ltd care home 7 Number of places (if applicable): Under 65 Over 65 0 physical disability Additional conditions: 7 The maximum number of service users to be accommodated is 7. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability (PD) Date of last inspection Brief description of the care home Rowland House is set in a residential area of Surrey. The house has recently extended its accomodation and facilities to provide care for six residents with physical difficulties. The accomodation is adapted to support people who use wheelchairs. The home has a lift to all three floors. The lower floor contains a physiotherapy and fitness centre. The home has an extensivly landscaped rear garden that is purpose built for wheelchairs and is a prominent feature to the home. Each resident has their own bedroom three of which are en suite. The communal areas are spacious and bright and well decorated. Care Homes for Adults (18-65 years) Page 4 of 28 Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection of the care home was an unannounced Key Inspection. Mrs L Garrett, Regulation Inspector, carried out the inspection and the newly appointed manager represented the service. This was only the second day of employment for the manager so she was assisted by the rehabilitation manager and the occupational therapist. The provider arrived at the home in time for the feedback session at the end of the inspection day. The inspector arrived at the service at 10:00 and was in the home for six and a half hours. It was a look at how well the home is doing. It took into account information provided by the home and any information that CSCI has received about the service since the last inspection in January 2007. We looked at how well the service was meeting the key national minimum standards Care Homes for Adults (18-65 years) Page 6 of 28 and complying with the regulations and has in this report made judgements about the standard of the service. Documents sampled during the inspection included the homes care plans,risk assessments, daily records and some policies and procedure. The Annual Quality Assurance Assessmet (AQAA) was given to us during the inspection as it had been received by the home a month following posting. The responsible individual for the service had notified CSCI of the delay. From the evidence seen by the inspector and comments received, the inspector considers that the home would be able to provide a service to meet the needs of individuals who have diverse religious, racial or cultural needs. No complainant has contacted the commission with any complaints about the service. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People wishing to use the service have their needs assessed prior to admission to ensure the service can meet their needs. Evidence: The staff told us that pre-admission assessments are carried out by the homes occupational therapist and one other person with acquired brain injury knowledge. The homes provider joined the inspection toward the end of the day and stated that he to does some assessments. It was stated that people wishing to use the service are encouraged to visit the service prior to admission if this is possible. The provider said that part of the conditions of admission is for the people to agree to the rehabilitation package on offer which includes physiotherapy and occupational therapy. This is included in the contract. One care plan was sampled for the person most recently admitted to the home in October. There was no pre-admission assessment in place. Later in the inspection the provider organised for the assessment to be e-mailed from head office. The care plans Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: did not contain any individualised care plans or risk assessments. The only information available was the discharge plans from the hospital. The staff explained the the admission process takes a long time and that staff are continually assessing. For the well being of the people who use the service some care plans and risk assessments should be in place soon after admission to allow staff to adequately care for the individuals.A requirement will be made at the end of the report that pre-admission assessments must be kept at the home in the individuals care plan so that staff have access to them at all times. The statement of purpose was available at the home but had not been reviewed since September 2006 but no service user guide was available for prospective people wishing to use the service. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service have care plans and brief risk assessments in place but the information is stored in a variety of places taking some time to gather all of this information. Evidence: Two care plans were sampled. One care plan belonged to the most recent admission to the home. This did not contain current information about the person using the service including individualised care plans and risk assessments. Staff were using the discharge plans that they had received from the hospital. The staff that were helping with the inspection stated that gathering information about each individual took time and they were in the process of writing the plans. Staff assisting with the inspection agreed that information about each person using the service was kept in many places. The newly appointed manger said that she would focus on this area to ensure that the care plans and risk assessments are kept in one folder. It will be a requirement at the end of the report for the manager and staff to review all the care plans to ensure that Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: the information held for each individual is relevant and accessible by staff and people using the service. The other folder sampled contained care plans and risk assessments. The risk assessments were very basic and did not identify what the actual risk was. The provider stated that the paper work had recently changed and he was not familiar with the new format. Information available for each person using the service was available in different folders and it was discussed with the staff that old information should be archived so that each folder contained the most recent information. Gathering all of the information about each individual took time as they were contained in a variety of folders. The staff said that the care plans are currently under review with a plan to change the current system in the home. All care plans had been agreed with the person using the service and signed. Support plans are reviewed every ten to twelve weeks following the review. The reviews that take place are held with the person using the service and a member of staff and could also include a family member, care manager and lawyer. People who use the service are consulted about decisions they make. Care plans and risk assessments are in place to demonstrate this. The rehabilitation manager stated that the home used to hold weekly house meetings but that the people using the service had requested that they meet when there is an issue to discuss. The rehabilitation manager stated that the people using the service also have opportunities to sit with staff on a one to one basis to discuss issues personal to them. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are supported to make choices about their lifestyle and their recreational activities. Evidence: On the day of inspection the people who use the service were all up and dressed and ready to participate in the planned activities for the day. Two individuals were in the lounge discussing their plans for the day and another was beginning their physiotherapy session. The staff explained that one person using the service attends work experience weekly with the assistance of the staff. Staff also said that they try to help the people using the service to do activities that they were interested in prior to their accident. Staff said that the people were often reluctant as this activity now had to be undertaken whist in a wheelchair. Most people at the service talk about what Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: they will do when they no longer need the wheelchair. There is a planned activity rota on the wall for staff and people using the service to refer to. There is also reference to activities in their individual plans of care.People who use the service are assisted to visit the local shops, cinema, pubs and restaurants. River trips have taken place during the summer and they are also assisted to attend the local church on Sundays for those that wish to do this. Staff said that one person using the service went home for a holiday in the summer which was successful. Family and friends are welcome at the home at any time and all people using the service have this support. A detailed care plan was in place for one particular person agreeing how some visits by a friend takes place and where. These had been signed and agreed by all parties and placed in the individual plan of care. People using the service also have access to the e-mail facility to enable them to keep in contact with long distance family members. During the inspection we observed that staff spoke courteously to all people using the service and that the home had a relaxed atmosphere with people talking with staff freely and openly. Staff were observed to respect the individuals privacy and dignity and knocked on bedroom doors prior to entering and addressing the people who use the service by their preferred name. People using the service are offered a health well balanced diet. Staff explained that the emphasis was on healthy eating as the purpose of their stay at the home was for rehabilitation. It makes rehabilitation very difficult if the people who use the service gain large amounts of weight. The AQAA states that the home has received help from the community dietitian to aid with healthy meal choices and the company has employed the services of a dietitian/nutritionist who is available for advice when necessary. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All people using the service receive support for their personal care needs and the home ensures that each individual has access to healthcare support when required. Evidence: Care plans sampled showed that care is delivered at flexible times according to the needs of the people using the service. It was not clear from the plans sampled how each person using the service would be supported by staff for washing , dressing or taking a shower. The care plans sampled were not person centered and did not contain information about each persons preferences with regard to personal care. The staff spoken to on the day understood the areas that were to be addressed and that new care plans were in the process of being written. It was documented in the care plans the gender preferences regarding the receiving of personal care for each person using the service. All of the people using the service are registered with a local general practitioner (GP). They are able to visit the surgery for routine healthcare check ups and screenings when required. The home also has access to the continence promotion service, nursing Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: services within the company and the district nurses. The dentist and optician also visit the home regularly for those people who require this facility. All people who use the service have access to a neuro physiotherapy programme. The completed AQAA states that better provision has been made for the delivery of neuro psychology and psychiatry services when required by the people using the service. Medication is supplied to the home by a large pharmacy group. All medications required in an emergency are supplied by the local chemist. The AQAA states that during the last year the home has improved their medication management system and all staff have now received training and the pharmacy complete medication audits every six months. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be confident that their complaints would be listend to and that they are protected from abuse. Evidence: The home has a complaints policy and all people using the service and their family or representaives have access to it. The policy was dated August 2004 and a discussion took place with the provider as to the need to update this policy and to change the address of CSCI to the current one. The staff assisting with the inspection said that the home has received no complaints this year. The AQAA said that people using the service had contacted head office directly with any of their concerns for the period when the home had no manager. These concerns or comments have not been documented in the home in their complaints log. The home has a copy of the local authoritys safeguarding procedures. Records confirmed that all staff have received training and staff were knowledgeable about these procedures. The AQAA confirmed that during the last year the home has had one referral under the safeguarding procedures and that this matter has now been resolved. Care Homes for Adults (18-65 years) Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides a safe, well-maintained, comfortable environment for the people using the service to live in. Evidence: The homes premises are suitable for its stated purpose with good communal areas inside and out. The staff showed us the recently completed basement area which houses a gym which the physiotherapist uses when delivering rehabilitation sessions. There is also a lounge area with wall mounted television and sofas. The basement has access to a patio area of the garden with seating available. All areas of the home are accessible to wheelchair users and the people using the service also have the use of a lift. All bedrooms are personalised and the AQAA states that new people wishing to use the service are able to choose their own colour schemes prior to moving into their new bedroom. Recent refurbishment at the home has included an outside laundry area. The staff said that this was to enable people who use the service to participate in their own washing. The laundry area was very cluttered and was not accessible for people using Care Homes for Adults (18-65 years) Page 19 of 28 Evidence: wheelchairs on the day of inspection. Staff said that the people using the service had not begun to use the facility yet. New washing macines have been installed which are domestic in nature. There is no facility for a sluice wash and staff have to double handle any soiled or infected linen. Infection control procedures at the home would benefit from a review to ensure that staff and people using the service are protected by the homes washing facilities. On the day of inspection the home was found to be clean and hygenic with hand washing facilities available in the home. Care Homes for Adults (18-65 years) Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A competent and qualified staff team supports the people who use the service and the homes recruitment procedures protect them. Evidence: The home has a stable staff team and this was confirmed by observing the rotas talking to staff and comments seen in the AQAA. The AQAA stated that the home still has some difficulty recruiting permanent night staff but they have an agreement with the agency that they will supply staff familiar with the home to give consistency for the people using the service. Records showed that all staff have achieved their National Vocational Qualification or are in the process of achieveing this qualification. All new staff have an induction programme for the home and are then registered on a nationally recognised induction programme and again records confirmed this. Two employment folders were sampled and these confirmed that all appropriate employment checks are carried out prior to staff commencing their employment with the home. This practice safeguards the people who use the service. Care Homes for Adults (18-65 years) Page 21 of 28 Evidence: Staff confirmed that regular training takes place and this is available for all staff. Records confirmed that fire awareness, food hygiene, safeguarding adults, manual handling and infection control are some of the courses staff have attended. Specialist training is also available that is appropriate for staff to appropriately care for the people who use the service. Care Homes for Adults (18-65 years) Page 22 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service and the staff will benefit from having a permanent manager that has been newly appointed. the home has good links with various agencies to ensure good health and safety practises within the home. Evidence: The provider has recently recruited a new manager for the home and she stated that this was only her second day. She said she had begun the companies induction and had spent some time observing the staff and people who use the service to learn about work practises. She has her NVQ at level four and stated that this was her first post as a registered manager. Previously she had worked as a service manager of a domiciliary care agency. She was being supported by other staff members in the home and the responsible individual for the home.The AQAA states that the manager needs to start her registered managers award and this is being organised. The AQAA states during the last year improvement in the home has been difficult in the absence of a good manager but that the future is important to them to ensure they meet the needs of their residents and staff. Care Homes for Adults (18-65 years) Page 23 of 28 Evidence: Staff stated that the home had not sought the views of people who use the service this year but that questionnaires had been compiled and were about to be sent out. As in other years we were told that when they are returned an action plan will be drawn up to address any issues that have arisen. Regulation 26 visits by the responsible individual should take place unannounced each month. There was only a record of one visit this year. The provider stated that he knew they had taken place and would make sure that the records of the visit is available at the home for inspection. Policies and procedures are in place for health and safety and staff have access to them. The company retains the services of a qualified health and safety officer. The AQAA states the home has good links with the local fire service and has recently reviewed its fire risk assessment policy and procedure. Care Homes for Adults (18-65 years) Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 14 All people who wish to use 07/02/2009 the service must have a preadmission assessment and a copy of the assessment be kept in the individual care plan. All staff have access to this assessment and are then able to keep the document under review and is able to to revise the document if necessary. this ensures all people wishing to use the service receive the appropriate care. 2 6 15 All care plans should be reviewed to ensure that the information that is held in the folders is relevant to the person using the service. All people using the service and or their representatives should have access to care plans that are current and relevant to ensure staff have up to date information about 07/02/2009 Care Homes for Adults (18-65 years) Page 26 of 28 the person to enable them to adequately care for their needs. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 28 of 28 - 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!