Inspection on 06/06/07 for Ruckland Court Care Home

This inspection was carried out on 6th June 2007.

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

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

Other inspections for this house

Ruckland Court Care Home 14/12/05

Ruckland Court Care Home 05/09/05

Ruckland Court Care Home 23/02/05

Ruckland Court Care Home 09/09/04

Ruckland Court Care Home 11/03/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Ruckland Court Care Home Ruckland Avenue Lincoln Lincs LN1 3TP Lead Inspector Ken Hague Unannounced Inspection 6th June 2007 08:30 am X10015.doc Version 1.40 Page 1 X10015.doc Version 1.40 Page 2 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 Ruckland Court Care Home DS0000002550.V339225.R01.S.doc Version 5.2 Page 3 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. Ruckland Court Care Home DS0000002550.V339225.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Name of service Ruckland Court Care Home Address Ruckland Avenue Lincoln Lincs LN1 3TP 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) 01522 530217 01522 513371 enquiries@lacehousing.org LACE Housing Limited Mrs P Shuck Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (49), Physical disability (1) of places Ruckland Court Care Home DS0000002550.V339225.R01.S.doc Version 5.2 Page 5 SERVICE INFORMATION Conditions of registration: 1. 2. Any service user admitted within the category of Physical Disability (PD) shall be between the ages of 50 and 64 years inclusive. The home is registered to provide personal care for service users of both sexes whose primary needs fall within the following categories:Old Age, not falling within any other category (OP) - 49 Physical Disability, age 50 to 64 years inclusive (PD) - 1 The maximum number of service users to be accommodated at any one time is 50. 11th May 2006 3. Date of last inspection Brief Description of the Service: Ruckland Court is a purpose-built establishment. It provides personal care for older people over the age of 65 years. It is owned by a voluntary organisation, LACE Housing, and the day-to-day running of the home is organised by a Registered Manager, Pat Schuck. The home is located in a residential area to the north of the City of Lincoln. The city’s amenities can be reached by car or bus. Accommodation for service users comprises mainly of single occupancy flats. Single flats usually contain a bed, sitting room, kitchenette, shower and toilet, although there are 8 single occupancy flats with a separate bedroom. There are 6 double flats; these are usually allocated to married couples or relatives who may choose to share. The double flats have similar accommodation and a separate lounge. Each flat has a lockable front door with a letterbox. Newspapers, mail and groceries are delivered directly to each flat. The home has communal dining areas and lounges for service users to use if they wish to. The dining room is a shared facility with day centre attendees. Service users from the home can also choose to attend the day centre if they wish. There is a small shop and hairdressing salon on-site. The home is surrounded by gardens and there is a central courtyard area with raised flowerbeds and seating for service users to use and enjoy, weather permitting. There are designated car parking spaces available at the front of the property. The home charges £373 to £419 per week. The care home has a statement of purpose and service users guide which sets out the resources of the home and the facilities offered to residents These documents are shown to all visitors who are considering coming to stay in the home. Ruckland Court Care Home DS0000002550.V339225.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 6.5 hours. The registered manager was provided with feedback at the end of the inspection. The main method of inspection used was called ‘case tracking’ which involved selecting three residents and tracking the care they receive through the checking of their records, discussion with them and the staff, and where more appropriate observation of interaction between staff and residents and related care practices. A sample of care records was inspected. Two members of staff were interviewed and the opinions of four residents were sought. A Pre-inspection questionnaire was supplied prior to the site visit being made. In addition 31 “have your say” documents completed by residents were sent to the Commission for Social Care Inspection. This document asks 12 questions and invited residents to make comments regarding the care they receive from the home. The feedback and comments from the ”Have your say documents” is included within this inspection report. The inspector had lunch with the residents during the site visit. What the service does well: The home provides a comfortable, safe and homely environment for people to live in. The care home is very well managed. Residents have detailed care plans, which enables staff to know how residents needs are to be met. Regular residents meetings and care reviews are held where residents comment on the services provided by the home. Staff respect the privacy and dignity of residents. Staff are well trained and supported by the registered manager and have a sound knowledge of residents needs. The staff team work well together and have established a good working relationship with the community health care teams and local GPs. Ruckland Court Care Home DS0000002550.V339225.R01.S.doc Version 5.2 Page 7 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. Ruckland Court Care Home DS0000002550.V339225.R01.S.doc Version 5.2 Page 8 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 Ruckland Court Care Home DS0000002550.V339225.R01.S.doc Version 5.2 Page 9 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): Standard 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service have good information about the home in order to make an informed decision about whether the service is right for them. The personalised needs assessment means that people’s diverse needs are identified and planned for before they move to the home. The home does not offer at this time a dedicated intermediate care EVIDENCE: The files of three new residents were examined as part of the case tracking process. They all contained a full assessment including a risk assessment for each individual resident caried out prior to their addminsion to the home. The assessments set out the care needs, social needs and health needs of each individual resident. Residents confirmed that they have been involved in the writing of their initial assessment. The members ofstaff interviewed stated assessments are always carried out prior to residents admission. Ruckland Court Care Home DS0000002550.V339225.R01.S.doc Version 5.2 Page 10 The three Residents being case tracked all stated that they received an assessments prior to being admitted to the home. Residents stated that their families had also contributed to the assessment and resulting care plan. The registered manager stated that an individual copy of the service users guide is given to all new residents when addmitted to the home. The statement of purpose for the home is displayed in the main reception area. Additional information to enable the residents to make an informed choice regarding coming to stay at home is provided by lace housing. Residents confirmed that they have been sent an individual letter stating that their assessed needs could be met by the resources of the care home. The registered manager confirmed a dedicated intermediate care services are not been provided by the home. Ruckland Court Care Home DS0000002550.V339225.R01.S.doc Version 5.2 Page 11 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): Standards 7,8,9 ,10 &11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans identify all areas of need and provide detailed care instructions for staff; this enables staff to provide appropriate care. Residents’ health needs will be met. EVIDENCE: Three individual resident’s care plans were inspected. They all contained a care plan signed by the assessors the resident. Care plans were dated and evidence found that they are being form the reviewed on a monthly basis with the resident to ensure their needs are always met. Care plans sets out the methods of providing safe care to each resident. Where a risk had been identified the management of the risk has been balanced against the choices and wishes of the individual resident. Ruckland Court Care Home DS0000002550.V339225.R01.S.doc Version 5.2 Page 12 Care records contained the resident’s choices of activities, health care needs, personal care needs and dietary needs. Medical history was recorded. The input from community health care services, chiropodist, dental care and eye care were recorded on each care plan. Staff have been trained by an outside agencies in the administration and storage of medication. Medication records had been completed in accordance with the national guidelines. Drugs are being stored correctly. Staff and the registered manager stated that residents can self medicate if they request to do so and a risk assessment confirmed that this would be safe practice. One of the three residents being case tracked were self-medicating. An appropriate risk assessment was on their individual file. The registered manager confirmed that the boots pharmacist visits on a regular basis to give advice and to monitor the medication practice of the care home. Information from the” have your say documents” completed by residents and discussion with residents and staff provided evidence that the rights of residents are respected and their privacy and dignity is upheld. Observations on the day of the site visit supported this judgement. Staff were observed to seek permission to enter residents flats. They were overheard offering choices to residents discuss in choices close and meals. The residents the case tracked stated the care was provided in the sensitive manner and that staff enable them to keep the independence as far as possible take into account their own abilities. One resident stated “staff are very kind you couldnt find a better home than this”. The care records for a resident who was registered blind described their choice and wishes, which must be considered when personal care was provided. This resident confirm that their wishes and choices are set out in their care plan. Residents live in separate flats. They all have there own front door and letterbox. External doors are fitted with a bell push which staff use to gain access. The action to be taken in the event of the death of the residents was recorded on individual care plans. Ruckland Court Care Home DS0000002550.V339225.R01.S.doc Version 5.2 Page 13 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): Standards 12,13,14 &15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are enough suitable activities provided for residents that are in accordance with their needs and wishes. They receive a healthy and balanced diet that is based on their likes and dislikes. They are able to control their lives as much as they are able. EVIDENCE: The registered manager listed, in the Pre inspection questionnaire, a number of activities offered to residents including opportunities to take part in events in the community. Have your say documents provided evidence of activities take place. Residents were of served to be taking part in activities during the day the site visit this included in some attending the adjacent Day Centre. Individual care record stated the choice of activities of each individual resident. The home provides religious services for residents who wish to take part and pursue their individual religious beliefs A number of residents were taking part in a communion service on the day the site visit. Ruckland Court Care Home DS0000002550.V339225.R01.S.doc Version 5.2 Page 14 Staff stated that the care home has a visiting policy, which is flexible to meet the choices and wishes of the residents. Residents confirm that family and friends are made welcome when they visit. Relatives are encouraged to visit at any reasonable hour. The visiting policy is displayed in the care home. A resident stated “my family live outside Lincoln but like visiting and me at the care home. They tell me staff make them feel welcome. In their opinion I could not be in a better place.” The choices and wishes of residents in respect of their social life and in the provision of personal care was found to be recorded on their individual files. Residents choose which chiropodist, hairdressers and optician they use. They stated in discussions that they felt able to decide what activity they took part in and if appropriate not to take part in activities. The registered manager stated there is no optician was due to visit the home in the next two weeks. An internal audit conducted by Lace Housing in April 2007 provided evidence that chiropody has been discussed at the last residents meeting. Residents are asking for more frequent visits at present they visit every six weeks. This request is to be addressed by the care home. The registered manager sent a copy of the menu prior to the site visit this demonstrated that choice was being offered. The inspector observed staff asking residents at lunchtime what choice of meal they required. The dietary needs of individual residents, were found to be recorded on their care plan. The “have Your say” documents presented a mixed picture. The majority of residents were happy with the choice and quality of food being provided. Nine residents surveys stated that they were sometimes happy with the food. In formal discussions with staff they acknowledge that some residents would grumble occasionally regarding the choice of food. However staff felt that the choice and quality of food was good. The three residents being case tracked all stated they were delighted and satisfied with the choice and quality of food being provided. The inspector shared lunch with the residents on the day of the site visit. The food was well presented and of good quality. Ruckland Court Care Home DS0000002550.V339225.R01.S.doc Version 5.2 Page 15 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): Standards 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home listens to resident’s concerns and acts on them. There are procedures in place to protect residents from any possible abuse. Staff have received appropriate training to protect residents from being harmed. Residents feel they live in a safe environment. EVIDENCE: Staff were aware of the home’s and Lincolnshire County Council’s Adult Protection procedures. They also demonstrated a clear understanding of what the key issues are. They confirmed that they would not hesitate to report any concerns. Two members of staff were presented with two scenarios where abuse may have taken place. Both members of staff were able to describe the correct action is to be taken to protect residents and report the incident. Residents spoken to confirmed that they knew how make a complaint on would feel confident approach in any member of staff of management. The complaints policy is on display in the entrance hall and residents have their own personal copy in the service user guide. The Commission for Social Care Inspection has received no complaints since the last key inspection. No adult protection investigation has been carried out in the home since the last key inspection. Ruckland Court Care Home DS0000002550.V339225.R01.S.doc Version 5.2 Page 16 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): Standards 19 & 26 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The ongoing maintenance program ensures that the care home offers a comfortable environment for residents. The up-to-date infection control policy is followed and maintains a safe environment. EVIDENCE: The home is very well maintained, decorated to a high standard and clean throughout. The registered manager stated that a refurbishment programme had been completed since the last inspection. A new a fire alarm system has been installed. All corridors have been redecorated and new carpets fitted. New curtains have been fitted to all corridor windows. Residents have picked new pictures and plants to be fitted in corridor areas. Ruckland Court Care Home DS0000002550.V339225.R01.S.doc Version 5.2 Page 17 All lounges and have been redecorated and refurbished including curtains, carpets and chairs and tables. The registered manager stated that the residents have decided and indicated what colour scheme they would like within their home prior to the redecoration. The area outside the home is also well maintained and safe. Residents are encouraged to bring possessions into their rooms and to make them homely. Each room is individually furnished, and residents stated that they were fully supported to use their rooms safely and in the way they wished. There are enough bathrooms and toilets to meet the needs of the residents and appropriately serviced equipment is in place to support resident’s physical needs as appropriate. Staff confirmed they regard the needs and safety of residents as central to their role. The staff interviewed confirmed that fire alarms are tested weekly, and were able to describe the appropriate action they would take in order to maintain residents and staff safety in the event of a fire. They confirmed a fire drill had been carried out recently All areas of the home were clean and smelt fresh. Discussions with staff members and the deputy managers identified no health or safety or infection. The residents stated that they are very happy with the facilities mean provided by the Company. One resident described it as “a home from home”. Ruckland Court Care Home DS0000002550.V339225.R01.S.doc Version 5.2 Page 18 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): Standards 27.28.29 & 30 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Well-trained staff supports residents. The manager follows a robust recruitment policy which protects residents. EVIDENCE: Staff stated there are always sufficient numbers on duty to answer the needs of all residents. The manager stated that staffing levels are constantly reviewed to ensure resident’s needs are met by the numbers of staff on duty. Residents confirmed that they were happy with the present staffing levels. They stated that requests for help using the call bell are answered quickly. A resident stated “when I ring the call bell staff do come to help me I don’t have to wait.” There are comments in the” have your say” documents which give further evidence that staff respond quickly to any request for help. The registered manager stated that have been immense improvements made to staff training since the last inspection. A member of staff has now been appointed to act as training coordinator. Ruckland Court Care Home DS0000002550.V339225.R01.S.doc Version 5.2 Page 19 This has resulted in the registered manager and training coordinator being able to identify training needs from supervision and appraisals and match individual needs to a new training resources. The Database has been set up to enable a wider range of external training resources to be identified. The home now has 60 of its care staff who hold an NVQ two or equivalent in care. The national target is 50 . The present training coordinator is to complete the registered managers award which again will increase training resources for the care home. The registered manager stated that staff are now very enthusiastic about training. Staff informal discussions did talk about the training needs and the courses they have taken to date in an unenthusiastic manner. Staff interview stated “this is a nice home to work in, we feel valued and supported. Teamwork is good staff morale is high”. Three Residents spoken to during the site visit stated that they feel safe living in the care home. Staff stated they felt residents are in safe hands at all times. Care records inform staff how to meet individual residents needs safely. The registered manager stated that the recruitment policy of the home is being followed at all times. The inspection of the recruitment records for two new member of staff confirmed this to the case. All appropriate documentation was on the individual staff member’s files. This included POVA, CRB, references and proof of identity. Ruckland Court Care Home DS0000002550.V339225.R01.S.doc Version 5.2 Page 20 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): Standards 31,33,35 & 38Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are provided with leadership and guidance from the registered manager ensuring that residents needs are met. The home’s up to date health and safety policy and infection control policy is being followed which ensure a safe environment is maintained. EVIDENCE: The care home has an experienced registered manager. Staff stated that she is approachable; residents described her as a very caring professional person. There are financial procedures in place to ensure that residents financial interested are safeguarded and protected. No health and safety issues were identified. The care home was found to be clean and tidy. Ruckland Court Care Home DS0000002550.V339225.R01.S.doc Version 5.2 Page 21 Staff were seen to treat with residents with courtesy and respect. No negative evidence was found for these standards in any discussions or documents. Ruckland Court Care Home DS0000002550.V339225.R01.S.doc Version 5.2 Page 22 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 3 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 16 17 18 Score 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 3 X 3 Ruckland Court Care Home DS0000002550.V339225.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action 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 Ruckland Court Care Home DS0000002550.V339225.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Ruckland Court Care Home DS0000002550.V339225.R01.S.doc Version 5.2 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!