Inspection on 06/12/05 for Sandbanks

This inspection was carried out on 6th December 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sandbanks 31/07/06

Sandbanks 21/04/05

Sandbanks 01/11/04

Sandbanks 11/05/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Sandbanks 1 Cacklebury Close Hailsham East Sussex BN27 3LW Lead Inspector Judy Gossedge Unannounced Inspection 6th December 2005 02:30 Sandbanks DS0000042776.V249655.R01.S.doc Version 5.0 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 Sandbanks DS0000042776.V249655.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. Sandbanks DS0000042776.V249655.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Sandbanks Address 1 Cacklebury Close Hailsham East Sussex BN27 3LW 01323 843234 01323 441796 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) East Sussex County Council Vacant Care Home 19 Category(ies) of Learning disability (19) registration, with number of places Sandbanks DS0000042776.V249655.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The maximum number of service users to be accommodated is nineteen (19). Service users must be aged between eighteen (18) and sixty-five (65) years on admission. Service users with a learning disability only to be accommodated. One named service user assessed as requiring nursing care, can use the facilities at Sandbanks to be provided with respite care. 21st April 2005 Date of last inspection Brief Description of the Service: Sandbanks is run by East Sussex County Council (ESCC), and is a purpose built property on two floors, set in its own grounds in Hailsham, about one mile from the town centre. Service user accommodation comprises of seven single bedrooms, lounge, and kitchen/diner area on the first floor for the use of the long stay service users. Respite and short term care is provided within three single bedrooms, a separate kitchen/diner, and lounge in a separate flatlet on the ground floor, a bed sitting room, and a further eight single rooms on the ground floor with a lounge and large dining room. There are a range of assited bathing facilities in the home. Level access is facilitated by the provision of a passenger lift in the home. There is a garden at the side of the home and a central courtyard. Sandbanks DS0000042776.V249655.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over four and three quarter hours on 6 December 2005. This is the second statutory inspection for the year and should be read in conjunction with the first inspection carried out on 25 April 2005 to give an overview of all the standards to be assessed within this period. A tour of the premises took place to look at communal areas and a selection of service users bedrooms, rotas and care records were inspected. Eight of the ten service users resident were spoken with in the communal areas. Due to communication difficulties it was not possible to speak to all service users individually, and so the opportunity was also taken to observe the interaction between staff and service users in the communal areas. The duty manager, and the three support workers on duty were spoken with. Comment cards were also left for service users and their carers and representatives to complete after the inspection if they wished. There has been a period of change with a new Manager commencing working in the home in September 2005 following interim management arrangements in place. The CSCI is awaiting an application for a Registered Manager. There has been some reduction in occupancy in the home whilst work has been completed to recruit staff to fill the staff vacancies in the home and reduce reliance on agency staff. What the service does well: What has improved since the last inspection? Since the last inspection a new more detailed format to record service users individual care plans has been implemented. Sandbanks DS0000042776.V249655.R01.S.doc Version 5.0 Page 6 A new medication room has now been provided and policies and procedures reviewed. The organisation has now put in place a procedure to demonstrate the regular maintenance of equipment and services. Evidence has been provided that the Water Regulations 1999 are met. 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. Sandbanks DS0000042776.V249655.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sandbanks DS0000042776.V249655.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5. There is detailed information about Sandbanks available to be viewed prior to any admission to the home. There are pre-admission procedures in place to ensure that service users on planned admissions are appropriately placed at Sandbanks. Service users have not been protected by the provision of a written contract/terms and conditions with the home. EVIDENCE: There is a detailed Statement of Purpose and Service Users Guide available to view. There is regular quality assurance information collated for service users and their carers to read. A copy of the last report is available to read in the entrance to the home. There were no new service users resident at Sandbanks at the time of the inspection. So it was not possible to evidence, but the Manager has previously stated and staff confirmed on the night that a Social Care Assessment is completed with new service users by staff from one of the Social Services Department’s Assessment Teams, and forwarded to the home. Staff will also go to meet new service users and their carers/representatives to gain information to help them provide the care needed. Sandbanks DS0000042776.V249655.R01.S.doc Version 5.0 Page 9 A written contract between the home and the service user detailing the terms and conditions of any period of care provided has not been in place, but has now been developed and is in the process of being introduced. Sandbanks DS0000042776.V249655.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. The service users individual plans in place adequately provide care staff with the information they need to ensure that service users individual care needs are met. Service users are enabled to make decisions in all areas of their daily living during their stay. EVIDENCE: Sandbanks DS0000042776.V249655.R01.S.doc Version 5.0 Page 11 Four service users individual plans (profiles) were viewed, which were detailed, and are drawn up annually where possible with the service user. Three had also been subject to a six monthly review to ensure that the agreed goals are being met and staff confirmed that the fourth was in the process of being completed. The individual plans are kept together in large folders, on the long stay unit. Some were worn, not all were easily accessible and were not all secure in the folder. The current system for storing the care plans could be improved, possibly with a contents page and dividers, to make information contained within more readily accessible. One long-term service user did not have a copy of their profile in the file. This was subsequently reported to the Manager for a resolution. Supporting risk assessments were also seen to be in place. Service users were observed being given opportunities to make decisions in all areas of their daily living whilst at Sandbanks. Sandbanks DS0000042776.V249655.R01.S.doc Version 5.0 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 and 16. Service users are encouraged to have opportunities for personal development and supported to pursue their own interests and hobbies. EVIDENCE: Service users continue to attend their daily activities as they would at home, and returned to Sandbanks that evening from a number of different venues attended during the day. For those service users being provided with longterm care, if they wish they can also attend a range of different activities. Service users spoke of participating in a range of activities in the local community. A number were due to go to a local club later in the evening. Two of the long stay service users were due to go food shopping as all the ingredients for the meals are purchased with the service users and prepared separately on the unit. Some service users were deciding if they wanted to go out on a drive and to stop off at a local pub, a number stayed at Sandbanks and listened to music in their own bedroom, help put up the Christmas decorations or watched television. Several service users spoke of the Christmas party being held at Sandbanks at the weekend. Another service user was looking forward to their Christmas shopping trip to an out of town Sandbanks DS0000042776.V249655.R01.S.doc Version 5.0 Page 13 shopping complex near London the next week. Service users being provided with long-term care do not have as part of the basic contract price the option of a minimum seven-day annual holiday outside the home. There were no relatives visiting at the time of the inspection but have been seen visiting on previous visits to the home. Standard seventeen was not inspected on this occasion. But the service users ate their evening meal in the dining room on each of the units. The evening meal consisted of beef burger and chips on the long-stay unit, and shepherds pie or chilli downstairs, which all the service users ate. Their evening meal was appetising and well presented. Staff and service users ate together and discussed their day and the proposed evening activities. The mealtime was relaxed and friendly. Service users spoke well of the food provided. Sandbanks DS0000042776.V249655.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Care and support is provided which is flexible and sensitive to individual service users. Positive relationships have been formed between staff and service users. The home has a good procedure to manage medicines that meet the needs of the service users. EVIDENCE: The sample individual care plans viewed, service users and staff spoken with, and observations during the inspection confirmed that care and support given is sensitive to the individual care needs of each of the service users. Records referred to specialist advice and guidance, which had been sought. Relationships between staff and service users and the care given was observed to be very good, and service users were treated with respect at all times. Service users were observed to need a range of assistance with personal and health care needs, and which was detailed in their individual care plans. Where service users only stay at Sandbanks for respite care or short term care, they remain with their own GP if local, or will visit the local surgery and register on a temporary basis. Sandbanks DS0000042776.V249655.R01.S.doc Version 5.0 Page 15 There are detailed policies and procedures in relation to medication in place. Confirmation has been requested of the training to be provided to meet the requirements of the standard. Medication storage has been improved with one new storage area and staff spoke well of the enhanced facilities. Two support workers were seen to be double checking during administration and staff confirmed procedures now in place when medication is taken out of the unit to day care facilities. Service users do bring medication in with them for the period of respite care and at the time of the inspection none of the service users were administering their own medication. The storage and records viewed of medication administered were adequate. Regular visits from a pharmacist for advice and support is not in place. Sandbanks DS0000042776.V249655.R01.S.doc Version 5.0 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. There is a clear and effective complaints procedure in place, which enables service users and their representatives to raise any concerns. There are detailed policies and procedures in place to protect service users from abuse. EVIDENCE: The organisation has a detailed compliments and complaints policy and procedure in place. Any complaints received are monitored through the line management arrangements in place within the organisation. Two complaints were recorded in the complaints log since the last inspection, one of which is currently being investigated. The CSCI have not received any complaints in relation to Sandbanks. There are detailed policies and procedures in place in relation to vulnerable adults. Not all of the staff spoken with confirmed that they had received training in adult protection procedures, but all were aware that any concerns should be reported to a manager. The Acting Manager subsequently stated that staff training requirements are currently being ascertained. There has been one incident in the home which has been satisfactorily investigated under adult protection procedures. Sandbanks DS0000042776.V249655.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28 and 30. The standard of the environment is good and provides service users with an attractive and homely place to live. EVIDENCE: Décor in the home is to a good standard, and furnishings are of a good quality and domestic in style following the refurbishment of the home in 2003. There are nineteen single bedrooms of which eleven do not meet the minimum space requirements, a sample of the bedrooms were viewed. Where possible particularly service users who are being accommodated on the long stay unit have been encouraged to select the colour of their bedroom and their own furniture. There are no en-suite facilities, but there are sufficient toilets, and a selection of assisted bathing facilities in the home. There are several communal areas for service users, a kitchen dining room and lounge on the long stay unit, a lounge in the three bedroom flat and large dining room with seating area. In addition, there is a further lounge for respite and short term care service users. Service users were observed using all these facilities participating in a range of activities. The home was clean and odour free at the time of the inspection. Confirmation has been received to confirm that the Water Supply Regulations 1999 are met. Sandbanks DS0000042776.V249655.R01.S.doc Version 5.0 Page 18 Routine fire checks of the building were viewed and were adequate. Sandbanks DS0000042776.V249655.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. Staffing levels were adequate to ensure that all the care needs, the health safety and welfare of the service users resident were met. Consistency in communication and the care provided has improved. ESCC recruitment policies and procedures need to be followed in order to protect service users. EVIDENCE: The home was calm and relaxed on the day of the inspection, and the staffing in place was adequate to meet the needs of current service users resident. It enabled staff to support service users on trips out during the evening and service users remaining in the home to be supported in their chosen leisure pursuits. Feedback from staff and records confirmed there has been less reliance on relief and agency staff to provide staff cover in the home, which has improved the consistency of care provided. Also that there has been further recruitment of new staff to the staff team and who are due to commence work in the home shortly. Staff spoke of improved moral amongst the staff team. All recruitment is co-ordinated by the personnel section at ESCC’s head office, which the Inspector has visited and viewed sample documentation to support the recruitment process in place. Some gaps in the required documentation Sandbanks DS0000042776.V249655.R01.S.doc Version 5.0 Page 20 were found and this has been raised for a resolution. In future recruitment practices will need to be demonstrated at the home as part of any inspection completed. It was not evidenced that all staff have a Criminal Records Bureau check in place. It was not possible to evidence the percentage of care staff who hold an NVQ level 2 in care. An update has been requested of the number of staff who hold this qualification and of work being completed to meet training requirements. The duty manager evidenced the proposed induction process which new staff recruited to the home will be taken through. Confirmation has been requested that this meets Sector Skills Council requirements. Sandbanks DS0000042776.V249655.R01.S.doc Version 5.0 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Robust quality assurance systems in place enable service users and their carers/representatives to give their views on the service provided at Sandbanks. Satisfactory arrangements need to be put in place to demonstrate that the health, safety and welfare of service users and staff is ensured. EVIDENCE: There is a new manager who has started working at Sandbanks. The CSCI is awaiting an application for a Registered Manager for the home. There are opportunities for service users to put forward their views about the home and the care that they receive, which informs ESCC and staff in the home of the quality of the service being provided. Staff and service users referred to a service users meeting which was due to be held the next weekend. An annual development plan for quality assurance is now in place in Sandbanks DS0000042776.V249655.R01.S.doc Version 5.0 Page 22 the home. Regular monthly visits by a representative of the organisation, which are recorded to meet the requirements are in place. It was not possible to evidence on the day that support workers had received the required health and safety training: Moving and handling, first aid, fire training, basic food hygiene and infection control. Staff stated that staff training records are in the process of being updated. Confirmation of the fire training provided has been requested and that a regular fire check of the building has been carried out. The organisation has now implemented a system to evidence that the maintenance of equipment and services has been carried out. A sample of the incident and accident forms completed were viewed. Six of the hot water taps from wash-hand-basins and baths were tested. For one, there initially was no hot water flowing from the tap and then the hot water was discoloured. For another the temperature recorded was 53.2°C and not close to the recommended safe temperature of 43.0 ° C. An Immediate Requirement form was left to address these issues. Checks on the hot water temperatures were seen but should be more frequent. Sandbanks DS0000042776.V249655.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 X X 1 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 2 3 1 2 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Sandbanks Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score 2 X 3 X X 2 X DS0000042776.V249655.R01.S.doc Version 5.0 Page 24 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA5 Regulation 15 (1) Requirement That confirmation is received that the process of issuing a contract to service users detailing the terms and conditions of their stay at the home has commenced. This issue is outstanding since 30.09.05. That confirmation is provided of medication training to be provided to meet requirements. That an update is provided of the number of care staff who hold NVQ Level 2 or equivalent and the work in place to enable staff to meet this requirement. That evidence is provided to confirm recruitment procedures in place and that all existing staff and relief staff have completed a satisfactory Criminal Records Bureau check. This issue is outstanding since 31.12.04. That confirmation is received that staff receive appropriate fire training within the required timescale. This issue has now been outstanding since 31.01.05 and 31.07.05 That confirmation is sent that DS0000042776.V249655.R01.S.doc Timescale for action 31/01/06 2 3 YA20 YA32 13 (2) 13 (4) (a) (c) 31/01/06 31/01/06 4 YA34 19 (1) (b) (i) 01/01/06 5 YA42 24 (d) 31/01/06 6 YA42 13 (4) (a) 31/01/06 Page 25 Sandbanks Version 5.0 7 YA42 18 (1) (c) (i) 8 YA428 18 (1) (c) 9 YA42 13 (4) (a) 10 YA42 13 (4) (a) the regular fire safety audit is completed. That confirmation is sent that all relief staff have completed moving and handling training to meet requirements. This issue is outstanding since 31.07.05. That confirmation is sent that staff have received the required moving and handling, first aid, basic food hygiene and infection control training. That hot water outlets accessed by service users are maintained at close to the recommended safe temperature of 43°C. The hot water is accessible and the discolouration is checked and acted upon. That regular checks of the hot water outlets accessed by service users are more frequent. 31/01/06 31/01/06 06/12/05 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA20 Good Practice Recommendations That information and advice is sought from a pharmacist. Sandbanks DS0000042776.V249655.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Sandbanks DS0000042776.V249655.R01.S.doc Version 5.0 Page 27 - 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!