Inspection on 02/06/06 for Smug Oak House

This inspection was carried out on 2nd June 2006.

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 no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Smug Oak House 21/11/07

Smug Oak House 05/03/07

Smug Oak House 01/11/05

Smug Oak House 24/05/05

Smug Oak House 13/01/05

Smug Oak House 03/08/04

Smug Oak House 24/03/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Smug Oak House Drop Lane Bricket Wood St Albans Hertfordshire AL2 3TX Lead Inspector Julia Bradshaw Key Unannounced Inspection 2 and 9th June 2006 11:00 nd Smug Oak House DS0000019528.V297963.R01.S.doc Version 5.2 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 Smug Oak House DS0000019528.V297963.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Smug Oak House DS0000019528.V297963.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Smug Oak House Address Drop Lane Bricket Wood St Albans Hertfordshire AL2 3TX 01923 857 223 01923 857 223 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) www.adepta.org.uk Adepta Ella Lockwood Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Smug Oak House DS0000019528.V297963.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st November 2005 Brief Description of the Service: Smug Oak House offers a purpose built residential service for 10 adults with Autistic Spectrum Disorders and other associated needs. The house has been divided into three units, one for 5 residents, one for 4 and one for 1. This was done to help staff accommodate the differing needs of the residents. The residents all attend a nearby day centre that is also run by PentaHact and is a specialist centre for people with Autism. The house is in a very rural setting some distance from most amenities, but the house has its own transport and service users access the local community frequently. The slightly isolated setting of the home does in some ways suit the particular needs of the service users. The service offered is specialised and individually tailored to meet the very complex needs of the residents all but one of whom have lived there since it opened, in fact the service was set up and designed specifically for them. Smug Oak House DS0000019528.V297963.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Inspection was unannounced and carried out over one day with a further visit on the 9th June in order to follow up some requirements made on the first Inspection day and to cover the outstanding standards not completed on the 2nd June 2006. Generally this was a positive inspection with the majority of standards being met. The atmosphere of the home was calm and friendly. The staff work hard to maintain a homely environment with a service user group who, due the nature of their disability, can challenge the environment in which they live in. The home has a good system in place for assessing service users needs and review their care plans regularly. The home provides a range of activities both within the home and using outside leisure facilities. The service users at Smug Oak House also attend the Bricket wood day-care provision from Monday to Friday. What the service does well: What has improved since the last inspection? The manager has worked hard since the last inspection to improve the standard of the environment with some areas of the home being recently decorated and some new equipment has been donated/supplied to the home. Record keeping and service user plans are being further developed and improved to incorporate the new Person Centred Planning system into the home. The management team has worked hard to maintain support and good communication systems during a lengthy and complex Adult Protection investigation within the home. The care worker currently being investigated has been transferred to head office and is not involved in any ‘care work’ or contact with service users whilst the investigation continues. Smug Oak House DS0000019528.V297963.R01.S.doc Version 5.2 Page 6 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. Smug Oak House DS0000019528.V297963.R01.S.doc Version 5.2 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 Smug Oak House DS0000019528.V297963.R01.S.doc Version 5.2 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): 1-4. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. A detailed Statement of Purpose and service user guide is held within the home. Generally there is a good system of pre-admission assessment in place to ensure that the care needs of people who may want to move into the home are fully understood and can be fully met. Risk assessments were out of date. EVIDENCE: A detailed Statement of Purpose and service user guide is held within the home and all current and prospective service users are provided with a copy. The Statement contains information for the service user to make an informed choice about where to live. However, the home should endeavour to further develop all relevant documents into a more ‘user friendly’ format, which is accessible to all current service users and also to prospective service users and their families and carers. Smug Oak House DS0000019528.V297963.R01.S.doc Version 5.2 Page 9 Full assessments of service users needs and aspirations are made before they move into the home and these are reviewed as part of the care planning process. Individual risk assessments were in place and had been reviewed since the last inspection took place. The staff team are in the process of implementing the Person Centred Planning approach into the home with one-service users PCP having been completed. Smug Oak House DS0000019528.V297963.R01.S.doc Version 5.2 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 - 10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service Individual needs and choices within the home are being promoted to encourage and empower user self-determination. Service user plans fully reflect the service users needs. Service users have the opportunity to contribute to some decisions taken within the home. Service users risk assessments are in place and reflect risks in relation to personal health and safety. However, consent must be obtained for the use of the listening device situated in one service users room. EVIDENCE: All service users have an individual care plan and an allocated key worker to support them within the home. Individual daily notes and guidelines for the service users where observed within the home. All service users are supported within the Whole Life review process and the home is in the process of implementing Person Centred Planning, with one persons completed and the Smug Oak House DS0000019528.V297963.R01.S.doc Version 5.2 Page 11 remaining plans will be completed before the next inspection takes place. The home has a comprehensive framework in place to ensure the care plans are implemented and to ensure changing needs are continuously assessed and reviewed. The ethos within the home promotes that each individual owns the care plan. All information within the home is handled with care and respect. All personal notes and files detailing information on the service user are locked away. The home has adequate risk assessment procedures and all risk assessments were up to date and accurate regarding generic risk assessments. However, the manager must obtain consent for the use of a listening device in one of the service users rooms. There were also several individual risk assessments in place. The home has good systems of communication with both the service users and their carers and information is made available. There is a general policy on confidentiality. Service users’ individual records are accurate and they are stored securely in a locked filing cabinet. All staff should sign each document to confirm they have read the necessary policies and procedures. Smug Oak House DS0000019528.V297963.R01.S.doc Version 5.2 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): 11-17 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Individual needs and choices within the home are being promoted to encourage and empower user self-determination. Individual rights and opportunities are recognised and supported, where possible. Restrictions on service users independence and rights are recognised and respected. Service users are provided with a varied and wholesome diet. EVIDENCE: Activities are offered within the home by care staff during the evenings and weekends as well as service users accessing local day care provision. Formal service user meetings are not held within the home due to the complex needs Smug Oak House DS0000019528.V297963.R01.S.doc Version 5.2 Page 13 of the service users group. However, the manager stated that the staff are able to obtain service users views through informal methods of communication. All service users benefit from trips out to the shops, cafes and local parks. The home benefits from having on-site transport and assists service users in accessing the local community. None of the current service users would be able to access public transport with ease from Smug Oak House due to inaccessability of transport services. The current service users are unable to engage in work outside of the home. However, every effort is made to support people who move into the home to continue with social activities, which they previously enjoyed. Likes and dislikes are strongly held by individuals and well know by the staff team. Some of the service users can state a preference whilst with others it is a process of constant observation that determines their preferences. The home provides short breaks for each service user. Three groups of service users enjoyed holidays away in Spain, another group went away to Centre Parcs and to Weymouth. A 1:1 staffing ratio is provided on all holidays. The home welcomes and encourages involvement from families and friends of the service users and the home also benefits from receiving funds and equipment form the ‘Herts Support Group’. This fundraising group have provided the home recently with a new television cabinet, snoozlem equipment, 2 bicycles, and a carrier for the car. They also part funded the purchase of a new swing in the garden. They have opportunities to meet people at places like St Joseph’s Pastoral centre and through a variety of social environments, although service users with autism often find maintaining these friendships difficult. Some service users go home to visit their families at weekends Smug Oak House DS0000019528.V297963.R01.S.doc Version 5.2 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): 18-21. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The current medication practices and maintenance for medication are detailed and comprehensive. The ageing, illness and death of a service user is handled with respect and information recorded is accurate. Service users emotional and physical needs are being met adequately. All personal and health care support is well maintained within the home ensuring individual needs, choices and preferences are met at all times. EVIDENCE: Risk assessments and service users individual care plans include their preferences regarding how they are guided and supported. Intimate personal care is provided in the privacy of the bedroom or bathroom with assistance from a worker who is acceptable to the service user. The manager must obtain consent for service users who have listening devices within their bedrooms. Staff endeavour to be flexible in their approach with regard to routines within the home. As needs are identified, additional specialist support is provided by Smug Oak House DS0000019528.V297963.R01.S.doc Version 5.2 Page 15 the community nurses from the Learning Disabilities team and also the local psychiatric services are accessed when necessary. The home operates a key worker system and service users appear to have the opportunity to be consulted regarding their care plan and the services offered to them at the home. The current service user group are unable to administer their own medication and therefore medication is prescribed and administered by the senior staff team plus permanent staff who have received the appropriate induction. The home has a robust policy and procedure in place to support the safe administration, storage and receipt of medicines. All staff receives training prior to being deemed competent to administer medication. All service users are offered regular health check ups and visits by medical/health professionals take place in private. Smug Oak House DS0000019528.V297963.R01.S.doc Version 5.2 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 & 23 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The complaints procedure within the home is sufficient and adequate in order for the service users to feel that their individual views are listened too Robust policies, procedures and training are in place to ensure service users are protected and safe. EVIDENCE: The home has a comprehensive complaints procedure in place, which states that all complaints are responded to within 28 days. A record is maintained of complaints made detailing actions and outcomes as necessary. This is also on display in the home. The complaints procedure includes the correct contact details of the CSCI. There was a requirement from the last inspection that the home to keep a log of both complaints and compliments. This has now been actioned. There is an active Adult Protection issue at the home which has been investigated by Adepta and is now being pursued by The Crown Prosecution Service and the outcome of this prosecution will not be known until the end of 2006. However staff continue to ensure that the home’s robust procedures are maintained and service users are protected from abuse and harm. Staff receive adequate Protection of Vulnerable Adults training. Staff employed at the home are all subject to enhanced Criminal Records Bureau (CRB) checks. Staff personnel files were inspected and all the necessary documentation was available for inspection. Smug Oak House DS0000019528.V297963.R01.S.doc Version 5.2 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 - 30 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service Attention is required to the exterior and interior of the home. The health and safety of service users is currently being compromised. Individual risk assessments are being maintained. EVIDENCE: Unfortunately during the inspection process several fire doors were discovered to be wedged open due to being ill-fitted. An immediate requirement was therefore issued. There were several areas of the home that require attention. These include a damp patch in the bedroom of House 4. One service users room requires re-furbishment, a new sofa and Fridge Freezer is needed. The kitchen cupboards in House 4 also require re-fitting. New flooring is also required in some parts of the buildings. The vanity units that are currently in service users bedrooms are damaged and in poor condition and require replacement. Smug Oak House DS0000019528.V297963.R01.S.doc Version 5.2 Page 18 Staff have worked hard to improve and develop service users bedrooms and to personalise these rooms. Due to the complex needs of the service users the environment requires constant attention and repair. The service users can benefit from a snoozlem facility within the home, which was funded by the Herts Support Group. The home benefits from a large garden with a recently fitted garden swing. Service users bedrooms have been personalised and with a variety of their own furniture where possible and are maintained to an adequate standard. The home was both clean and hygienic on the day of the inspection. Care staff are responsible for the domestic duties within the home and there is a handyperson who visits the home twice a week. Smug Oak House DS0000019528.V297963.R01.S.doc Version 5.2 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): 31-36 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service The home is suitably staffed with experienced individuals ensuring that at all times service users changing needs can be met. The staff team are enthusiastic and appear to take pride in the service. Recruitment procedures are robust and effective in the protection of service users. EVIDENCE: The Staff spoken with during the inspection appeared to be clear of their individual roles and responsibilities. The members of staff on duty was seen to support the main aims and values of the home. The home has clearly defined job descriptions. All staff have received a series of mandatory training course in order for them to meet the needs of the service users Recruitment practices were inspected and proven to be accurate and adequate. The two files checked contained all the required information. There is currently Smug Oak House DS0000019528.V297963.R01.S.doc Version 5.2 Page 20 one member of care staff who has been transferred to head office carrying out administration duties whilst an Adult Protection issue is pursued by the Crown Prosecution service. Supervision and appraisal take place and staff spoken to during the inspection confirmed they receive supervision at least six times a year. The home employs one manager, two assistant managers, and fifteen support workers. The home provides one waking night care and one sleeping in person, per night. The home also employs a part-time handyperson. Staff work a variety of shifts to meet the changing needs of the service users including, 7.30a.m. to 3 p.m. and 3 p.m. to 10.p.m. If there are any vacant shifts that require covering the home is provided with bank staff in order to maintain consistency. Recent training includes, Makaton, Team building, understanding Autism, food hygiene, performance management, Person Centered Planning, and manual handling. Smug Oak House DS0000019528.V297963.R01.S.doc Version 5.2 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 & 42 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. The service users can confident that their views underpin the self-monitoring review and development by the home. The health and safety of service users is currently compromised. The home maintains adequate records in order to protect service users. The home benefits from good leadership skills form the management team. EVIDENCE: The home has various systems in place to ensure that service user’s choices are respected, within their abilities and understanding. The care planning system in place provides an opportunity to share and discuss each person personal goals and aspirations with the relevant key worker and outside Smug Oak House DS0000019528.V297963.R01.S.doc Version 5.2 Page 22 professionals. Records and documentation are audited by the organisation. Policies and procedures were in place for the protection of service users but unfortunately due to the current Adult Protection investigation and pending prosecution of one member of staff, the manager and staff need to be extra vigilant in this particular area. There were several areas within the home at the time of the inspection that caused concern for the health and safety of the service users. These are mentioned in both the ‘Environmental and Requirement’ and this report section. Regulation 26 records were incomplete. The last record on file was January 2006. Fire records within the home were checked and found to be seriously out of date and putting service users at risk. An immediate requirement was left at the home in relation to this issue. The manager must ensure that all fire checks are carried out in line with fire regulations and current procedures and all records are completed and accurately maintained. Smug Oak House DS0000019528.V297963.R01.S.doc Version 5.2 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 Standard No Score 1 3 2 3 3 3 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 1 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 2 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 2 X X 1 3 Smug Oak House DS0000019528.V297963.R01.S.doc Version 5.2 Page 24 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 YA8 Regulation Requirement Timescale for action 12/06/06 15 (2) (c) Consent must be obtained for the service users who have listening devices within their bedrooms. 13 (4) (c) All fire doors must be adjusted or repaired in order to prevent these doors from not closing properly and hence putting the health and safety of both service users and staff at severe risk. All fire records MUST be completed and recorded. All areas of the home that have been identified in the ‘Environmental’ section of this report require urgent attention Regulation 26 visits must be carried out monthly and an accurate and detailed report be made available within the home for inspection. All health and safety records, in particular Fire records must be maintained and recorded accurately in line with the current regulations. 2. YA24 02/06/06 3 YA24 23 (1) 30/06/06 4 YA39 26 (4) (c) 09/06/06 5 YA42 17 (2) Sch 4 02/06/06 Smug Oak House DS0000019528.V297963.R01.S.doc Version 5.2 Page 25 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 YA6 Good Practice Recommendations Provide CSCI with timescales for completion of the review of care plans. Smug Oak House DS0000019528.V297963.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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 Smug Oak House DS0000019528.V297963.R01.S.doc Version 5.2 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!