Inspection on 30/09/08 for Southview Care Home Limited

This inspection was carried out on 30th September 2008.

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

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

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Southview Care Home Limited 30 York Place Stoke Plymouth Devon PL2 1BP The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Antonia Reynolds Date: 3 0 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 33 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Southview Care Home Limited 30 York Place Stoke Plymouth Devon PL2 1BP 01752240800 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Southview Care Home Ltd Name of registered manager (if applicable) Mrs Tracey Ann Page Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 3 0 care home 3 learning disability Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) The maximum number of service users who can be accommodated is 3. Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 33 A bit about the care home Southview is privately owned by Southview Care Home Limited although the same owners have been operating the home for several years. The house is an end of terrace, two-storey property, located in Stoke village in Plymouth. The home does not have designated parking space but on-street parking is available in the vicinity. Fee levels start at 520 Pounds per week but are based on individual assessment and needs. Information relating to the service, including copies of inspection reports, can be obtained from the Registered Manager, Mrs Page. Three people with learning disabilities live at the home. The house is very close to the town centre and local shops. Care Homes for Adults (18-65 years) Page 5 of 33 There is a bus stop near the home. The bathroom and toilet are on the first floor. Everybody has their own bedroom on the first floor. No-one has to share a bedroom. One bedroom has its own shower and toilet. Care Homes for Adults (18-65 years) Page 6 of 33 The home has a garden and there is a park nearby. Care Homes for Adults (18-65 years) Page 7 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 8 of 33 How we did our inspection: This is what the inspector did when they were at the care home This inspection consisted of an unannounced visit to the home, by one inspector, between 10am and 2.30pm on Tuesday, 30th September 2008. The term we will be used throughout this report as it is written on behalf of the Commission for Social Care Inspection. The Registered Manager, Tracey Page, was available for consultation and discussion during the inspection process, as was the Responsible Individual, Karl Page. We talked to all three people who live at the home and one person was spoken with at length. Two survey forms for relatives were left in the home for them to complete if they wish to. Care Homes for Adults (18-65 years) Page 9 of 33 We talked to the staff member on duty. Three survey forms were left in the home for other staff to complete if they wish to. We looked all around the home. We looked at some of the policies and procedures in the office. Policies are rules about how to do things. Procedures tell people how to follow the rules. Care Homes for Adults (18-65 years) Page 10 of 33 What the care home does well The Registered Manager is qualified and experienced to manage this home. The management culture is open and respect for the people who live in the home is clearly demonstrated, thereby ensuring that they are kept safe from harm. People are consulted about every aspect of their lives and the staff and management team are constantly looking for new ways of improving communication and consultation. Where restrictions on choice or liberty are imposed, due to peoples specific needs, they are aware of the reasons. People can choose to take part in different activities outside the home with staff support. Care Homes for Adults (18-65 years) Page 11 of 33 Everybody has a care plan that contains detailed information for staff to follow about how to meet the needs of the people who live in the home. What has got better from the last inspection This was the first inspection of the home since it was registered as a limited company. However the home has been owned by the same people for several years. No requirements or recommendations for improvement were made at the last inspection. Some rooms have been redecorated. Care Homes for Adults (18-65 years) Page 12 of 33 Policies and procedures have been updated. What the care home could do better Two written references need to be obtained for all new staff members, before they commence employment, to ensure that recruitment practices are robust and protect the people who live in the home. The names of staff who attend fire drills should be written down. This is so that the Registered Manager can identify any staff members who have not received the training. This is to ensure that all staff know what to do if there is a fire in the home. Care Homes for Adults (18-65 years) Page 13 of 33 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Antonia Reynolds 33 Greycoat Street London SW1P 2QF 02079792000 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 14 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 15 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home’s pre-admission processes ensure that people who wish to live in the home are provided with information, and opportunities to visit, to help them decide if this the right place for them. Evidence: There have been no new admissions to this home for over three years. Individual records are kept for each of the people who live in the home and these contained assessments, care plans and risk assessments, all of which had been recently reviewed. Ongoing evaluation is recorded daily. The Registered Manager confirmed that the people living in the home were consulted and involved in the decision to move into this home. There are procedures in place to ensure that detailed pre-admission assessments are carried out before anyone starts living in the home. Discussion with the Registered Manager confirmed that this includes meeting and consulting with the person concerned, their relatives or representatives and any other professionals involved in the persons care. People are invited to visit the home before admission to have a look round and meet the other people who live there as well as the staff. Peoples communication needs are assessed and communication facilitated by the use of symbols and pictures. This means that people who live in the home are enabled to Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: express their wishes and needs to the staff in a variety of ways. Care Homes for Adults (18-65 years) Page 17 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who live in the home are very well supported by the staff team. They are enabled to participate in, and make decisions about, all aspects of their lives. Evidence: The attitude and approach of the staff team is excellent in that each person who lives in the home is encouraged, enabled and supported to make their own decisions, choices and be as independent as possible. Discussions with the people who live in the home, as well as the staff, demonstrated that the running of the home, and all routines and activities, are organised around the wishes, choices and needs of the people who live there. One person described his activities during the week and said I can do what I want and the [staff] help me. Each person has a very detailed plan of care providing clear information about the support that each person needs. This plan also contains information about what staff must do to keep people safe, based on risk assessments that are regularly reviewed. People who live in the home are also supported to complete My Life books which enables them to be actively involved in deciding what care and support they need as well as considering aims and aspirations. Discussion with the people who live in the home, a staff member and the Registered Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: Manager confirmed that staff are fully aware of the needs of each person. The people who live in the home participate in all aspects of the day to day running of the home, including domestic activities and tasks, with staff support where necessary. Staff support people to make decisions about their lifestyle, activities and movements both inside and outside the home. The Registered Manager, as well as documentation, confirmed that individuals are encouraged to administer their own finances, with staff support if necessary. The home looks after the personal spending money of two people who live in the home. The records of expenditure were well maintained and regularly audited by the Registered Manager. Care Homes for Adults (18-65 years) Page 19 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who live in the home are supported to lead active lives, participate in community and leisure activities, choose their own daily routines and maintain regular contact with their families. Evidence: Discussions with people who live in the home, the staff member on duty and the Registered Manager, as well as documentation, showed that people are enabled to live as full a life as they wish to. They have opportunities for personal development, such as cooking and budgeting, and are encouraged to make their own decisions about their lifestyles. People are consulted about where they want to go on holiday each year and they usually go to different places. A discussion took place between the staff on duty and the people who live in the home about a possible planned trip to France next year. This showed that the people who live in the home are involved in all the decisionmaking about their holidays. People who live in the home are encouraged to participate in all the domestic activities in the home and to take part in leisure and Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: educational activities of their choice. People are supported to use public transport where possible but the home does have a car for people to use. Contact with relatives and friends is encouraged and promoted. One person spoken with said that the staff respect his privacy and always knock on my door before they come in. The bathroom has a lock fitted to ensure privacy. One of the bedroom doors has a suitable lock fitted but not the other two due to the specific needs of the people who live in those rooms. The home does not have a set menu because each person chooses whatever they wish to eat at each mealtime. The people who live in the home said they like all the meals and help prepare meals if they want to. Care Homes for Adults (18-65 years) Page 21 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who live in the home receive support in the way, and at the time, that they want and need. Health care needs are addressed as soon as they are identified. Evidence: Discussions with the people who live in the home and the Registered Manager, as well as documentation, confirmed that each person receives personal support in the way they prefer and require. Each person has a plan of care that provides detailed information about personal, emotional and health care needs. Information contained within personal files, as well as discussion with the Registered Manager confirmed that external professional advice and guidance is sought when necessary from local health care professionals, learning disability services and social services. Through discussion and observation it was clear that timings are flexible and the choice of the people who live in the home. None of the people who live in the home are self-medicating and the home uses a monitored dosage system prepared by the local pharmacist. Medication was locked away safely and regular medication reviews take place. Records pertaining to the administration of medication were up to date and the practice of administering medication, described by the Registered Manager, was found to be safe. The Registered Manager knew what to do in the event of someone refusing their medication and that unused or contaminated medication needs to be returned to the Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: pharmacy for disposal. Care Homes for Adults (18-65 years) Page 23 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who live in the home are protected from abuse, neglect and self-harm. People can be confident that all complaints and concerns are listened to and acted upon immediately. Evidence: Neither the home nor the Commission for Social Care Inspection have received any complaints regarding the home. The home has a complaints procedure and the people who live in the home said they would tell the staff if they had a problem or they did not like something that was happening in the home. Regular house meetings are held where any issues can be raised and dealt with immediately, although it was also clear from discussion that people may raise any issue at any time. The staff member on duty and the Registered Manager were knowledgeable about the procedure to follow should an untoward incident occur where people who live in the home may need to be safeguarded. All staff are expected to attend training regarding the protection of vulnerable adults so that they are fully aware of the local procedures that need to be followed. Care Homes for Adults (18-65 years) Page 24 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Southview is a clean and comfortable home and the standard of the décor is good, providing people with an attractive and homely place to live. Evidence: The home is spacious, comfortable, safe, clean and well maintained, providing a warm and welcoming environment that is homely and comfortable for the people who live there. Each person has a single bedroom on the 1st floor and one of these has an en suite shower and toilet. Bedrooms are individually furnished and contain many personal possessions that have been arranged in accordance with peoples wishes. The Registered Manager confirmed that people may choose the décor and furnishings for their bedrooms. One bedroom door was fitted with an appropriate lock and the person who lives in that room has a key. The other two bedrooms did not have locks due to the particular needs of those people. The home has a bathroom on the 1st floor consisting of a bath with a shower, toilet and wash hand basin. The bathroom door is fitted with a lock that affords sufficient privacy but staff can gain access in an emergency. There are shared rooms on the ground floor consisting of a kitchen/dining room, lounge room and a laundry. All the communal rooms are well-furnished, homely and clean. There is an office on the ground floor that is also used as a sleeping in room for staff. The home has a portable telephone so that people may make and receive telephone calls in private. The home has a ‘no smoking’ policy. The home has a small garden, with a paved area, at the back of the house. Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: Care Homes for Adults (18-65 years) Page 26 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who live in the home benefit from a consistent, well supported and supervised staff team. Recruitment procedures are not as robust as they should be potentially placing people at risk of harm. Evidence: The Registered Manager confirmed that there is a small core of staff who have worked at the home for several years. Three staff files were inspected and two of them contained all the required checks and references. However one file did not contain any written references. Discussion with the Registered Manager confirmed that she had known this person for many years, therefore any risk to the people who live in the home was minimal. Discussions with the people who live in the home, as well as staffing rotas, showed that there are usually two staff members on duty during the day, and one staff member sleeping in at night. The Registered Manager said that there are times when three staff are on duty depending on the needs and activities of the people who live in the home. There are also times when the member of staff on duty at night stays awake if any of the people who live in the home are unwell. This demonstrates that staffing levels are flexible around the needs of the people who live in the home. The owners of the home, one of whom is the Registered Manager, work regular shifts in the home. This means that they are able to observe and monitor the performance of staff. Regular staff and supervision meetings ensure that the people who live at the home are receiving consistent support from the staff team and training Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: needs are quickly identified. Training records, as well as discussions with the staff member on duty and the Registered Manager, confirmed that staff receive a comprehensive induction. New staff are also expected to shadow more experienced members of staff for the first six weeks of their employment so that they become very well acquainted with the needs of the people who live in the home. Training includes topics such as safeguarding vulnerable adults, first aid, food hygiene, health and safety, manual handling, fire safety, medication administration, infection control and person-centred planning. They also have access to more specialised courses related to working with people with learning disabilities such as mental capacity, dementia awareness, nutritional needs and National Vocational Qualifications. Care Homes for Adults (18-65 years) Page 28 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The management approach is open, inclusive and positive, providing clear leadership and guidance. The rights, health, safety and welfare of people who live in the home are protected and promoted. Evidence: The Registered Manager has several years experience of working with people with learning disabilities and has gained appropriate qualifiations. She has attained both care and management qualifications, namely a level 4 National Vocational Qualification in care and the Registered Manager’s Award, demonstrating her knowledge and competence. Health and safety checks, including fire equipment, gas safety and portable electrical appliances are carried out regularly. Staff receive training in fire safety awareness and the staff member on duty knew what to do in the event of a fire, as did the people who live in the home. Records show that fire drills take place regularly but the names of staff attending were not documented. The Registered Manager confirmed that all staff complete training in emergency first aid, health and safety, food hygiene and infection control. The use of hot water and hot surfaces, that is, radiators, has been risk assessed. The risk assessments showed that radiators do not need to be guarded and thermostatically controlled valves, to regulate the hot Care Homes for Adults (18-65 years) Page 29 of 33 Evidence: water temperature, are not needed. The home has a comprehensive quality assurance system, which includes consultation with the people who live in the home, their relatives, staff and other people/professionals who have contact with the home. Care Homes for Adults (18-65 years) Page 30 of 33 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 31 of 33 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 34 The Registered Manager should follow the homes recruitment procedure on every occasion when employing new staff by obtaining two written references. This is so that the people who live in the home are safeguarded against any potential risk of harm. The Registered Manager should document the names of all staff who attend fire drills. This is to ensure that all staff are properly trained in fire safety evacuation. 2 42 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web:www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 33 of 33 - 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!