Inspection on 07/11/05 for Spanish & Portuguese Jews Home For The Aged

This inspection was carried out on 7th November 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Spanish & Portuguese Jews Home... 18/07/07

Spanish & Portuguese Jews Home... 28/11/06

Spanish & Portuguese Jews Home... 20/04/05

Spanish & Portuguese Jews Home... 06/12/04

Spanish & Portuguese Jews Home... 20/04/04

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Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Spanish & Portuguese Jews Home For The Aged Edinburgh House 36-44 Forty Avenue Wembley Middlesex HA9 8JP Lead Inspector Julie Schofield Announced Inspection 7th November 2005 09:40 X10015.doc Version 1.40 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 Spanish & Portuguese Jews Home For The Aged DS0000017448.V280085.R01.S.doc Version 5.1 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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Spanish & Portuguese Jews Home For The Aged DS0000017448.V280085.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Spanish & Portuguese Jews Home For The Aged Address Edinburgh House 36-44 Forty Avenue Wembley Middlesex HA9 8JP 020 8908 4151 020 8908 3103 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) Spanish & Portuguese Jews Home for the Aged Ms Christine Gilmore Care Home 51 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (41) of places Spanish & Portuguese Jews Home For The Aged DS0000017448.V280085.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th April 2005 Brief Description of the Service: Edinburgh House is a home accommodating up to 51 elderly Jewish residents and provides personal care. It is part of a complex, which includes sheltered housing units and a day centre and is situated on Forty Avenue. This is a busy road linking Wembley Park with East Lane. Transport facilities include bus routes and a nearby underground train station (Wembley Park). The home has a large car park in the grounds and there are garden/patio areas around the building, which are attractive in appearance. The home consists of three floors (ground, first and second) and there are residents’ bedrooms and toilet/bathing facilities on each floor. There are a number of lounge areas on the ground floor including a large entrance hall that opens into a conservatory and there are residents using each of the communal spaces in the home. One lounge (Sunflower) is for the mentally frail residents. The pink lounge is for the high dependency/very frail residents and is situated on the second floor. The home has a spacious dining room for most of the residents although the Sunflower lounge and the pink lounge have their own dining areas. There are separate meat and milk kitchens, in accordance with dietary laws. There are offices on the ground floor for the manager and other senior staff. There is also a suite of offices on the first floor, which are used by the finance staff. The home has a number of pets. Spanish & Portuguese Jews Home For The Aged DS0000017448.V280085.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over two visits. It started on a Monday the 7th November and continued on Thursday 10th November 2005. The manager, deputy manager and members of staff assisted. Eight residents spoke with the Inspector and gave their comments and comment cards were received from 34 residents. 24 relatives of residents living in the home returned comment cards or letters. The Inspector would like to thank all who took part in the inspection. Records were inspected and a partial site inspection took place. What the service does well: What has improved since the last inspection? During the previous inspection in April 2005 a number of statutory requirements were identified. There is now compliance. The care plan includes a risk assessment in respect of falls, residents (or their relatives) are given a copy of the care plan, regular reviews of the placement and care plan Spanish & Portuguese Jews Home For The Aged DS0000017448.V280085.R01.S.doc Version 5.1 Page 6 are carried out, the case file includes a record of health care appointments and the home has obtained a copy of the local authority’s interagency guidelines in the event of abuse. They have also implemented the recommendations made. Care plans are evaluated on a monthly basis and the resident (or their relative) signs the care plan. The Pharmacy Inspector carried out an inspection in October 2005 and progress towards compliance with the statutory requirements identified was checked. The home has complied with all but 2 of the statutory requirements identified. However the timescale for completion of these 2 statutory requirements had not expired. There was evidence that the home had implemented or was in the process of implementing the recommendations made. 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. Spanish & Portuguese Jews Home For The Aged DS0000017448.V280085.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Spanish & Portuguese Jews Home For The Aged DS0000017448.V280085.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 The home does not provide an intermediate care service. Standard 3 was inspected during a previous inspection in April 2005. EVIDENCE: Spanish & Portuguese Jews Home For The Aged DS0000017448.V280085.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 Assessing the needs of a client and identifying these in a care plan, which is tailored to meeting the individual needs of the client, enables the client to receive a quality service. Reviewing care plans on a regular basis ensures that changes in the needs of residents are identified and can be addressed. The health and well being of residents is promoted through regular health care checks and appointments. Residents are supported in taking their medication, as prescribed by their GP, in order to maintain their general health. Standard 10 was inspected during a previous inspection in April 2005. EVIDENCE: During the previous inspection 3 statutory requirements were identified in respect of the care plans. The homes has now complied with each of these. Care plans now include a risk assessment in respect of falls, a copy of the care plan is now given to the resident (or their relative) and the care plan (and placement) is now reviewed on a regular basis. Five of the 24 relatives that returned a comment card ticked that they were not informed of important matters affecting their relative and it is recommended that the home reviews how it communicates with relatives. Spanish & Portuguese Jews Home For The Aged DS0000017448.V280085.R01.S.doc Version 5.1 Page 10 During the previous inspection a statutory requirement was identified that case files contain a record of health care appointments. There is now compliance. Two of the relatives commented that the resident could drink more fluids and it is recommended that residents be reminded of the jugs of water and juice available in the lounges and offered these at regular intervals. In October 2005 the Pharmacy Inspector carried out an inspection of the storage, handling and administration of medication in the home. There has been compliance with the following statutory requirements. There is now a list of signatures and initials of the staff trained in the safe handling of medicines, the trolley is secured to the wall, controlled drugs are stored in a designated cupboard, there is a system to document the quantities of medicines for residents receiving respite care, staff have been instructed not to use tippex on the MAR, the administration of insulin has been reviewed, the GP will give bulk prescriptions for certain items, the date of opening is recorded on liquid medicines and dosage changes are documented. The timescale for compliance for the remaining 2 statutory requirements has not expired. There was evidence that the recommendations made in respect of the recording of controlled drugs and the removal of finger pricking devices for self testing from use have been implemented and that the remaining 3 recommendations are in the process of being implemented as the home is awaiting a reply from their pharmacist. Spanish & Portuguese Jews Home For The Aged DS0000017448.V280085.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 A comprehensive programme of activities, both inside and outside the home provide residents with opportunities for stimulation and enjoyment. Standards 13, 14 and 15 were inspected during a previous inspection in April 2005. EVIDENCE: The home has a comprehensive programme of activities and the weekly programme was available for inspection. A resident said that they were given individual copies of the weekly programme and that there was a large copy on display near the dining room. A resident suggested that an announcement could be made at mealtimes to remind residents of the activities taking place that morning or afternoon. It was noted that on some days activities were taking part in different lounges at the same time. Activities included a sewing group, massages, physiotherapy, fitness walking, current affairs, music and crafts, keep fit etc. Some residents attend a day centre or friendship club. Outings were also arranged and the home has its own transport. A resident said that he enjoyed taking part in the fun day and dressing up in fancy dress. Another resident said that she had dressed up as the Queen and had worn a tiara. Examples given of outings included a trip to Longleat and a trip to the Animal Welfare Trust Open Day. Two residents said that they had enjoyed a Spanish & Portuguese Jews Home For The Aged DS0000017448.V280085.R01.S.doc Version 5.1 Page 12 summer holiday to Bournemouth that the home had arranged for a group of residents. Spanish & Portuguese Jews Home For The Aged DS0000017448.V280085.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17, 18 The resident’s right to exercise judgement in financial and civic matters is respected although the resident may need the assistance of an advocate to achieve this. Protection of vulnerable adults training for staff and familiarity with the home’s procedure and the interagency guidelines contribute towards the safety of residents. Standard 16 was inspected during a previous inspection in April 2005. EVIDENCE: Eight of the 24 relatives who returned a comment card ticked that they were not aware of the home’s complaints procedure and it is recommended that this is an agenda item at the next relatives meeting. Residents are able to have a private meeting with their solicitor etc. If necessary their rights in financial matters are protected by a power of attorney or the court of protection acting on their behalf. The home has information about advocacy schemes and the activities co-ordinator has acted informally on behalf of residents if there are issues that the residents would like to raise. Residents have voted at the elections and the home’s minibus has been used to transport them to the polling station. A statutory requirement was identified during the previous inspection that the home obtains a copy of the local authority’s interagency guidelines in the event of abuse and there has been compliance. The home now has a copy, which is available for reference. Residents said that if they were concerned or worried Spanish & Portuguese Jews Home For The Aged DS0000017448.V280085.R01.S.doc Version 5.1 Page 14 about something they could speak to one of the managers or team leaders and named people they would approach. Training in adult protection procedures was included in the programme of training for staff in 2005. Spanish & Portuguese Jews Home For The Aged DS0000017448.V280085.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 Residents live in a home with comfortably furnished and decorated communal areas, which are kept clean. They are satisfied with the accommodation and facilities in the home. The home needs to keep its fire precautionary equipment and systems in good order so that the health and safety of residents, staff and visitors to the home is protected. Standard 26 was inspected during a previous inspection in April 2005. EVIDENCE: A partial site inspection took place. All communal areas, toilet and bathing facilities, kitchen, laundry, offices and bedrooms, where the door had been left open, were seen. The home was maintained to a good standard with comfortable furniture and attractive furnishings. It was clean and tidy and free from offensive odours. A relative commented that the home “always smells clean”. One resident commented that there has been an odour of urine in the toilets near the lounge and dining room and it is recommended that these are checked by staff at regular intervals throughout the day. Residents said that Spanish & Portuguese Jews Home For The Aged DS0000017448.V280085.R01.S.doc Version 5.1 Page 16 the home was always clean and that their rooms were lovely. The gardens were well kept and although the inspection took place in November the shrubs and plants provided residents with pleasant views. Residents said that they enjoyed sitting in the garden in the summer and that they were able to have their meals in the garden, when they wished. A copy of the letter sent by the LFEPA and dated 3rd November, following a recent inspection, identified that fire safety arrangements were below the standard expected and recommendations/requirements have been made. Spanish & Portuguese Jews Home For The Aged DS0000017448.V280085.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29, 30 The home continues to support staff undertaking NVQ training as residents benefit from staff who have developed their understanding and awareness of the needs of the client groups. Comprehensive recruitment procedures include carrying out checks on prospective carers, in order to protect the safety and welfare of the residents. The home needs to ensure that a valid enhanced CRB disclosure has been obtained for each member of staff. A comprehensive programme of training for staff enhances the quality of service received by residents. Standard 27 was inspected during the previous inspection in April 2005. EVIDENCE: There is now a new company providing NVQ level 2 training for its carers and 10 members of staff began their training in October 2005. This is in addition to the 10 carers who already hold an NVQ level 2 qualification and a further 2 carers who are privately studying for this awarded. The manager has been advised that the carers who commenced training in October will need approximately 12 months to complete their training. If all the staff currently undertaking training complete this the home will achieve the target of 50 of carers being qualified to an NVQ level 2 standard. Therefore the timescale for compliance with this standard has been extended from the 31st December 2005 to the 1st November 2006. Four staff files were inspected. Each contained a PoVA First check, an application form, 2 references, proof of ID (passport details), right to work if Spanish & Portuguese Jews Home For The Aged DS0000017448.V280085.R01.S.doc Version 5.1 Page 18 required, contract and terms and conditions of employment. One file contained only a standard CRB disclosure and one file contained an enhanced CRB disclosure that had been obtained whilst working for a previous employer. This is not portable. A discussion took place with the member of staff who has responsibility for the induction and foundation training for new members of staff. A copy of the training record and booklet was available for inspection. It refers to the Care Standards Act and NVQ training. A training programme is also in place for staff, which includes topics specific to the client group e.g. dementia and to the needs of residents e.g. safe working practices. Training in respect of the Jewish religion and festivals is also given to new members of staff so that they fulfil the aims of the home. Spanish & Portuguese Jews Home For The Aged DS0000017448.V280085.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 35, 38 By continuing her personal development, through further training, the manager is promoting the efficient and effective running of the home. Staff, residents and relatives have worked together in building a team spirit and creating an inclusive atmosphere in the home. Support is given to residents who need assistance in managing their finances so that residents’ financial interests are protected. Risk assessments and training for staff in safe working practice topics promotes the health and safety of residents, staff and visitors to the home. EVIDENCE: The manager has enrolled on a Registered Manager’s Award course of studies and said that she is nearing completion. The manager created a team building exercise which included unit managers organising a fun day. On the day the residents on the high dependency unit Spanish & Portuguese Jews Home For The Aged DS0000017448.V280085.R01.S.doc Version 5.1 Page 20 took part in a hat parade while residents on the other 2 units, about 24 in total, took part in a fancy dress parade. The day also included games, a special lunch and entertainment e.g. a display of traditional dancing by Nepalese carers. Relatives were invited to attend. The fun day also included a display of blankets where the squares had been made by staff, residents and relatives visiting the home on a “knit and natter” basis. The blankets were given to charity but there was a prize for the best blanket and residents and staff from the unit that had made the blanket went on an outing to Buckingham Palace. The manager said that unit managers worked together as a management team and that the unit manager and the staff on their unit worked together as a team. This exercise in team working has developed closer relationships within the teams and benefited residents. Residents confirmed that residents’ meetings took place in the home and there was a notice that the next meeting would be held on the 14th November. A resident said that the home was “beautifully run”. There is a named member of the finance team who is responsible for supporting residents with their personal allowances. Only 2 of the residents who receive their personal allowance through the home are able to manage this for themselves and to draw this on a weekly basis. The residents sign a form acknowledging receipt of their money. The other 5 residents have computer records of the running total for money kept in safe keeping, on their behalf. It is kept in a separate bank account from those used by the company but the account does not pay interest to the residents. Training in health and safety is included in the content of the NVQ level 2 course and the home also offers training in safe working practice topics i.e. first aid, manual handling, fire safety and infection control. Recorded risk assessments are in place for some safe working practice topics. A record is kept of accidents in the home. Spanish & Portuguese Jews Home For The Aged DS0000017448.V280085.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 3 18 3 2 X X X X X X X STAFFING Standard No Score 27 X 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 4 X X 3 X X 3 Spanish & Portuguese Jews Home For The Aged DS0000017448.V280085.R01.S.doc Version 5.1 Page 22 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 OP19 Regulation 23.4 Requirement That the home complies with the recommendations/requirements identified by the LFEPA in their letter dated 3/11/05. That 50 of care staff achieve an NVQ level 2 qualification. (Previous timescale of 31st December 2005 not met). That each staff file contains an enhanced CRB disclosure and that it has not been obtained whilst the member of staff has been in previous employment. That the manager achieves an NVQ level 4 in management. (Previous timescale of 31st December 2005 not met). Timescale for action 01/05/06 2 OP28 18 01/11/06 3 OP29 19.1 01/07/06 4 OP31 9.2 01/04/06 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 OP7 Good Practice Recommendations That the home reviews how it communicates with relatives DS0000017448.V280085.R01.S.doc Version 5.1 Page 23 Spanish & Portuguese Jews Home For The Aged 2 3 4 5 6 7 OP8 OP12 OP16 OP19 OP30 OP35 about important matters affecting the resident. That carers remind residents of the jugs of water and juice available in the lounges and offer these at regular intervals to residents. That an announcement be made at mealtimes to remind residents of the activities taking place that morning or afternoon. That the home discusses the complaints policy at the next relatives meeting. That the toilets near the lounge and dining room are checked at regular intervals during the day by staff. That the home cross references its induction and foundation training package with the TOPSS standards and makes amendments, if necessary. That money kept in a bank account on behalf of a resident earns interest for the resident. Spanish & Portuguese Jews Home For The Aged DS0000017448.V280085.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 Spanish & Portuguese Jews Home For The Aged DS0000017448.V280085.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!