Inspection on 21/07/05 for St Cross Grange

This inspection was carried out on 21st July 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

St Cross Grange 01/02/07

St Cross Grange 17/01/06

St Cross Grange 08/11/04

St Cross Grange 15/06/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE St Cross Grange 140 St Cross Road Winchester Hampshire SO23 9RJ Lead Inspector Marilyn Lewis Unannounced 10:00 a.m. 21/07/05 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 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. St Cross Grange H54 S11598 St Cross Grange v227663 210705.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service St Cross Grange Address 140 St Cross Road Winchester Hants SO23 9RJ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01962 854865 Greensleeves Homes Trust Ms Philippa Wrightson CRH 29 Category(ies) of OP Old age registration, with number of places St Cross Grange H54 S11598 St Cross Grange v227663 210705.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th November 2004 Brief Description of the Service: St Cross Grange is one of seventeen care homes for older people, owned and operated by Greensleeves Homes Trust, a not for profit organisation. The home provides care for up to twenty-nine male and female residents over the age of sixty-five years of age. St Cross Grange is a large Victorian house, situated on outskirts of Winchester. Access to the M3 is a few minutes away and there is a local bus service nearby. There are local shops within a short distance and Winchester city centre is just over a mile away. The home comprises three floors, with accommodation provided on the ground and first floor and the top floor being used for management offices and additional storage space. Residents have access to a communal lounge, library, dining room and conservatory. The large garden is mainly laid to lawn, with car parking facilities to the front and side of the property. St Cross Grange H54 S11598 St Cross Grange v227663 210705.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over five and a half hours on the 21st July 2005. The inspector toured the home and had the opportunity to meet with six of the twenty- four people resident at the time of the visit, two visitors, the registered manager, deputy manager, assistant manager and the training officer for the organisation. Care plans were sampled for three residents and records seen for medication, fire, fridge and freezer temperatures and for the maintenance of electrical equipment, water systems and specialist equipment. Staff rotas and personal files for three staff members were also seen. Service users at the home, wish to be known as residents and this has been respected. What the service does well: A clear statement of purpose and service user guide provides prospective residents with the information they need to make a decision about life at the home. No one is admitted to the home without a full care needs assessment, ensuring the home can meet the identified care needs. Detailed care plans provide the information staff require to fully support the residents. Staff follow clear procedures for dealing with medicines and where appropriate residents are supported to administer their own medication. Residents are treated with dignity and their wishes are respected throughout their stay at the home. The home provides a varied and interesting programme of activities that residents are able to access as they wish and visitors to the home are made to feel welcome. Residents are offered a choice of well presented and appetising meals, taken in a relaxed and friendly atmosphere. St Cross Grange H54 S11598 St Cross Grange v227663 210705.doc Version 1.30 Page 6 Residents know that all complaints will be taken seriously and acted upon promptly. The provision of specialist equipment, comfortable communal rooms, personalised individual rooms and sufficient bathroom and toilet facilities gives a clean, safe and homely environment for all who live and work there. The number and skill mix of staff is sufficient to meet the care needs of the residents. The registered manager provides strong leadership and an open approach to management that benefits the residents, visitors and the staff. Residents’ financial interests are safeguarded by the homes’ procedures for handling the small amounts of money kept at the home. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Cross Grange H54 S11598 St Cross Grange v227663 210705.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection St Cross Grange H54 S11598 St Cross Grange v227663 210705.doc Version 1.30 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 standard(s) 1, 2 and 3 Prospective residents and their relatives are given clear information about life at the home and no one is admitted to the home without a full care needs assessment, ensuring the home can meet their care needs. EVIDENCE: The home has a statement of purpose and service user guide in place that provides clear information for prospective residents and their relatives with regard to life at St Cross Grange. The documents state the organisational structure of the home, the experience and qualifications of staff and the facilities and services provided at the home including the number and size of the residents’ individual rooms. The documents are produced in a format that is suitable for prospective residents and can be made available in Braille should the need arise. On admission, each resident is given a written contract of terms and conditions for residency at the home. The contract states what is covered by the fees and notes services and facilities that are available at additional cost such as hairdressing and dry cleaning. St Cross Grange H54 S11598 St Cross Grange v227663 210705.doc Version 1.30 Page 9 A full care needs assessment is undertaken for each prospective resident prior to admission. The assessment is completed by the registered manager, at the prospective residents’ home or place of residence. The assessment covers personal, social and emotional care needs. Information from care managers and health professionals is included in the completed assessment report and relatives are encouraged to participate in the assessment process. T St Cross Grange H54 S11598 St Cross Grange v227663 210705.doc Version 1.30 Page 10 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 standard(s) 7, 9 and 11 Detailed care plans provide staff with the information required to meet the residents’ care needs and clear procedures for dealing with medicines ensures the safety of residents’ health. Residents are cared for with dignity and their wishes are respected throughout their stay at the home. EVIDENCE: Individual care plans were sampled for three residents who had been admitted to the home within the last nine months. The plans were detailed and provided staff with clear information with regard to the residents’ care needs and the actions required to meet those needs. The residents’ leisure interests and hobbies were noted and also their likes and dislikes, such as, likes an early morning cup of tea. The plans contained risk assessments including those for moving and handling and falls. The care plans seen had been reviewed frequently and were signed by the resident. The home has clear procedures for dealing with medicines. Medication records seen had been completed appropriately and records for controlled medicines St Cross Grange H54 S11598 St Cross Grange v227663 210705.doc Version 1.30 Page 11 sampled, matched the stock held. The temperature of the fridge storing some medicines was being monitored and recorded. Staff receive in house training from the registered manager, who is a qualified nurse, and up to date information is available for medicines used in the home. Some residents self administer their own medication. Risk assessments are in place for these residents and their ability to self administer their medicines is reviewed regularly. Residents’ wishes regarding care when dying is recorded in their care plans and the registered manager said that residents were able to remain at the home if at all possible. Advice and support is accessed through the district nurses and the GP. Visitors are able to stay with the resident as they wish including overnight if necessary. The inspector saw a letter from a family of a resident who had recently died at the home thanking staff for treating their relative with dignity and for their support and consideration at a distressing time. St Cross Grange H54 S11598 St Cross Grange v227663 210705.doc Version 1.30 Page 12 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 standard(s) 12,13,14 and 15 Residents exercise choice and control over their lives and are able to participate in a variety of suitable leisure activities both at the home and in the community. The home offers residents a choice of balanced, well-presented meals that are provided in a relaxed friendly atmosphere. EVIDENCE: Staff at the home have developed an activities programme that is suitable for the residents. The programme includes visits from a ‘Pat a dog’, musical evenings, sing-a-longs, and film evenings. Transport is hired for residents to go on outings to places of interest, with recent trips to Mottisfont Abbey and a local garden centre. The registered manager said that in June the home held a successful open day, where residents and their visitors enjoyed cream teas. During the inspection visit, a gentle exercise session was being held for ten residents. The assistant manager, who takes the exercise sessions, has attended a training course on providing exercises for the elderly. Three of the residents participating in the session said they enjoyed it with one commenting ‘ I look forward to the exercise group every week’ The registered manager said that discussions were taking place with an activities co-ordinator with regard to providing additional programmed activities. St Cross Grange H54 S11598 St Cross Grange v227663 210705.doc Version 1.30 Page 13 Some of the residents make their own arrangements to go out into the city or to visit relatives and friends in the community. The residents’ cultural needs are recorded in their care plans and a local minister visits the home for a communion service monthly. Records seen indicated that some residents regularly attend local church services. The statement of purpose states that visitors are welcome at the home but should notify staff if they are going to visit late at night. Two visitors to the home, spoken to during the inspection, said that they are made to feel welcome at the home at any time. It was evident during the inspection visit that residents are able to exercise choice and control over their daily lives. Residents were able to choose to participate in the exercise session, read the daily newspapers, sit quietly and chat or walk in the grounds. Residents are able to take their meals in the dining room or the privacy of their own room. Menus seen indicated that residents were able to choose from varied and interesting meals. On the day of the visit, meals served at lunchtime looked appetising and well presented. Residents had a choice of roast chicken with roast potatoes, swede and cabbage or tuna pasta bake, with sponge pudding and custard for desert. A good supply of fresh fruit was also on offer. Four residents spoken to during lunch said that the food provided at the home was good. The atmosphere in the dining room was relaxed with staff supporting residents in a friendly and unhurried manner. St Cross Grange H54 S11598 St Cross Grange v227663 210705.doc Version 1.30 Page 14 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 standard(s) 16 Residents know that any complaints will be taken seriously and acted upon promptly. EVIDENCE: The home has a complaints procedure in place that states who will investigate the complaint and gives timescales for the process. The complaints records seen indicated that all complaints and concerns are taken seriously and investigated promptly. The complaints procedure is readily available for residents and visitors to the home. The three residents spoken to with regard to voicing complaints, knew how to make a complaint but said that they had no cause to do so. St Cross Grange H54 S11598 St Cross Grange v227663 210705.doc Version 1.30 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 standard(s) 19, 20, 21, 22, 23, 24, 25 and 26 The provision of specialist equipment, comfortable communal rooms, personalised individual rooms and sufficient bathroom and toilet facilities gives a clean, safe and homely environment for all who live and visit there. EVIDENCE: St Cross Grange is a large Victorian house providing accommodation for twenty nine residents in single rooms, although at the time of the inspection a husband and wife chose to share one of the larger single rooms. At the time of the inspection the home looked clean and well maintained. Visitors are required to ring a bell for entry to the home ensuring staff are aware of people visiting the property. Visitors are also asked to complete the visitor record book. Since the last inspection the home has recruited a part time gardener to maintain the grounds of the property, which looked attractive with hanging baskets and seating provided on the lawn. St Cross Grange H54 S11598 St Cross Grange v227663 210705.doc Version 1.30 Page 16 The home has a lounge with adjoining conservatory and a library that is also used as a quiet lounge. Residents also sit in the large hallway where as one commented ‘I can see who’s coming and going’. The separate dining room is also used for the exercise sessions. All the rooms looked comfortable and the furniture looked to be in good repair. The home has sufficient bathroom and toilet facilities with three assisted bathrooms, two non- assisted bathrooms and one shower room. Wheel chair users are able to access the separate toilets located on the ground and first floor. Two of the residents’ individual rooms have en-suite shower and toilet facilities, eleven have en-suite toilet and wash hand basins and the remainder are fitted with a wash hand basin. On the day of the inspection visit, all the bathroom and toilet facilities looked clean and in good order. The home has two hoists available to assist resident with poor mobility and ramps and grab rails are provided where necessary to allow residents as much independence as possible. A passenger lift and stairway allow access between the ground floor and the first floor and a stairway gives access to the second floor used by staff. A call alarm system is fitted in all areas accessed by residents. Residents’ individual rooms are cheerful and homely and suit their needs. The registered manager said that residents were encouraged to bring personal items into the home and rooms seen had been personalised with items such as pictures, photographs and ornaments. A refurbishment programme is underway with one room being refurbished each month, starting with rooms that at present are vacant. Three refurbished rooms seen looked attractive with new carpet and furniture and matching curtains and bed covers. Rooms in the home feel light and airy with many with windows that provide views over the gardens. Lighting is domestic in style and in keeping with the character of the home. At the time of the inspection all areas of the home looked clean and was free from offensive odours. The registered manager is a clinical nurse specialist in infection control and all staff receive training in infection control during induction. Disposable gloves and aprons were seen to be readily available for staff. St Cross Grange H54 S11598 St Cross Grange v227663 210705.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 Residents’ needs are met by the number and skill mix of staff on duty at any one time but their safety could be put at risk by the lack of robust recruitment procedures. EVIDENCE: The registered manager said that staffing levels were flexible to meet the needs of the residents and rotas seen indicated that sufficient staff were on duty to support the residents. Two staff members and three residents spoken to also said that they felt there were enough staff on duty. The home employs a registered manager, deputy manager, assistant manager and nineteen carers. Separate staff are employed for catering, domestic, maintenance and gardening duties. Agency staff are employed to cover holidays and sickness as required. The deputy manager is a trained social worker who started work at the home a month ago. The deputy manager and the assistant manager have separate areas of responsibility and it was evident when speaking to them that they were aware of their roles and responsibilities. During the visit the inspector met with the training manager for the organisation who was discussing the future training programme for staff employed at the home with the deputy manager who is taking over the responsibility for staff training at the home. It was decided to look at the training programme and records at the next inspection when the deputy manager has been in post for longer and the future training programme has been arranged. The registered manager has taken a keen interest in training St Cross Grange H54 S11598 St Cross Grange v227663 210705.doc Version 1.30 Page 18 for staff members and at least fifty percent of the care staff hold NVQ level 2 or above. The registered manager said that the home had been accepted by a local university to provide training for student nurses in caring for the elderly in residential care homes and were awaiting the arrival of the first students. Prospective employees are required to complete a suitable application form and attend an interview with the registered manager. Records seen for three staff members recently employed at the home indicated that one carer had not had a Criminal Records Bureau check completed prior to starting work at the home, but had a check done for a previous employer. This was discussed with the registered manager and it was agreed that the carer would be supervised until a check was completed for the home. No one is to start work at the home until a Criminal Records Bureau check has been completed. St Cross Grange H54 S11598 St Cross Grange v227663 210705.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35 and 38 Residents and staff benefit from strong leadership and an open approach to management. Regular quality assurance monitoring ensures the views of the residents are obtained and used to measure the success of the aims and objectives of the home. The lack of consistent monitoring of the temperatures of the fridge and freezer equipment could put the health of residents at risk. EVIDENCE: The registered manager is a trained nurse with experience in providing care for the elderly. She holds a BSc(Hons) in Health and Social Studies and has been in post for four years. The registered manager said that she reports directly to the Directors of the organisation. St Cross Grange H54 S11598 St Cross Grange v227663 210705.doc Version 1.30 Page 20 The registered manager operates an open door approach to management. Four staff members spoken during the visit said that they received support and encouragement from the registered manager and three residents said that they felt able to speak to her if they had any concerns or queries. The registered manager said that she meets with the Directors of the organisation to arrange an annual development plan for the home. Feedback from residents on the quality of care provided at the home is gained through meetings held every two months and through questionnaires. The registered manager said that the questionnaires usually have a specific topic with the most recent survey concentrating on food items offered for breakfast. The responses obtained are audited and acted upon. Comment cards received by the Commission from nine residents of the home indicated that the residents found the care provided to be good. Two visitors to the home commented on the good quality of care provided for the resident they visited and also said that it was a pleasure to see staff spending time talking to the residents. The home holds small amounts of money for residents. The monies are stored individually in a secure place. Records seen for three residents matched the balance held. Receipts are kept for transactions. During a tour of the home it was noted that all hazardous substances such as cleaning products were kept securely stored. The kitchen looked clean with food stored appropriately. However records for the monitoring and recording of the fridge and freezer temperatures were incomplete. It had been a requirement of the inspection dated 8th November 2004 that the temperature of the fridge and freezer be recorded on a daily basis. Records seen indicated that electrical equipment, water systems and specialist equipment such as the hoists were checked at regular intervals. Fire records indicated that all staff received fire safety training and fire drill practice but the fire drills were at an arranged date and time so staff were aware they were to take place. This was discussed with the registered manager and it was agreed that fire drills would take place without prior warning for staff. This will be checked at the next inspection. St Cross Grange H54 S11598 St Cross Grange v227663 210705.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 3 3 x 3 x x 2 St Cross Grange H54 S11598 St Cross Grange v227663 210705.doc Version 1.30 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 OP29.3 Regulation 19(1)(b) Requirement The registered person must ensure that all staff complete a Criminal Records Bureau check and a satisfactory check of the Protection of Vulnerable Adults register prior to commencing employment at the home. This is a partial outstanding requirement of the inspection dated the 8th November 2004. The temperature of the fridge and freezer used to store food must be monitored and recorded daily. This is an outstanding requirement of the inspection dated 8th November 2004 Timescale for action 31/07/05 2. OP38.2 13(4)( c ) 22/07/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations St Cross Grange H54 S11598 St Cross Grange v227663 210705.doc Version 1.30 Page 23 Commission for Social Care Inspection 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 St Cross Grange H54 S11598 St Cross Grange v227663 210705.doc Version 1.30 Page 24 - 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!