Inspection on 21/04/09 for St Stephens Nursing And Residential Home

This inspection was carried out on 21st April 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Stephens Nursing And... 21/01/09

St Stephens Nursing And... 03/04/07

St Stephens Nursing And... 01/11/05

St Stephens Nursing And... 31/05/05

St Stephens Nursing And... 02/11/04

St Stephens Nursing And... 27/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 07/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Stephens Nursing And Residential Home St Stephens Nursing And Residential Home 4 St Stephens Avenue Bispham Blackpool Lancashire FY2 9RG     The quality rating for this care home is:   one star adequate 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: Jacqueline Riley     Date: 2 1 0 4 2 0 0 9 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. that people have said are important to them: They reflect the things 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 Older People 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. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: St Stephens Nursing And Residential Home 4 St Stephens Avenue St Stephens Nursing And Residential Home Bispham Blackpool Lancashire FY2 9RG 01253352625 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : st_stephens@btconnect.com Mrs Brenda Christine Bell,Mr Keith Bell care home 31 Number of places (if applicable): Under 65 Over 65 0 dementia Additional conditions: 31 The registered person may provide the following category of service only: Care Home only - Code PC To Service Users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia - Code DE The maximum number of Service Users who can be accommodated is: 31 Date of last inspection Brief description of the care home St Stephens Nursing Home is registered to care for up to 31 people with dementia. The home is a detached 3-storey house with a purpose built 2-storey extension to the rear. The home is situated in the residential North shore area of Blackpool, close to the seafront, and approximately 10 minutes by car to the town centre. There is good access to local transport networks. There are a full range of appropriate aids and adaptations in place to meet the needs of residents who are frail and immobile. The home has 27 single rooms, 14 with en Care Homes for Older People Page 4 of 28 Brief description of the care home suite facilities, and 2 double rooms. The home has a Statement Of Purpose and Service User Guide providing information about the care being provided, the qualifications and experience of the owners and staff and the services people can expect if they choose to live at the home. Information provided by the home on 21st April 2009 showed that fees for the home are £364.70 to £583.68 per week with some additional costs for one to one funding. There are added expenses for transport, magazines and other small items. Care Homes for Older People Page 5 of 28 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: A key inspection of the service was undertaken which included an unannounced visit to the home over a five hour period on 28th April 2009. We spoke to the registered manager and general manager, five staff members, and a number of residents. As the majority of people living in the home demonstrate a range of dementia type conditions communication was limited. We therefore rely on comments from people we can talk to including staff and surveys we receive when planning the inspection of the home. As part of the inspection process we asked staff about peoples needs. We also looked at their rooms, care plans, records and daily notes this is called case tracking. We also Care Homes for Older People Page 6 of 28 invite others using the service to pass on their opinions if they wish. We had a reasonable response from questionnaires sent to people who use the service for their views on how they experience the service. Some of the comments are included in this report. Every year the person in charge or manager is asked to provide us with written information about the quality of the service they provide, and to make an assessment of the quality of the service. We use this information, in part, to focus upon our inspection activity. We looked at recruitment and training records of two staff members. We walked around the building and watched people living and working in the home to see how everyone supported and talked to each other. What the care home does well: What has improved since the last inspection? What they could do better: We looked at recruitment and found in one instance a member of staff has received a Protection of Vulnerable Adults check, however the home is still waiting for the return of a criminal records check. This has been for some length of time and the home have now applied for another check so that people using the service are safe. We found that in instances where allegations of abuse are raised with the home it is necessary for the manager to use the protocols in place for suspected abuse. In such instances records must be kept of any allegations and actions taken so that people are protected and there is a clear audit trail of information, including the decision making process. We found the range of activities available to people living in the home remains limited. There is a weekly entertainer visiting the home and a monthly entertainer. We saw there is a daily activity record in the main office however after speaking to people using the service we found this is not usually implemented. We were told there is little activity available to their relative. Staffing levels were also found to impact on the time staff have available to provide activity or stimulation for people. People living in the home would benefit from a programme of activity designed to meet the needs of people with dementia conditions. We spoke to staff about training and found there has been limited training made Care Homes for Older People Page 8 of 28 available for staff to train to meet the needs of people with dementia conditions and challenging behavior, however the manager told us this is currently being developed and will be made available to all care staff. Some staff training in mandatory areas of moving and handling and first aid have not been updated for some staff which has the potential for a negative outcome for people using the service. We looked at the homes induction training records and found that they need to be reviewed so that they provide more evidence the staff are equipped with the knowledge,skills and competence in specific areas so that they are able to provide the necessary level of care required. We spoke to the manager about this and a new induction record is being considered which provides more evidence of the competency levels of staff in any one area of care. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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 admission and assessment procedures are clear and precise to ensure the needs of people living in the home are being met. Evidence: We looked at the records of three people, they had assessment information recorded in detail, so that staff know what the individual needs are. Included in the assessment information were assessments by other professionals as well as the homes own pre assessment prior to people being admitted to the home. These processs makes sure peoples needs are assessed prior to coming into the home. We talked to the registered manager and senior staff who said pre assessments are always undertaken so that the home knows if the home can meet the needs of the resident. In some instances people are not able to communicate their needs or information due to the level of dementia or psychiatric conditions. We saw in one Care Homes for Older People Page 11 of 28 Evidence: instance a relative is involved in the care planning and review process and works closely with the management and staff team so that they feel confident the home can meet their relatives needs. Comments included, they tell me if there are going to be any changes made, the home does what they can for my relative and I am confident about what they can do for them,I had other relatives here so I knew what to expect. Staff spoken to said they use this assessment information to determine the level of care people need. Comments received said,the manager makes sure assessments are taking place so we have the necessary information to provide the right level of care. Care Homes for Older People Page 12 of 28 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. Promotion of health is taken seriously. Peoples welfare is closely monitored and health needs are identified and met. Evidence: The records of three people who were case tracked as part of the inspection process were up to date and complete. The information was clear with evidence of relatives being involved in the care planning process. Comments told us, I talk with staff about what I need and they put it into place. We found the care plans are well structured with evidence of reviews taking place on a regular basis so that changes can be made accordingly. The care plans have individual sections including health care. In this section the specific medical and healthcare needs of the people are recorded. We saw there are good links with doctors district nurses and social workers as well as specialists so that people living in the home are not disadvantaged in any way and their individual health needs are being met. Care Homes for Older People Page 13 of 28 Evidence: Records showed there are individual risk assessments on the files looked at. They identify the risks to the people living at the home and what action should be taken to manage the level of risk. Staff told us they regularly update this information as changes can occur on a regular basis. Medication practices we observed during the time spent at the home were seen to be safe and good records are being maintained so that the practices meet current guidelines. We spoke to the manager about who is responsible for administration of medication and were told only qualified staff are responsible for this task. The homes policies and procedures for medication management have been updated and staff are to be made aware of them so that they use current good practice guidelines. Staff told us they feel confident with the systems in place. We looked at how peoples dignity and privacy are protected and we found staff treated people with respect at all times. We made observations in communal areas and saw staff talked to people in a sensitive way, they assisted them in a dignified way and all residents were seen to be comfortable with the staff on duty. We saw staff always knocked on peoples doors and waited for a response before entering so that their privacy was protected. Comments we received said, Staff have always got time for my relative and they are so patient, they are always around for you, but they can be very busy sometimes. Staff said, we always respect residents right to privacy and we always treat them with respect and in a dignified way because many of them dont know what they are doing. Care Homes for Older People Page 14 of 28 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. 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. The range of activities available to people living in the home is limited meaning they have a lack of stimulation to meet their specialist needs. Meals are well presented and provide choice for residents. Evidence: We saw there are daily routines in place which staff said people with dementia conditions need for continuity. Most people spend time in the main lounge area for the day, this room is also used as the dining area. A few people spend the day in their rooms of their own choice, as confirmed when we spoke to them. We spoke to the managers and staff about what activities are available and found there is a weekly entertainer who visits the home, and there is a monthly entertainer who provides singing and music. Staff told us people enjoy this, by way of their responses. We saw there is a daily list of a range of activities including board games, hand massage and other activities which can be carried out by members of staff. We found however these activities are rarely followed. In some instances we were told this is due to staffing levels and the time staff can make available. Whilst there is no indication of people not having their needs met, there should be more emphasis placed on providing a range of activities for people so that they are stimulated. A comment told us there are no Care Homes for Older People Page 15 of 28 Evidence: activities available for people, whilst this was not seen to be the case activities were limited. In most cases there is a need to explore areas of activities specifically designed to meet the needs of people with dementia conditions. A random inspection in January 2009 provided some advice and guidance on areas the home should explore in order to develop sensory activity for people with dementia conditions. People living in the home have a good choice of daily meals which are served and presented in a pleasant way. We were told people like the choice of meals available to them. There is a designated cook who prepares meals daily. The main meal is served at lunchtime and was seen to be enjoyed by people living at the home. There are a number of people who require assistance with eating their meals. This was seen to be carried out in a sensitive way by staff, by way of sitting with them individually and talking to them. We saw people responded well to this approach. Staff told us there are choices at tea time, and in instances where people cannot communicate their choices the staff team try to find out what their likes and dislikes are from relatives and friends. Special diets are catered for and we saw this is in place for people with low fat diets and diabetic nutritional needs, so they are not disadvantaged in any way. Care Homes for Older People Page 16 of 28 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. Arrangements for recording and responding to complaints are in place making sure people feel listened to. Safeguarding procedures are in place however by not using the procedures in instances where allegations are made has the potential to put people at risk. Evidence: We looked at the homes complaints procedure, which is made available to people who use the service and their relatives or advocates during the admission process. We were informed people are aware of the complaints procedures and how to use it. Comments included, Many of the residents cant make complaints themselves because of their dementia, but the relatives know how to make complaints. We did not see any evidence of complaints being made to the home during the inspection process. Surveys we received told us people know how to make complaints and who to complain to. We found the home has policies and procedures in place for safeguarding people. They have recently been reviewed to take into account how people are protected. We spoke to staff about what knowledge they have in place about safeguarding people. They told us they have recently received updated training in this area and feel equipped with the knowledge to act on any suspicions of abuse. Training in this area is ongoing and all Care Homes for Older People Page 17 of 28 Evidence: staff will have received updated training in the near future. One safeguarding investigation has taken place and it was found the home did not make any written record of the allegation or use current safeguarding guidance to refer to the appropriate agency, which has the potential to put people at risk. Care Homes for Older People Page 18 of 28 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, 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. 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 living at the home live in a well adapted, clean and comfortable environment. Evidence: We looked around the home and found it to be maintained to a good standard. All windows in the home have been replaced since the last key inspection. It is set on three levels . The main communal lounge and dining room is situated along the ground floor area. There is a range of seating and dining areas for residents to use in this space. There are key pad locking facilities in this area as many residents would be at risk if they left the area unaided. Residents have access to the front entrance hall although there is a key pad locking mechanism on the main door again to manage risk factors for residents. People who live in the home occupy rooms on all floors. We found them to be pleasantly furnished with personal items including individual pieces of furniture, ornaments and photographs. Comments we received included, my relative has a really nice room with things that make it look familiar to them, I like to use my room because I have all the things I need in here. There are policies and procedures in place for infection control and some staff have had access to some training in this area. There are designated staff for domestic tasks Care Homes for Older People Page 19 of 28 Evidence: and laundry tasks, although their duties may also include care. The home was seen to be clean and free from offensive odours throughout. Laundry facilities are in place to meet the needs of the people living at the home, and care is taken to make sure clothing is returned to the named resident. Care Homes for Older People Page 20 of 28 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. 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. There are procedures for recruiting staff, ensuring the safety and protection of residents. Training for staff is being developed so that they are meeting the needs of residents. Staffing ratios are sometimes limited having the potential to have a negative impact on people living at the home. Evidence: We looked at how the home deploys its staff. Rotas looked showed us there is a skill mix of staff on any one shift. Some people are afforded one to one care which means they have a designated member of staff providing care during the day time period. We found that whilst the ratios meet the needs of people living in the home there are occasions when staff are short due to absence, in such instances the management team endeavor to bring into the home additional staff. Comments received told us staff feel stretched at times and there is little additional time available to carry out activities or other tasks in addition to the essential care needs. We spoke to the management team about this and it was acknowledged there can be instances when staffing levels are reduced due to absence and this is an area they are looking to improve. Staff training is being developed by the home. We spoke to the management team about this and were shown a training package which is being introduced for all care Care Homes for Older People Page 21 of 28 Evidence: staff. We saw there is a requirement for staff to receive mandatory training in moving and handling and first aid so that their practices are up to date. Some staff have had limited training especially in areas of dementia training and managing challenging behavior. Comments included, we need more training in managing the complex needs of the residents, as they are challenging in a lot of cases, I attended a lot of training some time ago but they need updating now. We saw the home have over 50 of the staff who have achieved a nationally recognised care qualification and that some of the staff team are taking higher levels of care qualifications so that they are equipped with the knowledge and skills to provide care to people. We looked at recruitment files and found they contained the necessary recruitment checks to ensure staff are fit to work in the home, in one instance there is a requirement to re apply for a criminal records check as the original had not been returned however this member of staff does have a first line check in place, and does not work alone but with other senior staff members until the return of an acceptable records check. Staff induction provides limited evidence the member of staff has reached a level of competency in specific areas of care. We found current information focuses on personnel issues and health and safety. Whilst both of these areas are essential there needs to be an induction format which takes into account staff competency in areas of care so that there is a clear baseline for future training and development. We talked to the manager about this and other types of induction records are being considered to improve the process. Care Homes for Older People Page 22 of 28 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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. St Stephens is managed with systems policies and procedures to promote the health and safety of people living and working there. Lack of staff meetings means that the staff team are unable to contribute their views and opinions about the service. Evidence: We looked at the management systems in the home and found many of the policies and procedures have been reviewed and implemented so that the information is up to date and reflects current good practice in the care the home. Surveys and comments we received told us people are generally satisfied with the service they or their relative receives at the home. We saw there are now monthly reports in place which take into account an audit of the service and how the service is operating, so that regular monitoring can be used to make changes to improve the service for people who live there. Care Homes for Older People Page 23 of 28 Evidence: Due to the level of dementia displayed by most residents there are no resident meetings taking place, however managers said comments from relatives, friends and advocates are taken into account. Surveys are used as part of a quality monitoring system which can effect change. There are no staff meetings taking place which means the staff are not being given the opportunity to contribute any issues they feel may be relevant to the running of the home. Staff comments told us they feel meetings would be beneficial and a place where they could share ideas and opinions. The way the home manages residents money is well documented and two records checked were accurate. The information we were provided with shows the home checks all appliances regularly for the health and safety of people using the service. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Older People Page 25 of 28 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 Requirement 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 Requirement Timescale for action 1 12 16 There must be evidence the 31/08/2009 home provides a range of activities for people who live there which are suitable for people with dementia conditions. Lack of suitable activities for people living in the home means they are disadvantaged and lack suitable stimulation to meet their specialist needs. 2 18 17 The home must make records of any incident which may be raised using safeguarding procedures for the health and safety of people using the service. In order to ensure people living at the home are protected actions taken when a safeguarding issue is raised must be recorded so that there is a clear audit of information and actions taken by the home. 30/06/2009 Care Homes for Older People Page 26 of 28 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 32 The home should put in place formal staff meetings so that staff have the opportunity to contribute their ideas and feelings about the service and the development of the service for the benefit of people who live and work there. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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 © (2009) 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 Older People Page 28 of 28 - 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!