Inspection on 21/07/06 for Stroud Green Lodge

This inspection was carried out on 21st July 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Stroud Green Lodge 04/11/08

Stroud Green Lodge 19/01/06

Stroud Green Lodge 18/04/05

Stroud Green Lodge 01/12/04

Stroud Green Lodge 05/07/04

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

CARE HOMES FOR OLDER PEOPLE Stroud Green Lodge 49 Stroud Green Way Addiscombe Croydon Surrey CR0 7BE Lead Inspector Michael Williams Key Unannounced Inspection 21st July 2006 11:00a 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 Stroud Green Lodge DS0000043303.V287797.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. Stroud Green Lodge DS0000043303.V287797.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Stroud Green Lodge Address 49 Stroud Green Way Addiscombe Croydon Surrey CR0 7BE 020 8654 1339 020 8654 9715 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) London Borough of Croydon Mrs Garmit Wright Care Home 27 Category(ies) of Dementia - over 65 years of age (27) registration, with number of places Stroud Green Lodge DS0000043303.V287797.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. A variation has been granted to allow one specified service user under the age of 65 to be accommodated. The variation remains in force until such time as the needs of the service user can no longer be met or until such time as the placement ceases. Existing specified service users who are not in the DE(E) category may remain at Stroud Green Lodge whilst their needs can still be met and they choose to remain. 19th January 2006 2. Date of last inspection Brief Description of the Service: Stroud Green Lodge is a registered care home and is owned by the London Borough of Croydon [LBC]. It provides personal, but not nursing, care for up to 27 service users. The homes registration is in transition; in future the home intends providing care for people over 65 years of age who have dementia. A condition of registration is that the few existing service users who do not have dementia may remain in the home if they wish to do so, providing the home can continue to meet their needs. The home is situated to the East of Croydon and is close to public transport. Accommodation comprises 25 single and 1 shared bedroom. None has ensuite facilities but each has a wash-hand-basin. There are communal areas, lounges and/or dining rooms, on each of the three floors. The managing organisation, the LBC, was considering proposals that would mean the early closure of this home as a part of the plan to build new facilities on other sites but at the time of reporting the Local Authority has revised its plans. Inevitably, relatives and the many other people who represent the service users were very disappointed by the uncertainty, and possibility of early closure. The temporary reprieve, estimated to be until 2008, will be welcomed by the many people who like Stroud Green Lodge as it is. The Commission does not seek to influence decisions about the opening and closing of care home but does expect standards to be maintained throughout the life of a home. Fees are currently from £517 per week. Stroud Green Lodge DS0000043303.V287797.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The CSCI undertook an unannounced inspection midday on 21st July 2006. Whilst the Local Authority’s plans for its closure have not been brought forward as expected, the long term plan to replace old care homes for new ones is still in progress. The purpose of this inspection was to monitor key standards and to check progress in meeting the Commission’s requirements and also to check the safety and well being of the remaining service users. Many service users and several of the staff contributed to the inspection and their contribution is acknowledged. One relative was present and also most helpfully contributed to the inspection process. Whilst no other visitors were interviewed on this occasion their letters of appreciation are displayed in the entrance hall and indicate how much they appreciate the care provided in this home. What the service does well: What has improved since the last inspection? What they could do better: Recommendations are made in respect of the admission process; the home is not always receiving adequate, up to date information from the referring agencies. This will not only hinder care planning but may lead to the admission of service users outside the home’s registration category – if for example a person has a mental illness and not dementia and this not clear at the outset. Stroud Green Lodge DS0000043303.V287797.R01.S.doc Version 5.1 Page 6 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. Stroud Green Lodge DS0000043303.V287797.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 Stroud Green Lodge DS0000043303.V287797.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): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all new service users are being admitted only on the basis of a full assessment undertaken by people trained to do so and that involves the service user or their representative. This will compromise the resident’s, and the care home’s, decision about the appropriateness of the placement. EVIDENCE: Two case files of recently admitted service users were checked; the residents interviewed and staff discussed the circumstances of their admission. The information provided in one instance was inadequate; the person making the referral did not provide a ‘single comprehensive assessment’ and delivered just copy of a letter (between the resident’s General Practitioner and consultant) – this letter was six months old and mentioned support and investigations that were to be arranged. Medication was delivered but no evidence of the prescriber’s instructions that is which doctor had advised the medication and for what condition. Standard 3 advises that if no assessment is provided by a care manager then the home must undertake its own assessment of service Stroud Green Lodge DS0000043303.V287797.R01.S.doc Version 5.1 Page 9 user’s needs and this is a recommendation; where the care manager or other referring agency has supplied inadequate information the home must supplement this by undertaking its own pre-admission assessment so as to ensure that placement would appropriate in all the circumstances. In both cases examined by the Commission it was not absolutely clear that each resident had dementia as their primary need for residential care. It is acknowledged that this standard is usually met by this home and that initial assessment are usually in place; relatives confirmed on behalf of service users that they were well informed about service provided in this home prior to admission; they are given a contract and have a copy of the ‘service user guide’ and a copy of the Commission’s reports are made available to them; and that they were fully involved in assessment. The two lapses identified on this occasion are therefore out of the ordinary and not the fault of the home’s staff – but they are responsible for ensuring an adequate assessment is undertaken by themselves whether or not one is not provided by a care manager. Areas of strength are welcome provided by staff for new residents; the flexible manner in which they have supported new residents who have arrived in the home rather unexpectedly and without a full background history and needs assessment; matters requiring improvement are need to use the home’s assessment format to supplement the referrer’s assessment; so this section, about pre-admission assessment and supply of information, is assessed as adequate. Stroud Green Lodge DS0000043303.V287797.R01.S.doc Version 5.1 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 the following standard(s): 7 8 9 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for care planning, the provision of health care and the procedures for dealing with medication are all satisfactory so as to ensure the social, and health care of service users can be met. EVIDENCE: In standard 3 in the previous section, about pre-admission assessments, it was noted that the home had recently admitted at least one service user without a full assessment being undertaken however in this section it is noted that the home has a comprehensive range of assessment, monitoring and reviewing formats some of which could be used to make that crucial pre-admission assessment. A sample of case files were checked, residents interviewed and staff asked to comment upon these care plans. A visiting relative also commented about her mother’s cultural background and how she wished to be treated and what special dietary requirement she had – in this case her mother preferred English meals to others. It was noted that a plan of care is drawn up with each service user setting out their individual social and health care needs so that staff can use this plan as the basis for the care they deliver. The home Stroud Green Lodge DS0000043303.V287797.R01.S.doc Version 5.1 Page 11 is promoting and maintaining service users’ health by ensuring they have access to health care services to meet their assessed needs and in doing so the home is supporting service users to make decisions about how their health will be managed. One resident I regularly supported by a District Nurses and this is line with the home’s registration – that it can provide personal care but not nursing care unless provided by a visiting District Nurse who will supervise special treatments. The home has in place procedures for ensuring the safe management of medicines. This includes, where appropriate, support and risk management for service users who wish to be responsible for their own medication so that they may do so safely. The staff demonstrated a clear understanding of the issues involved in accepting medication brought in by relatives and other visitors – the home quite correctly seeks confirmation of the medicines to be administered from the doctor who provided the original prescription. No errors were identified in the home’s handling of medicines. When providing personal care staff are ensuring service users’ privacy and dignity is being maintained at all times so that service users feel their right to be treated with respect is upheld. The home is clearly very respectful of service users’ final wishes so as to assure service users know that their last days will be as comfortable as their condition allows. The diversity needs of residents from different cultures or lifestyles was examined by talking to service users, talking to their visitors and to staff who showed sensitive awareness of the complex issues of meeting cultural and diversity needs including such matters as religious belief and lifestyle, food and drink, last wishes and so forth. Areas of strength are detailed care plans, assessment and reviews demonstrated by good clear documentation and no matters requiring improvement were identified - so this section, about health and personal care, is assessed as good. Stroud Green Lodge DS0000043303.V287797.R01.S.doc Version 5.1 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 the following standard(s): 12 13 14 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The daily routines in this home are reasonably flexible, within the constraints of a large service. Service users are being supported and encouraged to maintain links with family, friends and to exercise choice and control over their lives in so far as they wish and are able to do so. Service users are receiving a wholesome, appealing and well balanced diet in a congenial setting in accordance with their recorded requirements and preferences. EVIDENCE: Recommendations have been made in the past about the range of activities so the Commission once again checked whether or not the suggestion of relatives (to offer more opportunity for activities) has been acted upon. Staff advise the inspector that a member of staff is allocated a role as ‘activity person’ for each shift and this was the case when the Commission visited in July. Staff were supporting several residents in a shaded spot in the garden on what was a very hot and humid day - so a degree of lethargy was to be expected. Indoors residents were offered a range of in-house and table-top and activities involving gentle exercise. On the day of inspection many residents were engaged in table-top activities such as dominoes, scrabble, jigsaw puzzles, drawing and a quiz designed to aid memory. Staff confirmed that residents are also offered short excursions and shopping trips. During this site visit a Stroud Green Lodge DS0000043303.V287797.R01.S.doc Version 5.1 Page 13 new resident was heard to be asking for a key to his bedroom and staff were very kind and helpful in offering a key and explaining how staff would need access to clean the room and so forth. Staff also pointed that this person is ‘a very private person’ and likes to bathe alone and this they facilitate. A recommendation was also made in respect of diversity to ensure the home is recognising the diverse backgrounds of service users by offering meals from other cultures and on the day of previous inspection a mild curry dish was available – the cook points out that it is usually English residents who prefer ‘foreign’ meals rather than residents from minority ethnic groups and a visiting relative confirmed this unexpected and abstruse point of view. Areas of strength are effort staff put into helping service users spend their day meaningfully and no matters requiring improvement have been noted - so this section, about social life and diversity in the home, is assessed as good. Stroud Green Lodge DS0000043303.V287797.R01.S.doc Version 5.1 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 the following standard(s): 16 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies and procedures are in place for the protection of service users and arrangements for complaining about, or commending, the service are in place so as to assure service users that their concerns will be heard and complaints dealt with in a professional manner. EVIDENCE: One complaint recorded since last inspection, this was dealt with by the home’s manger and did not involve the Commission. No issues requiring referral to the ‘protection of vulnerable adults’ procedures were identified. Inevitably, the uncertain future of this home caused something of a furore amongst supporters of the home and residents and litigation followed. This is a matter in the hands of the registered providers (London Borough Croydon). It is beyond the control of the home’s manager to influence the future of the home. The Commission will continue to monitor this home to ensure national minimum standards are being maintained whilst in the transition stages of ‘new-for-old’. Areas of strength are the positive way in which complaints and concerns are handled by the home and the care with which staff work with residents to avoid allegations of abuse arising - and there are no matters requiring improvement are so this section, about complaints and protection, is assessed as good. Stroud Green Lodge DS0000043303.V287797.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 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The layout of the home and the manner in which it is being maintained means that this is a clean, safe, comfortable and suitable environment for the service users. EVIDENCE: The home was in a reasonable state of decoration, minor damage to paintwork was noted but in general it is a nice home, large and a little old-fashioned but nevertheless service users and relatives appear to be happy with the premises. No hazards were identified during the inspection and the accident record shows few accidents have occurred in the previous three months indication this is a safe environment for service users. It remains the case that the owners (the local authority) intend replacing their older care homes including Stroud Green Lodge, which do not meet modern standards, with premises that will meet service users’ needs in greater comfort and provide improved personal accommodation. Stroud Green Lodge DS0000043303.V287797.R01.S.doc Version 5.1 Page 16 Areas of strength are homeliness achieved in this large old building and the bright open atmosphere of the place - and no matters requiring improvement are noted - so this section, about the accommodation, is assessed as good. Stroud Green Lodge DS0000043303.V287797.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): 27 28 29 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The number of staff employed and their skill mix are appropriate to the assessed needs of the current service users in this home – so this will ensure that their needs are being met. The required procedures are in place to ensure recruitment of staff protects service users. The home has a staff induction, training, support and supervision regime in place so service users can be assured that staff are competent in their jobs. The recruitment, training and support of staff will ensure service users are ‘safe in their hands’. EVIDENCE: Staffing levels must be no less than required by previous regulatory bodies and this was the case on the day of inspection – for 25 service users there were six carers, the manager and ancillary staff for catering and cleaning. The Commission is impressed by the very professional and caring attitude of staff at a time when they are very anxious about the long-term future of the home and their own future. The process of staff recruitment was examined in some detail during the previous inspection and there have been no additional staff recruited since that time so the findings remain the same as before. The examination of staff folders to ensured the necessary checks have been undertaken before staff are allowed to work in the home. Staff were interviewed to confirm that they are properly recruited, receive induction training and on-going training and that they attend team meetings and individual staff supervision session. The Stroud Green Lodge DS0000043303.V287797.R01.S.doc Version 5.1 Page 18 residents and visitor said how kind and helpful staff are in this home and this compliment is passed on by the Commission to all staff in the home. In the previous inspection a recommendation was made in respect of the supervision of new staff who have not completed the police check [CRB]. In this instance the manager herself had been acting as the supervisor but it was recommended that a suitable member of staff working in proximity to the new worker be given this role. The recommendation was noted but no new staff have since been employed for this supervision arrangement to be put in place. It is noted and commended that all bar two of the 30 strong staff team are now qualified to at least NVQ level 2. Areas of strength are training and qualification of the staff team and there are no matters requiring improvement are - so this section, about staffing, is assessed as good. Stroud Green Lodge DS0000043303.V287797.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 33 35 36 37 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is registered with the CSCI as a person competent to run this home in accordance with its stated aims and objectives and in the best interests of the service users. The home is well managed, including finances, and is safe for service users. EVIDENCE: The arrangements for protecting residents’ finances were examined and found satisfactory with service user money records in place and in good order. Other aspects of the management of the home were re-evaluated including health and safety to ensure the service users are being well cared for; their own opinion is that this is the case. The premises were toured and the inspector observed how staff engage residents. A tranquil, even lethargic atmosphere prevailed and this was not surprising given the hot July day for this site visit. Stroud Green Lodge DS0000043303.V287797.R01.S.doc Version 5.1 Page 20 Service users were being cared for in a kindly manner with attention to their safety and well being including plenty of shade and lots of drinks. The premises were neat and tidy and in a reasonable state of repair. No hazards were identified on this occasion. A range of records were checked including residents’ files, food records, complaint records, accident records, money records and visitors’ book. Administration in this home is well managed and no problems arise except the matter of the pre-admission assessments is noted and this is a matter for the manager to take up with referring care managers. The main area of strength is the overall management of the home and as no matters requiring improvement are noted this section, about management and administration, it is assessed as good. Stroud Green Lodge DS0000043303.V287797.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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 3 3 Stroud Green Lodge DS0000043303.V287797.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 OP3 Good Practice Recommendations Pre-admission assessments: the home must is recommended to ensure that if care managers do not provide a written and comprehensive single assessment hen the home itself undertakes an assessment to ensure it will be able to plan for and meet prospective residents’ needs. Pre-admission assessments: The home is strongly recommended to ensure that it has an adequate preadmission assessment from a care manager or suitably qualified person so as to ensure that residents are not admitted outside the home’s registration category. Relative Support Group: This home now provides care for residents who have dementia and this is condition is often quite traumatic for some families to deal with so a forum is suggested as a support group for relatives of residents. 2 OP3 3 OP12 Stroud Green Lodge DS0000043303.V287797.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Stroud Green Lodge DS0000043303.V287797.R01.S.doc Version 5.1 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!