Inspection on 20/11/06 for Sussex Clinic

This inspection was carried out on 20th November 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

Sussex Clinic 11/11/08

Sussex Clinic 20/11/07

Sussex Clinic 11/01/06

Sussex Clinic 17/08/05

Sussex Clinic 05/10/04

Sussex Clinic 06/05/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

Thorndene

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

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

CARE HOMES FOR OLDER PEOPLE Sussex Clinic 44-48 Shelley Road Worthing West Sussex BN11 4BX Lead Inspector Mrs G Davis Key Unannounced Inspection 20th November 2006 10:00 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 Sussex Clinic DS0000024221.V308757.R01.S.doc Version 5.2 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. Sussex Clinic DS0000024221.V308757.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sussex Clinic Address 44-48 Shelley Road Worthing West Sussex BN11 4BX 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) 01903 239822 Sussex Clinic Limited Post Vacant Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Sussex Clinic DS0000024221.V308757.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. A maximum of 25 services users who require nursing care may be accommodated. Of whom 6 may have a Physical Disability (PD) and (PD)(E). Date of last inspection 11th January 2006 Brief Description of the Service: Sussex Clinic is a detached; two - storey building that was once previously registered as a private hospital. It is situated approximately ¼ of a mile from the centre of Worthing town with all its amenities and ¼ of a mile from the sea front. It is a privately owned Care Establishment providing residential and nursing care for up to forty residents in the category of Older Persons. Within those registered beds is a provision for up to six persons under the age of 65yrs with a physical disability Accommodation is provided in twenty-four single and nine double rooms. Four of the single rooms and one of the double rooms have en-suite facilities. The rooms are arranged on two floors with a lift giving access to all but two. Two lounges and a separate dining room provide the communal space. There is a generous parking area to the front of the building and a secluded and well-tended garden to the rear, which is suitable for wheelchair users. Mrs Manejeh Shoai - Naini represents Sussex Care Ltd as the responsible person. The Registered Manager’s post is currently vacant The current fees vary from between £256.00 to £550.00 per week. Sussex Clinic DS0000024221.V308757.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out the unannounced visit; commencing at 10:00hrs for a period of 6.5 hours. The registered person had completed a pre-inspection questionnaire and information from this, comment cards from both residents and relatives and the registered provider’s monthly monitoring reports, plus evidence from previous inspections, has been used to inform the planning, inspection process and, along with evidence gained during the inspection visit, this inspection report. During the visit the inspector spent time speaking to service users, relatives and staff members, examined documents and records and observed interactions between staff members and residents and the activities being undertaken. A tour of the building was carried out, which covered the communal areas, service areas and service users bedrooms, and it was considered that the establishment was reasonably comfortable, appropriately furnished and maintained to ensure safe surroundings to the residents. There was a high standard of cleanliness throughout the home and overall no odours were detected. The pre-admission assessments for four service users were seen and four care plans were tracked with any issues arising being discussed with Mrs Baird the Acting Manager. The inspector saw menus and food records and toured the kitchen which was clean and in good order. The inspector sampled the meal provided at lunchtime. Records for the management of the service were also seen including, staff recruitment, health and safety, maintenance and fire records. Feedback given by the inspector to Mrs Baird the Acting Manager at the end of the visit highlighted the positive aspects of the care provided by the care home as well as other issues identified in the body of the report. Three requirements and one recommendation have been made as a result of this inspection. Sussex Clinic DS0000024221.V308757.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Several of the residents and most of the relatives’ comment cards noted that there was not much social stimulation although the Inspector witnessed a carer taking time out with a small group of residents in the lounge to provide them with some music that they obviously enjoyed. Residents who were not well enough to go into the communal areas would benefit from some one to one stimulation. Other remarks were directed at the standard of décor with some people considering that “the facilities could do with some refurbishment” and “some of the décor could do with renovation”. Sussex Clinic DS0000024221.V308757.R01.S.doc Version 5.2 Page 7 The doors without Dorgards should not be propped open using a wedge and additional purchase of more Dorgards, or electronic closures should be considered. All information regarding the Commission for Social Care (CSCI) should be updated to include the recent change of contact details. For example the Complaints Procedure on display on the notice board referred to the old address and telephone number of the CSCI. All staff members should be provided with a refresher-training course on the Protection of Vulnerable Adults. A new Registered Manager must be recruited. The registration certificate displayed must be changed to reflect the current situation. 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. Sussex Clinic DS0000024221.V308757.R01.S.doc Version 5.2 Page 8 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 Sussex Clinic DS0000024221.V308757.R01.S.doc Version 5.2 Page 9 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): 1.2.3.6. Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. All the care plans scrutinised at the time of inspection identified that each resident had been subject to a thorough pre-admission assessment EVIDENCE: Three care plans of residents who had been living at the home for a number of months were selected at random. One care plan regarding an emergency admission was also scrutinised. The Senior Care Manager had carried out the pre-admission assessments and all were found to contain full and explicit information about all aspects of their emotional, social and health needs. This information had been used to inform the care plans for the guidance of the support workers. One resident who had been admitted very recently confirmed that she had been given a statement of purpose and service users guide before moving in to Sussex Clinic DS0000024221.V308757.R01.S.doc Version 5.2 Page 10 the home. She was very positive about her experiences during the admission period and stated that she had been made to feel welcome and safe. All had a copy of the contract on file, these were either a copy of the contract between the Local Authority and the resident regarding the care that would be required or a contract between the registered provider and the resident in the case of those privately funded. Intermediate Care is not carried out at the home. Sussex Clinic DS0000024221.V308757.R01.S.doc Version 5.2 Page 11 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 is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Four care plans were examined, including that of an emergency placement. Each contained clear identification of areas of need. Care staff members obtain explicit guidance from care plans that gave information on how each resident could be supported in order to meet those needs. All areas of risk had been identified and appropriate risk assessments undertaken to establish what course of action should be followed to protect the safety of the residents at all times. There was evidence of regular monitoring of each individual’s physical and emotional health and it was seen that appropriate action had taken place if any issues had been identified. All, apart from the recent emergency admission, had been reviewed on a monthly basis and changes made if required accordingly. Sussex Clinic DS0000024221.V308757.R01.S.doc Version 5.2 Page 12 Arrangements are made for the residents to attend any specialist clinics or health services required, and are registered with a local GP. Medication was safely stored and records were well kept in regard to the administering and disposal of unwanted drugs. The medication administration records were examined and no gaps were noted in the recording of medicines on the MAR sheets, handwritten entries had been signed and dated. Staff members had received medication training. The home has the appropriate equipment for the residents accommodated, with assisted baths, lifting hoists and each room evidenced that individuals were provided with other appropriate equipment as required. Many of the rooms are suitable for people who use wheelchairs and corridors are wide enough. Information from previous inspections and observation of the interaction between the staff members and the residents showed that the residents’ privacy and dignity is respected at all times by the staff. This was confirmed during the course of conversation with residents, their visitors and visiting professionals. One resident told the inspector “They are respectful and really treat me in a sympathetic way” another “ they treat me really well, they are very discreet when carrying out personal care, I’m never embarrassed” . Personal care is provided in the privacy of the resident’s bedroom, a bathroom or the medical room. Sussex Clinic DS0000024221.V308757.R01.S.doc Version 5.2 Page 13 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 is good. This judgement has been made using available evidence including a visit to the service. Despite the fact that there does not appear to be much organised activity residents were satisfied with their lifestyle and considered that they were free to do what ever they wanted to do. Most residents were of a great age and frailty and unable to engage in anything other than quiet pursuits. EVIDENCE: All care plans were noted to contain information regarding the past interests of the residents. On the day of inspection there did not appear to be any organised activities taking place. There was a notice advising of bi monthly dates for a visiting musician. Most of the residents were very frail and had significant nursing needs and were enjoying quiet pursuits in their own rooms, reading the paper or watching television. Four residents were seated in the main lounge and thoroughly enjoying the sound of Glen Millar’s Band. A number of relatives had commented on their comment cards that they considered that there was not much stimulation for residents; a visiting Social Care Worker echoed this remark. Sussex Clinic DS0000024221.V308757.R01.S.doc Version 5.2 Page 14 One resident who was younger and very disabled told the inspector that she “had plenty to do” It was clear on talking to the residents that they felt free to lead a lifestyle of their choice. One resident who had been admitted recently informed that she was delighted that they had agreed to her eating her meals in her room as she did not wish to go to the main dining room. A sample number of residents are spoken to at the time of the Reg 26 visit and their views published in the report The home has an open visiting policy and visitors are welcome to sit in the communal areas or in the residents’ own bedrooms if preferred. During the day the inspector was able to talk to a number of residents’ visitors to obtain their views of the care provided at the home. “My Mother is very frail----since she came into this home she’s got the care she needs” ----- “good clinical care here” The kitchen was visited during the course of the inspection and was found to be clean well ordered and appropriately equipped. The company’s main kitchen, which is located in another of the company’s homes nearby, provides all main meals. All required records i.e. freezer temps etc were being maintained. The inspector sampled the lunch provided to the residents; both vegetables and casserole were cooked to perfection and tasty, as was the spiced rice pudding to follow. There were alternatives to the main choice and special meals provided to those with specific dietary needs. Examination of the menus showed a varied and interesting range of well-balanced meals providing a wide choice. All of the residents spoken to confirmed that they really enjoyed their meals. “The food’s OK here - too OK, I’m on a diet!” Sussex Clinic DS0000024221.V308757.R01.S.doc Version 5.2 Page 15 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 is good. This judgement has been made using available evidence including a visit to the service. There was evidence that care staff members had been given training in the Protection of Vulnerable Adults and the staff members on duty were fully aware of the procedures to follow should disclosure occur, however, the whole staff team would benefit from a refresher training course in this matter. EVIDENCE: On checking the complaints log it was noted that there had been four complaints recorded since the last inspection in January 2006. The home has a complaints procedure in place that states that complaints will be responded to within a maximum of 28 days. It was seen that the registered person had responded to any complaint made appropriately and actions recorded. A recent Adult Protection Investigation had been resolved satisfactorily. Residents spoken to confirmed that they were able to complain and all knew who to refer to if they had any issues. Mrs Baird informed that information regarding how to complain was given either to the resident or to their representative on admission. The resident who had been admitted recently confirmed this. It was noted that the complaint procedure displayed on the notice board at the entrance of the home gave incorrect contact details re the Commission for Social Care and was in need of updating. Sussex Clinic DS0000024221.V308757.R01.S.doc Version 5.2 Page 16 Most staff members have attended training on the Protection of Vulnerable in the past and discussion with staff members identified that all were aware of what to do if they suspected that abuse had taken place. However all would benefit from a refresher course in the Protection of Vulnerable Adults. Staff recruitment records were seen to contain all security information required. Sussex Clinic DS0000024221.V308757.R01.S.doc Version 5.2 Page 17 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): 19.20.21.22.26. Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: A tour of the premises was made. The building had a reasonable standard of décor with some signs of inevitable wear and tear; however, there was a programme of ongoing redecoration in place. The home was well maintained and had a comfortable and homely atmosphere. The bathrooms were warm and contained equipment to facilitate bathing. There were other aids to support mobility available and each person’s room was equipped according to need. Most residents had personalised their room with their own things. Sussex Clinic DS0000024221.V308757.R01.S.doc Version 5.2 Page 18 There were three lounge areas comfortably and attractively furnished for residents to sit in. In addition residents’ can use a small building, separate from the main house, as a small chapel or as an area to carry out a number of recreational activities. The home was clean and fresh in all areas with no odours detected. The laundry was provided with hand washing facilities and all washing was handled following the correct infection control procedures. The room was seen to be clean and tidy. A new internal entrance had been created so that it could be accessed without having to go outside. There were attractive and secluded gardens for residents to walk in or sit out in fine weather. Some doors were kept open by electronic Dorgard, others were wedged open and the inspector reminded the manager that all fire doors should be kept shut at all times unless propped open using an electronic device that responded to the fire alarm system. Sussex Clinic DS0000024221.V308757.R01.S.doc Version 5.2 Page 19 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 is good. This judgement has been made using available evidence including a visit to the service. The home continues to be staffed appropriately EVIDENCE: There was a written rota that showed which staff members were on duty at any time of the day or night and that accurately identified those on duty at the time of inspection. On the day of inspection there were a suitable number of carers on duty in the morning excluding the Care Manager and a suitable number of trained nurses were amongst those on duty. Scrutiny of the rotas showed that the number of staff employed was adequate at all times. An examination of staff files and conversation with some of the care staff team revealed that there was a good skill mix and level of knowledge of the resident group within that team. It was seen that the registered person operates a thorough and robust recruitment procedure. Four files of staff members were examined (one of a person that had been recruited since the last key inspection) and seen to contain all information Sussex Clinic DS0000024221.V308757.R01.S.doc Version 5.2 Page 20 required by the National Minimum Standards. New staff members were only confirmed in post following the completion of a satisfactory Police and POVA Check. Training files were examined for four members of staff and it was seen that induction training had been given along with other service related topics. There appeared to be a commitment from the staff team to continue training and learning which was supported by the registered person. A number of staff had NVQ level II and above. (33 ) There was evidence on file and confirmed by other carers that they received regular supervision. Mrs Baird the home’s Head of Care who, until June, was the registered manager had carried this out. The home is without a registered manager currently. Sussex Clinic DS0000024221.V308757.R01.S.doc Version 5.2 Page 21 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): 31.33.35.38. Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. A new registered manager is required. However, the previous registered manager continues to act as the manager and will continue until a new registered manager has been appointed. There is some evidence that consultation with residents and relatives takes place but this needs to be developed more fully into a formal Quality Assurance System. EVIDENCE: There is no registered manager in post currently. Mrs Elaine Baird the previous registered manager has continued to work at the home in the capacity of Head of Care. In the short term this is a satisfactory Sussex Clinic DS0000024221.V308757.R01.S.doc Version 5.2 Page 22 arrangement until a new manager is appointed. The manager’s post is to be advertised. The registered provider carries out a regulation 26 visit and report on monthly basis and these indicate thorough monitoring of the service. Any complaint feedback would be used constructively to improve the performance of the home. Questionnaires are distributed amongst all stakeholders and the results will be used to inform the business plan. A business plan was not available at the time of inspection and there did not appear to be a formal Quality Assurance System in place. Verbal and written comments from relatives indicated a good level of satisfaction with the service provided. The policy of the home is not to manage the financial affairs or handle large sums of money for the residents and any expenditure on the residents’ behalf is billed to their representative to manage for them. Formal supervision had taken place for all staff. All systems and equipment had been serviced and maintained at the appropriate intervals. All accidents, injuries and incidents were recorded and reported to the appropriate authorities when required. The registration certificate on display in the front hall of the home was incorrect and required updating to show the recent vacancy of the manager’s post. Sussex Clinic DS0000024221.V308757.R01.S.doc Version 5.2 Page 23 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 3 3 3 X X N/A 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 2 3 3 3 3 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 2 X 3 X X 3 Sussex Clinic DS0000024221.V308757.R01.S.doc Version 5.2 Page 24 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. 1 2 Standard OP31 OP18 Regulation 8.1(a) i 13(6) Requirement Timescale for action 28/02/07 3 OP25 23.4. (a) The registered provider must appoint a registered Manager to manage the home on their behalf The registered person must 28/02/07 make arrangements, by training staff to prevent service users being harmed or being placed at risk of harm or abuse The registered person must take 30/12/06 adequate precautions against the risk of fire including the provision of suitable fire equipment. 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 OP16 Good Practice Recommendations The registered person should ensure that all references to the Commission for Social Care include accurate contact details including that in the complaints procedure Sussex Clinic DS0000024221.V308757.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Southampton HO 4th Floor, Overline House Blechynden Terrace Southampton Hampshire 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 Sussex Clinic DS0000024221.V308757.R01.S.doc Version 5.2 Page 26 - 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!