Inspection on 23/04/07 for Sybden

This inspection was carried out on 23rd April 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sybden 17/04/09

Sybden 21/04/08

Sybden 25/01/07

Sybden 02/06/06

Sybden 16/08/05

Sybden 05/05/05

Sybden 07/01/05

Sybden 28/06/04

Sybden 16/10/01

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Sybden Pipers Hill Great Gaddesden Hertfordshire HP1 3BY Lead Inspector Julia Bradshaw Unannounced Inspection 23rd April 2007 10:00 Sybden DS0000019559.V336297.R01.S.doc Version 5.2 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 Sybden DS0000019559.V336297.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 Adults 18-65. 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. Sybden DS0000019559.V336297.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sybden Address Pipers Hill Great Gaddesden Hertfordshire HP1 3BY 01442 269986 01442 217646 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) www.turning-point.co.uk Turning Point Southern Area Office Vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Sybden DS0000019559.V336297.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 27/01/07 Brief Description of the Service: Sybden is a residential home for six service users, who have a learning disability whose needs may require a high level of guidance and support. Prospective service users who are looking for a suitable placement, are supported to make a choice by regular visits, exploring options, and assessment of suitability of the home and that they are compatible with the current group of service users. Sybden is a single storey country house, situated in the small, rather idyllic, village of Great Gaddesden, which is approximately 5 miles from Hemel Hempstead town centre. The home has been extended and sits amidst extensive gardens. The location is relatively remote and rural. There are a few shops, for basic requirements, services and community resources but these are limited. The home does have its own transport, which provides access to local towns, just a few miles away. There is a bus route close by. Information regarding the service is available in the Statement of Purpose and the Service User Guide. These and a copy of the last inspection report are freely available on request. The range of fees for Sybden are between £900 and £1200. Sybden DS0000019559.V336297.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 23rd April.The home continues to have temporary manager in post although the situation regarding the permanent manager has recently been resolved and therefore this vacant post is currently being advertised. The staff continue to strive to improve and develop the environment and in particular the service users bedrooms, which all appeared homely, well decorated and reflected service users personal interest and hobbies. The temporary manager has been in post for a period of 9 months and has worked hard to implement some positive changes as well as improving some existing policies and procedures. The inspector was pleased to discover that the issues relating to the central heating and hot water temperatures have finally been rectified. However there was a concern that there were some strong smelling fumes coming from the boiler room and through into the offices, the manager agreed to investigate this immediately. Documentation examined included two service users’ care plans, staff recruitment, supervision and training records and quality monitoring records. A tour of the premises was made, taking in all the bedrooms, communal areas and the external grounds. The inspection indicated that standards had improved since the last inspection carried out in January 2007. Staff were observed to interact well with service users and were both professional and caring in their approach and manner. Requirements have been made in respect of the environment, IT equipment and service user assessments. What the service does well: The staff team endeavour to improve and develop the environment for the service users, which on occasions can receive high levels of misuse. The staff continue to adjust well to the major changes within the staff team and have worked hard to ensure that the service provided to the people living at Sybden is consistent and professional. The service users have both complex needs and severe challenging behaviour needs which requires the manager and staff team to be both professional and consistent in their approach with them. Observations of staff and residents interacting together indicated that there was a good rapport between each other and when dealing with some challenging behaviour, staff remain calm and pre-emptive in their approach. Staff are kind, gentle and knowledgeable about the specific needs of individuals and how to meet them. The environment continues to be developed and improved to provide a Sybden DS0000019559.V336297.R01.S.doc Version 5.2 Page 6 homely domestic setting in which the service users can live safely and lead lifestyles that suit them. In particular, the bedrooms are well presented and have suitable furnishings and décor that both promote the residents’ dignity and provide an acceptable level of comfort and individuality. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Sybden DS0000019559.V336297.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sybden DS0000019559.V336297.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1–5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are systems in place for assessing service users needs – prior to admission. Risk assessments were in place but have not all been regularly. EVIDENCE: A Statement of Purpose and a Service User’s Guide is in place that contains the required information about the service provided. These documents are made available to all prospective and current residents and their representatives and enable them to make an informed decision about whether the home would be suitable. The documents should be produced in a pictorial or symbol based format that is more accessible to the service users and the Service User’s Guide should be prominently displayed on the notice board. Three service users plans were inspected on this occasion and documentation was provided in order to meet this standard. Full assessments are made of every prospective service user’s needs, abilities, personal preferences and aspirations prior to admission so that it is clear that the home will be able to meet the individual’s requirements. The admissions procedure also includes a series of planned trial or familiarisation visits to allow the service user to Sybden DS0000019559.V336297.R01.S.doc Version 5.2 Page 9 experience the atmosphere and way of working in the home before making any firm commitment to a ‘permanent’ stay. The manager and staff have worked hard to improve the standard of information provided both within the home and in respect of prospective users of the service. Contracts are agreed with the Local Authority who are purchasing the service and service users have a copy of the agreement on their individual files. However some of these contracts still need updating and service users or their representatives must sign the contract and any amendments that occur. Sybden DS0000019559.V336297.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6 –10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users’ needs and aspirations are detailed in individual care plans that provide information to facilitate consistent care. However, one-service user’s care plan did not reflect an accurate the assessment of needs. Systems still need improving in order to ensure service users views are established and they can contribute to the running of the home Service users are supported to take responsibly assessed risks that balance health and safety and opportunities for stimulation and independence. Staff follow the home’s policy and maintain confidential information appropriately. EVIDENCE: All service users have an individual care plan and an allocated key worker to support them. Individual daily guidelines/diary notes for service users were examined. All service users will be supported within the Person Centred Sybden DS0000019559.V336297.R01.S.doc Version 5.2 Page 11 Planning programme once completed. Either the service user or their representative must sign Service user plans. Each service user is encouraged to take part in daily living tasks, where appropriate. Staff can sometimes find this challenging with the service users who have been living in institutions for many years who can be reluctant to take part in self-help programmes. The home is adequately decorated and the service users are involved with the choices for decoration collectively. All information is handled with care and respect. All personal notes and files detailing information on the service user are locked away. There was little evidence on the day of the inspection to confirm that the service users are supported and encouraged to contribute to the running of the home. Communication systems must be improved to ensure that all service users are enabled to contribute to the service in which they live. Service user meetings need to be held more regularly and organised in a way in which everyone has the opportunity to contribute. The manager must arrange a full assessment of need to be carried out for the service user who was discussed with the manager during the inspection, as their night time needs are currently compromised due to the levels of staffing currently provided. Sybden DS0000019559.V336297.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11 –17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Personal development opportunities are encouraged for all service users ensuring interactions within the local community and responsibilities are recognised and supported. A wholesome diet is provided and enjoyed. EVIDENCE: Four of the Service users attend various daycentres. The remaining service user stays at home during the day and are supported by care staff. Access to transport occurs with the use of the onsite transport, with staff support. Staff support and encourage all service users to maintain and develop social, emotional, communication and independent living skills. All service users are encouraged to assist in their personal tasks including washing, cleaning their rooms and personal clothes shopping, this is usually combined Sybden DS0000019559.V336297.R01.S.doc Version 5.2 Page 13 with a trip out for lunch. The service also provides annual holidays for all its service users. All service users are encouraged and supported to maintain links to the local community. The home is close to Hemel Hempstead and although is situated within a small village setting and appears quite remote. Routines promote and encourage service user independence. Menus are offered on a flexible basis, with service users making choices over the meals daily. Sybden DS0000019559.V336297.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal care needs and health care needs are supported with an individual approach acceptable/preferred by each service user. Medication procedures are currently adequate. EVIDENCE: A system of “ double” signatures/witnessing on all medication has been implemented since the last inspection took place. None of the service users are able to self-administer their own medication even with support. All non-blister pack medication must have a “date of opening” recorded. Good links are maintained with the local community mental health team and local psychiatric services. All service users use one local G.P. surgery and accurate records are maintained regarding service users individual health needs. Sybden DS0000019559.V336297.R01.S.doc Version 5.2 Page 15 The care plans inspected contained guidance to staff in how to manage personal care needs according to the service users preference. Likes and dislikes/preferences were recorded. Sybden DS0000019559.V336297.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home must improve its methods of communication. There is a complaints procedure in place. EVIDENCE: A written policy is in place which complies with the requirements of this standard and which staff said they were aware of. A record is maintained of complaints made detailing actions and outcomes as necessary. A written procedure in relation to Safeguarding adults is in place and this is used in conjunction with the Hertfordshire County Council Safeguarding Adults policy, which was on display within the main office. There is also a written whistle blowing policy in place. The policy in relation to service users monies, which includes audits and the maintenance of receipts for all purchases, is monitored by the manager. None of the service users are able to manager their own money. The inspector carried out a random check of two service users monies, which proved to reconcile with their individual ledgers. The manager must improve and develop the current systems of communications in order to ensure service users can make an informed choice. Sybden DS0000019559.V336297.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 – 30 Quality in this area is adequate. This judgement has been made using available evidence including a visit to this service. The general standard of the environment has been improved. The individual bedrooms have been tastefully decorated. Hot water temperatures were adequate, however, the fumes from the boiler need investigating. To ensure service users safety the security to the home must be improved. EVIDENCE: It was encouraging to discover that the manager had improved some areas of the environment, which have included new windows fitted to the extension of the home, the handriers have been removed and paper hand towel dispensers have been fitted to all areas of the home. Sybden DS0000019559.V336297.R01.S.doc Version 5.2 Page 18 Service users bedrooms continue to be presented in personal and homely style and maintained to a good standard. The home was clean on the day of the inspection. However the inspector discovered a “mal odour” which appeared to coming from the boiler room, which needed an immediate investigation, in order to protect and safeguard the service users, staff and visitors. There are two bedrooms that could benefit form having the flooring replaced with a more suitable, non- slip surface. The manager stated that this was due to be replaced later this year. This issue will be followed up during the next inspection. A recent environmental/ food safety audit of the home (8/03/07) commended the standards of food hygiene and cleanliness. A sensor has been fitted to the gate of the home in order to assist with the monitoring and security of the service users. However a discussion with the manager resulted in the agreement that further systems to improve security should be implemented. The current security could compromise service users safety, as there is little to prevent service users wandering out onto the road, which adjoins the home. The manager and staff should be congratulated on endeavouring to improve the current environment, within the confines of the current budget. Sybden DS0000019559.V336297.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 – 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Members of staff are provided with the training to support service users effectively and meet their needs. The home operates sound recruitment practices that protect the interests of service users. Staff receive individual supervision. EVIDENCE: On the day of the inspection there were three staff on duty and the manager arrived at the home later that morning, after attending a meeting in Watford. Although the staffing levels are adequate to meet the service users needs during the daytime hours, one service user requires two staff to assist with moving and handling during the nigh time. A review of the service users assessment is required in order to both meet the needs of this service user and to ensure that their health and welfare is maintained. Sybden DS0000019559.V336297.R01.S.doc Version 5.2 Page 20 Training records were checked and the manager confirmed that all staff have received mandatory training. Currently five people are doing NVQ level 3. One member of staff is doing NVQ level 2 and one person already has NVQ level 3. The temporary manager enrolled on NVQ level 4 in April 2007. The manager confirmed that all staff receives individual supervision on a six weekly basis. The manager has worked hard to improve and develop staff morale within the home and has co-ordinated some Team building training with an outside facilitator. Staff spoken to during the inspection appeared to feel supported by the current manager and felt they could discuss any issues affecting their work and the running of the home openly and honestly. The manager stated that the home was currently fully staffed. All new staff receives structured induction and foundation training Sybden DS0000019559.V336297.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The temporary manager has been in post since July 2006 and has worked hard to develop and improve the systems within the home. The home is operated in an inclusive manner that enables staff to contribute ideas and the service users to have some control over their lives within a risk assessment framework. Self-monitoring systems are adequate. IT systems within the home must be improved EVIDENCE: The home has undergone some major changes within the staff team over the past year and some historical issues relating to the staff make up. The inspector found that the staff felt that the current manager had been very Sybden DS0000019559.V336297.R01.S.doc Version 5.2 Page 22 supportive in affecting these changes and has improved the current service for the people who live at Sybden. The situation regarding the management team has now been resolved and the permanent managers post is currently being advertised. Adequate training is being provided to ensure all staff have the necessary underpinning knowledge to carry out their role effectively. The manager must carry out an immediate assessment on the service user who currently is requiring additional support during the nighttime. The situation regarding the mal functioning of the heating system on 25th January has now been resolved. However the inspector has asked the manager to investigate the “mal odour” being emitted from the boiler house and staff office. The manager failed to inform the Commission of a recent suspension of a member of staff, therefore a requirement has been made in relation to ensuring that a all serious issues relating to the service users health and safety must be reported to the Commission as soon as it occurs. Service users monies were checked on the day of the inspection and found to be accurate. The outstanding issue from the previous inspection has been resolved and the practice of “ borrowing” monies between service users has ceased. The current IT facilities within the home are inadequate and reliant on the use of one laptop, which has only been issued for the manager’s use. The manager stated that there been a problem in obtaining a service from an Internet provider, due to the remote setting of the home. However the laptop currently provided is a “ wireless” service and therefore this facility should be further extended for use by the whole staff team. Sybden DS0000019559.V336297.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 Adults 18-65 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 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 2 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 x 2 x x 2 x Sybden DS0000019559.V336297.R01.S.doc Version 5.2 Page 24 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard YA3 YA7 YA1 Regulation 14(2)(b) Requirement Timescale for action 30/04/07 30/04/07 3. 4. YA24 YA24 5. YA41 A full assessment is required for one service user who requires moving and handling. 12(2), 16 All policies and procedures (2) j, m affecting and involving service users must be produced in a and n & 24(3) format that is understood by the people that use the service. 13(1) 13 The mal odour coming from the (3) (4) (a) boiler room must be (b) investigated. 13(4)(a) The security and safety of the front entrance to the home must be improved in order to prevent service users from wandering out onto the road that adjoins the home. 17(1) (a) The Commission is kept informed of serious events affecting the safety of service users and the effective management of the home. 24/04/07 31/05/07 24/04/07 Sybden DS0000019559.V336297.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 6 Refer to Standard YA43 Good Practice Recommendations The organisation should improve their IT systems. Sybden DS0000019559.V336297.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Sybden DS0000019559.V336297.R01.S.doc Version 5.2 Page 27 - 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!