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Inspection on 12/07/06 for Tabley House General Nursing Home

Also see our care home review for Tabley House General Nursing Home for more information

This inspection was carried out on 12th 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Good information is provided to prospective residents and they are actively encouraged to visit the home and stay on a trial basis prior to making a permanent choice. Full and comprehensive assessments are carried out and care plans are in place to ensure the home will be able to meet the residents` needs. Medicines are well managed, ensuring that residents receive their prescribed medication. There is a good, friendly relationship between staff and residents and staff are mindful of service users` privacy and dignity. Residents and staff said that the management of the home is open and positive. The home is very well maintained and clean. It provides a comfortable and welcoming environment. Visitors are warmly welcomed into the home. Residents are consulted about their hobbies and interests and a varied programme of activities is available, which includes activities outside the home. Residents receive good and varied food. Staff recruitment, training and supervision ensure that resident`s interests are promoted and protected. There are more than adequate numbers of staff on duty to ensure the needs of the residents are met.

What has improved since the last inspection?

Care plans and recording have been improved to enable staff to understand the care needs of each resident. The clinical door is now being kept locked to maintain the safety of residents. The activities co-ordinator has two assistants to provide a greater choice of activities and residents are satisfied with the range of activities on offer. Formal supervision for staff is regularly being provided and staff appraisals are taking place. Fire prevention and other staff training is up to date and recorded appropriately. The interior and exterior environment has been improved, with replacement of some carpets and the decoration of a number of bedrooms, corridors and some outside replacement of windowsills and frames. New ramps have been provided so that the residents have easier access to the garden area.

What the care home could do better:

Care plans have improved since the last site visit. However, some of the alterations had not been signed or dated by staff and on one care plan correction fluid had been used. The record had therefore been partially destroyed. This demonstrates poor practice and breaches the NMC (Nursing and Midwifery Council)"Guidelines for record and record keeping." This was a requirement on the last inspection. Staff training in care planning needs to be in place to ensure that these guidelines are met.

CARE HOMES FOR OLDER PEOPLE Tabley House General Nursing Home Tabley Knutsford Cheshire WA16 0HB Lead Inspector Joan Adam Key Unannounced Inspection 12/13th July 2006 09:00 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 Tabley House General Nursing Home DS0000018823.V291279.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. Tabley House General Nursing Home DS0000018823.V291279.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Tabley House General Nursing Home Address Tabley Knutsford Cheshire WA16 0HB 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) 01565 650888 0156563230 karenlynskey@cygnethealthcare.co.uk Cygnet Healthcare Limited Karen Lynskey Care Home 59 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (44), of places Physical disability (2) Tabley House General Nursing Home DS0000018823.V291279.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 59 service users to include:MAIN HOUSE * Up to 44 service users in the category OP (Old age, not falling within any other category) of which :* Within the 44, up to 2 agreed service users in the category PD (Physical disability aged under 65 years) WEST WING * Up to 15 service users in the category DE(E) (Dementia over 65 years of age) Date of last inspection 5th January 2006 Brief Description of the Service: Tabley House is an eighteenth century country house set in acres of parkland in the Cheshire countryside. The accommodation, set on two floors, caters for up to 44 service users in thirty-eight rooms. All rooms have en-suite facilities. The majority of rooms are single, however a small number of shared rooms are available. The home caters for people over the age of sixty five and provides both personal and nursing care. The current charges for the home are £850 to £1,300 per week. This information has been provided by the home manager. Tabley House General Nursing Home DS0000018823.V291279.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One regulatory inspector undertook this unannounced site visit over two days. The Key inspection was arranged as part of the Commission for Social Care Inspection’s (CSCI) regulatory programme under Inspecting for Better Lives. Feedback was given to the manager on the second day. Records were inspected and staff practice was observed. Discussion took place with the registered manager, general manager, residents, relatives and staff. A tour of the premises was undertaken. Information was also provided by the home before the site visit. The service history of the home was also considered. What the service does well: Good information is provided to prospective residents and they are actively encouraged to visit the home and stay on a trial basis prior to making a permanent choice. Full and comprehensive assessments are carried out and care plans are in place to ensure the home will be able to meet the residents’ needs. Medicines are well managed, ensuring that residents receive their prescribed medication. There is a good, friendly relationship between staff and residents and staff are mindful of service users’ privacy and dignity. Residents and staff said that the management of the home is open and positive. The home is very well maintained and clean. It provides a comfortable and welcoming environment. Visitors are warmly welcomed into the home. Residents are consulted about their hobbies and interests and a varied programme of activities is available, which includes activities outside the home. Residents receive good and varied food. Staff recruitment, training and supervision ensure that resident’s interests are promoted and protected. There are more than adequate numbers of staff on duty to ensure the needs of the residents are met. Tabley House General Nursing Home DS0000018823.V291279.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Care plans have improved since the last site visit. However, some of the alterations had not been signed or dated by staff and on one care plan correction fluid had been used. The record had therefore been partially destroyed. This demonstrates poor practice and breaches the NMC (Nursing and Midwifery Council)“Guidelines for record and record keeping.” This was a requirement on the last inspection. Staff training in care planning needs to be in place to ensure that these guidelines are met. Tabley House General Nursing Home DS0000018823.V291279.R01.S.doc Version 5.1 Page 7 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. Tabley House General Nursing Home DS0000018823.V291279.R01.S.doc Version 5.1 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 Tabley House General Nursing Home DS0000018823.V291279.R01.S.doc Version 5.1 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): 3,6 The quality rating for this outcome area is good. This judgement has been made using available evidence including a visit to the service. Assessments of people’s care needs are carried out before they move into the home so there is information to show that their needs can be met. EVIDENCE: The pre-admission documentation of two residents who had moved into the home in recent weeks was looked at. It contained assessments of dependency levels and likes and dislikes of the resident. Discussion with the residents confirmed that they had moved into the home in the knowledge that it is suitable to meet their identified needs. The pre-admission assessments had been carried out by the manager or a senior member of staff. The home is not registered to take residents with intermediate care needs. Tabley House General Nursing Home DS0000018823.V291279.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 The quality rating for this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents’ health, personal and social care needs are met by staff who enable them to maintain their privacy and dignity. EVIDENCE: Five care plans were seen. Care plans identified areas of need such as pressure area care, mobility, continence, nutrition and general dependency. They contained sufficient information to provide staff members with the necessary information for them to look after a person’s needs. There was written evidence to confirm that care plans were being reviewed and where necessary re-written on a regular basis. The care plans seen showed that there had been consultation with residents or their families/advocates. Care plans at the home have improved since the last inspection visit, however some of them had been altered but the alterations had not been signed or dated by staff and on one care plan correction fluid had been used which partially destroyed the original record. This demonstrates poor practice and Tabley House General Nursing Home DS0000018823.V291279.R01.S.doc Version 5.1 Page 11 breaches the NMC ( Nursing and midwifery Council ) “Guidelines for record and record keeping.” Some residents said that they were involved in their care plans and had signed them. The manager is looking at new care planning systems to improve the recording of care given to residents living at Tabley House. Medications were managed separately for each unit and storage arrangements were satisfactory. The home used a monitored dosage system. Staff were seen administering medication to residents in an appropriate manner. Medication Administration Record Sheets were completed appropriately. Audits were carried out for medicines liable to abuse and were found to be in accordance with the records. During the inspection staff showed respect for the residents by the way they spoke to them. Staff acted in a friendly and warm manner towards residents. Personal care was conducted in the privacy of their own bedrooms. A number of residents were spoken with and all said that they were happy living at Tabley House. They felt that the staff treated them with respect and dignity. Tabley House General Nursing Home DS0000018823.V291279.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 The quality rating for this outcome area is excellent . This judgement has been made using available evidence including a visit to the service. The routines of daily living and activities available are flexible and varied to suit residents’ expectations, preferences and capacities. EVIDENCE: The home employs an activities co-ordinator and has recently employed two assistants. These staff members attend the local college and work with the activities co-ordinator to give an improved service to the residents. The residents spoken with said that the girls were “ an asset to the home” “ It is lovely to have someone just to chat with” “ their attitude is very good for ones so young and they have settled in well” All activities attended are recorded. The activities co-ordinator was spoken with during the visit to the home. Activities provided are varied and include bridge,, bingo, card games, manicures, quizzes, crosswords, croquet and flower arranging. A hairdresser visits the home twice weekly and entertainers are booked on a regular basis. The home has a minibus and trips are arranged to local shops, theatres and garden centres. A visit to the church at Great Budworth had taken place recently and residents said how much they enjoyed this. Tabley House General Nursing Home DS0000018823.V291279.R01.S.doc Version 5.1 Page 13 The recent introduction of the PAT dog service was in the home on the day of the visit and the residents on the West Wing looked to be enjoying this. A coffee shop has been opened for visitors to the museum in the grounds of Tabley house and the residents said that they often went there for lunch or coffee. A notice board in the main entrance to the home has a programme of events displayed and photographs of events are posted on this board. Residents said that they felt the activities had improved. The residents’ religious preferences were noted in the care plan. It was said that residents could see a minister of their choice. Staff said that residents could see visitors in private or in the shared areas. Residents spoken with confirmed this. There were no restrictions on visiting. Residents they said that they were able to choose where they spent their day and what they wanted to do. During this visit a partial tour of the home was undertaken and bedrooms seen were personalised with mementoes, photographs of families and friends and pieces of residents’ own furniture. The residents had a meeting in the garden with the cook to discuss the menus and to raise any concerns they have with the food on offer. Residents spoken with following the meeting said that they felt they could “ air their views and that they would be listened to.” Meals can be taken in the dining room or in the privacy of residents’ own rooms. There is a menu that has the flexibility to meet individual needs and choices. All of the residents that commented said, “on the whole the food was good” and that “ you can’t please everybody but choices are available.” Special diets are prepared where necessary. Tabley House General Nursing Home DS0000018823.V291279.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 The quality rating for this outcome area is good. This judgement has been made using available evidence including a visit to the service. There is a complaints procedure in place and the residents are protected from abuse. EVIDENCE: The home’s complaints procedure provides appropriate guidance and information as to how to make a complaint. There have been no complaints made to CSCI since the last inspection. One complaint had been made to the home and this had been investigated and recorded appropriately. This information was provided by the manager before the site visit and by looking at the complaints file. All of the residents spoken with said they knew the complaints process and would complain to staff if they needed to. The home has an Adult Protection procedure (including Whistle Blowing), which complies with the Public Disclosure Act 1998 and the Department of Health Guidance “No Secrets”. The manager and all staff have received training in this area. Both staff members and the home’s training records confirmed this. Tabley House General Nursing Home DS0000018823.V291279.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 The quality rating for this outcome area is good. This judgement has been made using available evidence including a visit to the service. Tabley House provides a comfortable environment for those living there and visiting. EVIDENCE: A partial tour of the home was undertaken. All the shared areas and a selection of bedrooms were seen. The home was furnished to a high standard with additional equipment such as grab rails, raised toilet seats and hoists provided as necessary to meet the residents’ needs. A good standard of décor was evident. Decoration at the home is on going and a number of bedrooms have been decorated and some have had new carpets. The upstairs corridor has also been redecorated. The lounge/dining areas had a variety of seating affording choice of style of seating. Bedrooms were entered with the consent of the residents. They were personalised with residents’ own furniture and mementoes. Tabley House General Nursing Home DS0000018823.V291279.R01.S.doc Version 5.1 Page 16 All areas seen were clean and free from any unpleasant odours. New door closures have been installed for residents with their own electric wheelchairs to improve their independence. A new fire alarm system has been installed and the roof space has been subdivided as required by the fire service. New ramps have been installed outside the lounge areas to enable easier access to the gardens for the residents. Window frames and sills have been replaced and the kitchen area on West Wing has been replaced. The new bath that had been fitted prior to the last inspection is not as yet in use. The company has been looking at ceiling hoists and the system is due to be installed on 17th July. Residents are looking forward to using the new bath but feel it has been a long time since the bath was installed to when they could use this. Meetings have been held with residents to keep them up dated. Tabley House General Nursing Home DS0000018823.V291279.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 The quality rating for this outcome area is good. This judgement has been made using available evidence including a visit to the service. Staffing levels and skill mix are sufficient to meet the needs of the residents, Residents are protected by the home’s recruitment practices and staff training. EVIDENCE: Rotas revealed that staff numbers complied with agreed minimum staffing levels and on most days this number was exceeded. Training at the home is on-going and copies of courses undertaken were seen on the staff files and on the training matrix. These included moving and handling, health and safety, fire awareness, first aid, food hygiene and protection of vulnerable adults. However, there was no evidence that trained staff had received training in care planning. Other planned training includes Challenging behaviour, mental health training, infection control, falls prevention, person centred care, continence promotion and a foundation course on medication. Tabley House General Nursing Home DS0000018823.V291279.R01.S.doc Version 5.1 Page 18 The home has over fifty per cent of care staff qualified in NVQ level two in care. Staff files were looked at for four newly employed staff members and all of these contained appropriate checks prior to commencement of employment. Tabley House General Nursing Home DS0000018823.V291279.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): 31,33,35,36,38 The quality rating for this outcome area is good. This judgement has been made using available evidence including a visit to the service. The systems for resident and staff consultation are good and the health safety and welfare of residents is protected. EVIDENCE: The home has an experienced and competent manager who has been registered with the Commission for Social Care Inspection. She has obtained the Regulation in Care Service Award. The residents and staff spoken with said that the home’s management team were approachable and supportive. Tabley House General Nursing Home DS0000018823.V291279.R01.S.doc Version 5.1 Page 20 The general manager completes monthly unannounced visits and copies of these reports are kept in the home and sent to CSCI. Day to day supervision was good and staff said they were well supported. Formal supervision was given to staff and records showed that the supervisor and staff member signed these. A selection of staff and manager session’s records were seen. Policies and procedures seen were up to date and accurate. These were kept secure within the home. During discussions some residents confirmed that they had access to information kept about them. The fire precautions record book was up to date and demonstrated that checks of the alarm system, emergency lighting, fire drills and staff training were taking place on a regular basis. The maintenance staff checked the hot water in the home and this was recorded. Certificates were seen for the passenger lift and the hoists and an up to date gas safety certificate was seen. Resident, relative and staff meetings were held on a regular basis and the minutes were recorded. Residents and staff said that these meetings were productive. Residents living at the home said that they felt they could make choices and that their views were listened to and acted upon. The home have a staff representative group which meets on a regular basis and the chairperson attends the board meetings to discuss any issues raised. The home has a quality assurance system in place. Care plans at the home have improved since the last inspection visit, however some of them had been altered but the alterations had not been signed or dated by staff and on one care plan correction fluid had been used which partially destroyed the original record. This demonstrates poor practice and breaches the NMC ( Nursing and midwifery Council ) “Guidelines for record and record keeping.” Tabley House General Nursing Home DS0000018823.V291279.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 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 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 2 X 3 3 X 3 Tabley House General Nursing Home DS0000018823.V291279.R01.S.doc Version 5.1 Page 22 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 17(1) (a) Requirement The registered person shall (a) maintain in respect of each service user a record which includes the information, documents and other records specified in Schedule 3 relating to the service user. The registered person must ensure that staff receive training in care planning in accordance with the NMC “ Guidelines for record and record keeping” Timescale for action 30/09/06 2 OP30 18(c) (i) 31/10/06 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 OP7 Good Practice Recommendations Alterations made to care plans must be signed and dated by the member of staff completing the documentation. Tabley House General Nursing Home DS0000018823.V291279.R01.S.doc Version 5.1 Page 23 2 OP7 Correction fluid must not be used on care plan documentation. Tabley House General Nursing Home DS0000018823.V291279.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 Tabley House General Nursing Home DS0000018823.V291279.R01.S.doc Version 5.1 Page 25 - 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!