Inspection on 05/01/09 for Talbot View

This inspection was carried out on 5th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Talbot View 11/01/07

Talbot View 23/02/06

Talbot View 01/11/05

Talbot View 13/10/04

Talbot View 21/06/04

Talbot View 28/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Talbot View 66 Ensbury Avenue Ensbury Park Bournemouth Dorset BH10 4HG     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Tracey Cockburn     Date: 0 5 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Talbot View 66 Ensbury Avenue Ensbury Park Bournemouth Dorset BH10 4HG 01202537571 01202547328 talbotview@care-south.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Care South care home 59 Number of places (if applicable): Under 65 Over 65 42 17 dementia old age, not falling within any other category Additional conditions: 0 0 One service user (name known to CSCI) in the category of LD(E) may be accommodated. Three service users (names known to the CSCI) in the category LD may be accommodated. Two service user (names known to CSCI) in the category of DE may be accommodated. Date of last inspection Brief description of the care home Talbot View is part of the Care South group of homes. Care South is a non-profit making organisation. Talbot View provides accommodation for a maximum of 59 older people who require personal assistance due to old age and frailty and or dementia type illnesses. The premises were purpose built in 2000 and provide accommodation in 59 single rooms, all with en-suite facilities on ground and first floor levels. The first floor is reached by a passenger lift or one of three stairways. Accommodation is arranged in Care Homes for Older People Page 4 of 27 Brief description of the care home four houses; Wareham Way and Lollipop Lane accommodate people with dementia care needs, Butlers Brook and Highmoor Heath accommodate older people with general personal care needs. Both dementia care houses have keypad entry systems to ensure residents safety. Each house provides single room accommodation and shared, communal areas consisting of lounge and dining room areas. The current fee range is 570 pounds to 735 pounds per week. Further information on contracts and fees can be found on the office of fair trading website: www.oft.org.uk Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We inspected the home with two people, due to the size of the service. We sent out survey forms for people to tell us what they think about the service. We had survey forms back from seven people who use the service, seven people who work in the service and one health professional. We looked at the annual quality assurance assessment sent to us, this told us what the service does well and where it needs to improve. This helped us decide what areas of the home to look at. During the site visit we talked to people about what its like to live in the home. We talked to staff about the training and support they receive and we looked at records the home has to keep. Care Homes for Older People Page 6 of 27 What the care home does well: What has improved since the last inspection? What they could do better: At the end of this inspection there are six requirements and one recommendation. It is important that care plans are reviewed regularly and when individual needs change, to not do this puts people at risk. To ensure that people are safe and well care for it is necessary to ensure that information recorded about care is done accurately and when agreed as failure to do this could risk someones health. To ensure that people living in the service are supported safely staffing in each unit in Care Homes for Older People Page 7 of 27 the home should be reviewed to ensure that there is the right number of staff to support people with higher levels of care. The home needs an accessible systems for checking when staff need to update their training so they have the skills they need to do the job well. When a registered manager has been away for more than six months it is good practice to put forward another manager for registration to ensure that people using the service have good outcomes. To ensure the safety of people living and working in the home fire checks must occur at the specified intervals. It is important that care plans follow current good practice guidance to ensure that people are protected and staff know the action they need to take. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering using this service have their needs assessed before a decision is made which means that everyone is clear about whether or not the home has the staff with the skills necessary to care for the individual safely. Evidence: The annual quality assurance assessment submitted by the manager says: Assessments take into account individual needs and wishes We looked at four files of people living in the home we found that no admission had been made into the home until an assessment had been completed. We found that were care management arrangements were in place there was a summary of the assessment and the care plan on the persons file. Care Homes for Older People Page 10 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to ensure that care needs are clearly recorded so that care staff know what to do. However reviews are not completed consistently and information is not always accurately recorded which could put some people using the service at risk. Evidence: We looked at the care files for five people who use the service. We found a variety of assessments and information. We found evidence of the involvement of health care professionals and we found evidence of equipment in place to relieve pressure and assist people around the home. We found for one person there had been no review of their care plan since June 2008 and the risk assessment regarding their risk of skin breakdown was very high and had not been reviewed since April 2008. We found a risk assessment in place for falls, none for catheter or skin care. We found that there was a turning chart but no instructions as to frequency of turning. Records showed gaps in turning times. There was no nutritional assessment or charts as to Care Homes for Older People Page 11 of 27 Evidence: fluid and diet intake. We spoke to a health care professional about how often the person should be turned and their opinion differed from the carer. The records did not clearly support either opinion. We found a number of gaps in recording with reviews not taking place with the last year. We found that care plans did not contain enough information on how people need to be supported. We looked at one care plan for someone with a diagnosis of epilepsy, the care plan contained some information on the condition but not enough detail on what to do if the person had a seizure. A member of staff said they had never had a seizure which is all the more concerning if they did have one and there is no information on what good practice would be to ensure their safety. The annual quality assurance assessment says that they should ensure reviews are taking place. We found in all the care files we looked at reviews were not taking place at the frequency we would expect if someones needs were changing. One health care professional told us that the service meets individual needs, promptly reports concerns and worries. We looked at medication and found that in general the administering of medication was handled well and that a good record was kept. Medication was stored safely and staff received training before handling medicines. During the inspection we observed staff speaking to people respectfully and in one particular incident at lunch time calming a situation with skill and patience. People told us that staff are good and Staff always help me when I ask Care Homes for Older People Page 12 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in recording recreational and social interests would add to the activities in the home and enhance peoples experience of living there. People are able to maintain contact with family and friends and the local community and are supported to make choices in their daily lives. The provision of a balanced diet adds to peoples wellbeing in the home. Evidence: A recommendation at the last inspection was for an activities organiser to be recruited this has happened and has made a difference to the range of activities available to people. The annual quality assurance assessment (AQAA) says: We provide activities which are tailored to the needs of certain residents and we also have one to one conversation with residents with different needs. During the site visit no activities were observed and it was noted that social histories and recreational interests were not recorded well in care plans. However staff, from observation, know individuals well and respond to their needs. Activities were posted on the notice board. The annual quality assurance assessment also said: The Chef is taking photographs of all meals offered, to be presented in a file for those Care Homes for Older People Page 13 of 27 Evidence: who are unable to understand what is being offered from the menu. This will also benefit the people with dementia and the hard of hearing. People told us that there is always a choice of food on the menu. One person saidI always enjoy the food here Meals are made in the central kitchen and transported to the four unit in trolleys which keep the food at the right temperature. People were observed either eating in the dining room in each unit or if they preferred in the lounge or in their own room. People were able to sit with whom they wanted and were able to eat their meal at their own pace. We found that information about the menu for that day was written on a board in each lounge. One person told us that staff come round and tell them what is on the menu for that day. Care Homes for Older People Page 14 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a system in place to ensure people are listened to and their concerns acted upon. Staff receive the training they need to keep people safe from harm. Evidence: No complaints since the last inspection, lots of compliments recorded such as thank you to everyone who provided such good food, nice clean laundry and lovely clean environment for X. Two people out of the seven who responded to the survey form said they did not know how to make a complaint. People who use the service told us they would speak to the manager if they were unhappy. Staff told us that they have received training in safeguarding and the home has a policy and guidance in place. Care Homes for Older People Page 15 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, well maintained home where they are able to have familiar things around them. The home has a well run laundry and infection control procedures are followed ensuring the home is hygienic. Evidence: The home is split into four separate units, we found the home to be clean, rooms personalised, pictures on doors such as a picture of one person on their wedding day. the annual quality assurance assessment (AQAA) says: We provide a clean, friendly environment with secure outside space. A good cleaning schedule. Talbot View has four separate dining rooms and four separate lounges. We have two gardens, one large open garden and one enclosed garden to meet the needs of the dementia residents. The grounds are maintained on a regular basis by the gardeners. Talbot View is a purpose built home with 59 bedrooms. 56 rooms have ensuite toilet facilities and 3 rooms have en-suite shower rooms. We have new sluices installed to meet the requirements of the home. A weekly collection of clinical waste. We encourage residents and families to familiarise the bedrooms with items brought in from their homes. The furniture is in a good state of repair, and kept clean We found that people who live in Talbot view are encouraged to personalise their bedrooms. The communal areas of the home provide space for people to meet Care Homes for Older People Page 16 of 27 Evidence: relatives and friends in private. The bathrooms are fitted with aids and adaptations to meet the needs of the people living in the home. We found the home to be well lit, clean and smelt fresh. The laundry room was clean and well maintained. Staff were observed wearing protective clothing. Care Homes for Older People Page 17 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are met by a reasonable number of staff on each shift however they are not always deployed around the home appropriately to fully meet peoples needs. The system for identifying staff training needs is not clear and means that some staff may not be receiving the training they need to do their job well. Evidence: We spoke to a group of four staff they said they had all received training in moving and handling, protection of vulnerable adults, fire. Other training provided included infection control, first aid. Only one had dementia training and they said this was offered as a choice and not mandatory. They also said that they felt there had not been as much use of agency staff in the past month. They felt that staffing arrangements were about right. Staff described acting manager as approachable. We looked at staffing records for month of November. There was regular use of agency at least every day; on 3/11/08, six agency staff. On 4/11/08 seven agency staff. Though there was evidence of the same agency staff being used in the home. In the months of December and January there was a much reduced level of agency staff being used. One person said that the staff are good get the help needed enough activities for me A recommendation made at the last inspection regarding written records being kept of staff members progress has been put into place and all staff who are completing induction and foundation training have work book which is their record Care Homes for Older People Page 18 of 27 Evidence: of progress. A requirement was made at the last inspection regarding recruitment checks and ensuring that staff do not start work until a protection of vulnerable adults check has been returned. This requirement has been addressed we looked at six staff files and all had the protection of vulnerable adults check completed and returned before they started work in the home. Six staff files were looked at all contained application forms, two written reference, dates of employment, CRB and POVA 1st checks and induction. In all six files there was evidence of proof of identity being sought. We looked at staff training records. Staff told us that there is access to training when they want it. Other staff told us that training in dementia care was not mandatory for all staff only those who work on the two unit who support people with dementia. Other members of staff told us that they work in every unit at Talbot View so it is therefore important that all staff receive dementia care training. Some staff have completed the Gemma Jones course on dementia care, the acting manager thought this course was not longer offered by the provider. We were told by staff that only senior staff did the Gemma Jones course. We spoke with a health care professional who works for the Primary Care Trust (PCT) they block book beds for rehabilitation. she said that the staff are very caring very consistent follow care plans well willing to help this person visits the home regularly to monitor people in the block booked beds and adjust the care plans and staff respond well to the changes. One visitor said it was rare on the unit they were visiting to see an agency worker. There was one there on the day of the site visit. Sometimes five agency staff working in an afternoon when nine staff on duty. the acting manager told us that since a successful recruitment drive the use of agency staff has diminished. There are ten staff on duty in the morning ( care staff) nine in the afternoon and three at night, three staff awake and a duty manager asleep. One member of staff wrote on the survey forms that attending a dementia awareness course is voluntary and they felt it should be compulsory. One person told us that the national vocational training at level two give you sufficient understanding in taking into account individuality and diversity. The AQAA states that of the thirty nine permanent members of staff 25 have NVQ at level 2 or above. At the previous inspection in January 2007 the inspection report noted: At the time of the inspection there was no summary of training available in the home. A copy of this is held at Head Office. Following the visit the manager has compiled a spreadsheet so that training needs can be monitored and identified. The home maintains a training folder for staff members where copies of certificates and verifications of attendance are held. At this inspection we found that the acting manager had no access to the computerised spreadsheet kept by the registered manager. The acting manager was keeping the folder with certificates up to date but there was no system for making sure that staff received refresher training. In one of the staff files we looked at it was difficult to Care Homes for Older People Page 19 of 27 Evidence: determine if the member of staff needed refresher training in food hygiene as they completed a course in December 2006 but there was no information on when that would need to be redone. Another member of staff had not had manual handling training since 2005. We asked staff if there was enough of them on each shift. One member of staff told us generally there was. We found in one unit there was a high number of people with a high level of care need but it was staffed with the same number of staff as another unit where people were frail but did not have the same high level of care need. We found that staffing rotas do not take account of the needs and routines of people using the service. We looked at the roster for all staff on duty and it clearly shows the number of staff on each shift and their role. Care Homes for Older People Page 20 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has been without a registered manager for over six months which is not good practice and leaves the service vulnerable. There is a quality assurance process in place which listens to people and their views of the service. Overall peoples health,safety and welfare is protected however some gaps in safety checks could put people at risk. Evidence: The registered manager has been off for eight months and the deputy manager has been acting up into the role. The acting manager told us that she is aware of the need to keep up to date with training and know that she should be undertaking a management qualification. It is important that the acting manager improves some of the systems in the home such as the recording of training needed by staff. During the site visit staff commented positively about the support they receive from Care Homes for Older People Page 21 of 27 Evidence: the acting manager. A requirement was made at the last inspection that electrical wiring must be checked every five years. This has been addressed. We found that not all fire safety checks were up to date with several gaps in the last month. We will be making a requirement regarding this. We are doing this because the safety of people living and working in the home is very important. A recommendation was made at the last inspection that all entries into financial records should be made in pen. In all of the records we looked at entries were in pen. Care Homes for Older People Page 22 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered provider must keep the service users care plan under review. It is important to keep care plans under review at least once a months so that it accurately reflects the changing needs of a person. 30/04/2009 2 8 12 The registered provider 30/04/2009 must ensure that where action has been agreed to maintain an individuals health this is recorded clearly and all staff know the action to be taken. It is important that records are accurately kept and that all staff know what to do and when to do it to ensure that skin at risk of developing a pressure sore is protected. 3 27 18 The registered provider must having regard to the size of the care home, the statement of purpose and 30/04/2009 Care Homes for Older People Page 24 of 27 the number and needs of people using the service, ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. It is important that each unit of the home is staffed according to the varied needs of the individuals living there.This is so that their health, personal and social care needs can be fully met. 4 30 18 The registered provider must ensure that staff receive training appropriate to the work they perform. It is important that staff receive the training they need to keep up to date with good practice and ensure the safety of the people living in the home. 5 31 9 The registered provider 31/03/2009 must be aware that a person shall not manage a care home unless he is fit to do so. The registered manager has been away from their post for over six months and in order to ensure good outcomes for people using the service another manager should be put forward for registration. 30/04/2009 Care Homes for Older People Page 25 of 27 6 38 23 The registered provider 31/03/2009 must make suitable arrangements for ensuring that testing of fire equipment occurs at suitable intervals. It is important that all fire checks take place at the specified time otherwise people could be put at risk. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 The registered provider should ensure that an individuals plan meets relevant clinical guidelines. This is of particular importance for people with epilepsy so that all staff know what to do. Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 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!