Inspection on 19/12/05 for The Crescent

This inspection was carried out on 19th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Crescent 02/10/07

The Crescent 19/07/06

The Crescent 26/07/05

The Crescent 19/10/04

The Crescent 05/05/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOME ADULTS 18-65 The Crescent 1 Island Crescent Newquay Cornwall TR7 1DZ Lead Inspector Kerensa Livingstone Unannounced Inspection 19th December 2005 09:30 The Crescent DS0000009012.V261470.R01.S.doc Version 5.0 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 The Crescent DS0000009012.V261470.R01.S.doc Version 5.0 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. The Crescent DS0000009012.V261470.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Crescent Address 1 Island Crescent Newquay Cornwall TR7 1DZ 01637 874493 01637 854254 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) Mr Michael Westmore Care Home 14 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (14) of places The Crescent DS0000009012.V261470.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th July 2005 Brief Description of the Service: The Crescent is registered as a residential care home that provides personal care and accommodation to 14 individuals who suffer from a mental illness. The Crescent is a three storey Victorian building that is situated in Newquay, overlooking the sea. The town centre is within easy walking distance, as are the bus and train stations. There is accommodation for 12 Service Users in the main house and more independent living for two in the annexe flat, which is attached to the main building. The property is a former hotel situated in close proximity to Newquay town centre. There is no designated car park and parking is on the road, this may be particularly difficult in the summer months. The location offers service users easy access to local amenities and shops. Newquay has its own cottage hospital that acts as an outpatient centre for all aspects of medical care, including mental health care. The owner of the home, Mr. Westmore has previously managed the homes running on a day-to-day basis. The Provider has recently moved out of the county and the Commission are clarifying the managerial arrangements for the home. The Crescent DS0000009012.V261470.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Crescent is an established home with a stable staff team and a relaxed, informal atmosphere. Service users were clearly comfortable within this environment and are observed to relate well to the staff. The Inspector had the opportunity to speak with Service Users, staff and inspect records. What the service does well: 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 Crescent DS0000009012.V261470.R01.S.doc Version 5.0 Page 6 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 The Crescent DS0000009012.V261470.R01.S.doc Version 5.0 Page 7 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2&3 Prospective service users have the opportunity to visit the home and a full assessment of needs and wishes is made. EVIDENCE: There have been no new admissions to the home since the last inspection. Detailed referral forms are completed prior to each admission to the home to form a Core Assessment. The Inspector observed comprehensive pre assessment information gathered for a new admission included contributions from both health and social services. The Registered Provider ensures that this includes the items listed in National Minimum Standard 2.3. Care Plans are completed in conjunction with the Community Psychiatric Nurse/Social Worker. Any potential restrictions on choice are discussed and agreed with the service user, they sign to demonstrate their agreement. There is an Emergency Admissions Policy and these are avoided. A gradual introduction to the home is planned for any new Service User including a full assessment, introduction to other Service Users living at the home and meeting the staff. There was evidence of this at inspection; a new prospective Service User is being introduced to the home, having visited the home, stayed for one night and then two nights prior to moving in after Christmas. All prospective Service Users must be provided with a copy of the Service Users Guide including a copy of the most recent report. The Crescent DS0000009012.V261470.R01.S.doc Version 5.0 Page 8 All Service Users are registered with a General Practitioner. The Inspector observed evidence of regular specialist input from services as required, such as Community Psychiatric Nurses, Social Workers, Chiropodist and Dentist. The Inspector and deputy Manager discussed the importance of ensuring that staff receive appropriate training to enable them to meet their needs. The Crescent DS0000009012.V261470.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 9 & 10 Service Users needs and personal goals including risk management strategies are identified within their individual plan, they contribute to the developing and reviewing of these plans. Records are stored appropriately. EVIDENCE: The Service User Plans are based upon the Core Assessment and developed in conjunction with the Service Users who sign them. There was evidence that the Service User and/or a representative were involved in the compiling and reviewing of the Plan. The Plan includes any restrictions on choice or freedom, which have been agreed with the service user. It covers all aspects of social, physical and psychological care. The Registered Person reviews the plans six monthly. Multidisciplinary review takes place within the Care Programme/Care Management process. There is no Keyworker system within the home. Service Users generally approach the staff member that they choose. The Crescent DS0000009012.V261470.R01.S.doc Version 5.0 Page 10 There is a Missing and Absent Residents Policy and a Risk Assessment and Management Policy. Risks are assessed prior to admission and are documented on the referral form. Individual risk assessments are completed for all Service Users, these include risk management strategies are recorded in the Service Users care plan. Service user records are stored securely in the office. Staff induction training includes confidentiality and a confidentiality policy is in place. The Inspector and Deputy Manager discussed the rights of Service Users to access information that is held about them, although this is not formalised within a Procedure. The Crescent DS0000009012.V261470.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 & 17. Service Users are encouraged to participate in activities within the local community and their rights are respected. Families and visitors are welcomed to the home, depending on the wishes of the Service User. Service Users enjoy the meals that are offered in the home. EVIDENCE: Staff work with the service users to identify practical or social life skills that they wish to develop. Service Users participate in the running of the home, for example with the preparation of food, washing up, tidying their rooms and some undertake additional duties within the home and receive a small payment for these voluntary duties. Specialist input is provided by Community Mental Health staff. Service Users are encouraged to maximise their independence and continue with existing interests and hobbies. Service Users are encouraged to participate in college courses, go to Church, attend the library, go to Yoga, participate in Creative workshop or a gardening job. Information about the community activities is made available to the Service Users. The Crescent DS0000009012.V261470.R01.S.doc Version 5.0 Page 12 The service users are registered on the electoral roll. Service users have good access to local amenities, including transportation. The location of the home in the centre of Newquay facilitates integration into the local community. Information is available about local activities or outings planned. There is a designated member of staff who ensures that the Service Users are aware of what is available within the local community and has arranged trips or outings. The Deputy Manager informed the Inspector that the staff were actively encouraging Service Users to participate in activities that interested them. Visiting is open until 22.00. Family contact varies from none to regular and frequent. Some Service Users are encouraged to go on daily walks, attend local groups or activities for example; Coffee Corner, Mind drop in and Roswyth. Service Users have a high degree of freedom, informing staff when they will be back. Service Users are encouraged to determine their own activities and interests. Service Users have responsibilities within the home for cleaning their rooms, clearing the dishes and generally tidying up. All Service Users have a key to their room door and the front door. The Service Users value their freedom of choice and say they are able to make choices about how they spend their time. Service Users receive their mail unopened. A four weekly rotational menu is in operation. On the day of the inspection the menu for lunch was bacon sandwiches followed by donuts. A Cottage Pie was being made for tea. Generally, the menus demonstrate a nutritious, varied and balanced diet. A choice of menu and salads are available. The Inspector was advised that fruit is available at all times. Fridge and freezer temperatures are recorded. A food records are kept. All staff have completed the Foundation Food Hygiene training, the Registered Provider and Deputy have completed Intermediate Food Hygiene. The Environmental Health Officer visited the home on the 16.11.05; certain recommendations are due to be actioned. The Crescent DS0000009012.V261470.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 21 Service Users have the opportunity to discuss their wishes about ageing, death and illness. EVIDENCE: Since the last inspection the Inspector was informed that the Registered Provider has replaced the existing medicines cupboard with a new wall mounted cupboard which complies with the Royal Pharmaceutical Society guidelines and the Misuse of Drugs Act 1971. Information is gathered to include the Service Users wishes and family/carers involvement. Information is gathered sensitively about the individual’s religious beliefs and their specific requests e.g. flowers, nest of kin, cremation and clothing. There is an up to date Service User Policy relating to Ageing and Death. The Crescent DS0000009012.V261470.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Service Users feel their views are listened to and aware of whom to speak with if there is a concern. There are systems in place to protect Service Users from abuse, neglect and self-harm. EVIDENCE: There is a clear complaints procedure, this includes the stages and the required information. The Inspector was advised that a record is kept of all complaints and outcomes recorded, however no complaints or concerns had been expressed since 2003. The Inspector and Deputy Manager discussed the importance of recording low-level complaints. The Commission has received no complaints in relation to this home in the last year. There is an up to date Protection of Vulnerable Adults Procedure and Policy, which includes the local Procedure 77 and contact details for the Commission. Whistleblowing is in a separate document. There is a Management of Service User’s money and valuables policy, which is dated, signed and up to date. All staff have received in house training on the Protection of Vulnerable Adults and when asked were aware of the action to be taken. The Deputy Manager has attended the County Council training and it is recommended that all staff undertake this training. Certain Policies and Procedures are due for up dating this includes the Procedure for Restraint. The Crescent DS0000009012.V261470.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26, 28, 29 & 30 The environment is homely and meets the needs of the active Service Users in the home. Personal accommodation is suited to the Service Users needs. EVIDENCE: The bedrooms include the required fittings and furniture. All Service Users have a single room and these rooms are personalised. Service Users inform the Inspector that they like their accommodation and the privacy that it gives them. All individuals have a front door and bedroom key. There is a large smoking separate lounge on the first floor with a television. There is a dining room with lounge area on the ground floor with another television. Private consultations would take place in individual bedrooms. Service Users can access the kitchen at anytime, although some items are locked away at night. There is a laundry on the other side of the kitchen, and its situation does involve dirty laundry being carried through the kitchen in a plastic container. The facilities suit the needs of the mobile client group; wheelchair access could be gained via the annexe flat. There is no lift in the building or specific The Crescent DS0000009012.V261470.R01.S.doc Version 5.0 Page 16 equipment for individual Service Users. Specialist equipment would be obtained on an individual basis. There is no call bell system in the home. Hot water is unregulated, hot surfaces uncovered and windows are restricted. The Provider assesses that the risk is manageable, has undertaken an environmental health risk assessment. Service Users are encouraged to take responsibility for the cleaning of their own rooms, staff provide support for this. There are no designated domestic staff, staff do this in addition to the cooking and caring for the service users. Most staff have completed Infection Control training in 2004 and an environmental audit of the kitchen and bathroom facilities was done at this time. There is an Infection Control Policy for the home. The Crescent DS0000009012.V261470.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 The staff working in the home undertake generic roles including cooking, cleaning, laundry and caring. There are no waking night staff. The Service Users like the staff and were observed to interact in a positive way. Specialist input is provided by the Primary Health Care and Mental Health services. EVIDENCE: The Crescent DS0000009012.V261470.R01.S.doc Version 5.0 Page 18 The staff undertake generic roles with no designated laundry, domestic, maintenance or catering staff. The current rota shows that there are two members of staff on duty for most of the day, except for some afternoons and in the evening where there is usually only one. No agency staff are used within the home. No staff are under eighteen and no one under twenty one is left in charge of the home. On the day of the Unannounced Inspection, the two staff on duty were observed to be busy. The staffing at night has been reduced from a waking member of staff to a sleeper, which at the Inspector’s last inspection had been working well. The Registered Provider has moved out of the county and the Commission are seeking to clarify the managerial arrangements for the home. As there is no Registered Manager. The Registered Provider must ensure that there are at all times suitably qualified, competent and experienced persons working at the care home in such numbers as are appropriate for the health and welfare of Service Users. Three staff are currently undertaking the National Vocational Qualification Level 2 training. The newest member of staff is completing a TOPSS induction booklet and is due to do the required training. Three staff have the National Vocational Qualification Level 2 training. The Deputy Manager is studying for her National Vocational Qualification Level 4 in Care. The Deputy Manager and Inspector discussed the need for the training provided for all staff to be reviewed prior to the next inspection. The Crescent DS0000009012.V261470.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 42 & 43. The Service Users enjoy living at the Crescent and speak well of the staff and their home. The current managerial arrangements for the home require clarification. EVIDENCE: The Registered Provider has sixteen years experience as the Provider and has previously managed The Crescent on a daily basis. However this has changed over the last year or so. A Deputy Manager is managing the home on a daily basis and is taking on more responsibility. The Deputy Manager is studying for the National Vocational Qualification Level 4 in Care and plans to do the Registered Manager’s Award. If the Registered Provider is no longer managing the Care Home on a day-to-day basis, an application must be made for a Registered Manager and Regulation 26 visits with reports must be made. Copies of these reports must be sent to the Commission for Social Care Inspection. The Registered Provider is required to provide evidence of financial viability as The Crescent DS0000009012.V261470.R01.S.doc Version 5.0 Page 20 a routine part of the inspection process. There is evidence of ongoing investment into the home. Employers Liability Insurance is in place within the home. At the last inspection it was recommended that the Registered Provider review the quality assurance tools to provide more focused questions and to widen the scope to other agencies as well as service users. The registered provider should make arrangements for the publication of a summary of the findings, including any action taken in response to these. The Inspector was advised that this had not been done yet. Hot water is unregulated and hot surfaces uncovered. Risk assessments have been undertaken for all Service Users, in relation to hot surfaces and hot water temperatures. The Registered Provider has completed a 4-day First Aid Course, and all staff have completed a 1-day course, with the exception of the newest one. The Deputy Manager plans to arrange this training for the newest member of staff. All windows have restrictors fitted. A legionella risk assessment has been undertaken by the Provider and who has assessed that no further action is required. Certain certification could not be located during the inspection e.g. electrical servicing annually, five yearly hard wiring checks and a Fire Officer report for the last year. Gas appliances were checked in July 2005. There is evidence that Fire drills and emergency lighting checks are carried out regularly. A Visitor’s Book is located in the reception area of the home. Evidence that staff have read and understood the Policies and Procedures should be gathered. The Crescent DS0000009012.V261470.R01.S.doc Version 5.0 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X 3 3 X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score X 3 3 X 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X X X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Crescent Score X X X 3 Standard No 37 38 39 40 41 42 43 Score 2 X X X X 2 3 DS0000009012.V261470.R01.S.doc Version 5.0 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 YA33 Regulation 18(1a), Sch. 4 Requirement Timescale for action 01/01/06 2. YA37 26 3. YA37 8(1b) 4. YA43 25(2) The Registered Provider must ensure that there are at all times suitably qualified, competent and experienced persons working at the care home in such numbers as are appropriate for the health and welfare of Service Users. The Registered Provider shall 01/01/06 visit the home in accordance with this regulation, if they are not in day-to-day charge of the home. The Registered Provider shall 01/01/06 appoint an individual to manage the care home where he is not, or does not intend to be, in fulltime day-to-day charge of the care home. The Registered Provider is 01/03/06 required to provide evidence of financial viability of the care home. The Crescent DS0000009012.V261470.R01.S.doc Version 5.0 Page 23 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. 2. 3. 4. Refer to Standard YA14 YA22 YA23 YA39 Good Practice Recommendations For a record of all activities, training, leisure pursuits and fulfilling activities to be kept. For low level concerns or complaints to be recorded. For all staff to attend the externally facilitated County Council Protection of Vulnerable Adults training. The Registered Provider should review the quality assurance tools to provide more focused questions and to widen the scope to other agencies as well as service users. The Registered Provider should make arrangements for the publication of a summary of the findings, including any action taken in response to these. This must be made available to the Service Users and a copy supplied to the Commission for Social Care Inspection. For evidence to be gathered that all staff have read and understood the Policies and Procedures. 5. YA42 The Crescent DS0000009012.V261470.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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 The Crescent DS0000009012.V261470.R01.S.doc Version 5.0 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!