Inspection on 22/08/06 for The Croft

This inspection was carried out on 22nd August 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Croft 23/05/07

The Croft 24/10/05

The Croft 25/10/04

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE The Croft Chestnut Lane Amersham Bucks HP6 6EJ Lead Inspector Nichola Cahill Unannounced Inspection 22nd August 2006 09:30 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 The Croft DS0000023060.V301983.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Croft DS0000023060.V301983.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Croft Address Chestnut Lane Amersham Bucks HP6 6EJ 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) 01494 732500 01494 732 510 www.heritagecare.co.uk Heritage Care Lorraine Coe Care Home 60 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0), Physical disability (0) of places The Croft DS0000023060.V301983.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 60 older people, some of whom may have dementia and/or physical disabilities 24th October 2005 Date of last inspection Brief Description of the Service: The Croft is a residential home providing accommodation for sixty elderly residents in the categories of old age and dementia. The accommodation is over two floors and access to the first floor is via a shaft lift, or stairs. The home has sixty single bedrooms all having en-suite facilities. The communal areas are well situated on the ground and first floor. The layout of the home is conducive to meeting the needs of residents. The home is divided into four units supporting half the residents in the category of dementia care. The home is situated in Amersham, a small market town close to all local amenities. The home has good road links to other larger towns; it is also served by public transport. Information regarding the services offered is available from the home on request. The homes fees range from £418.00 per week to £514.00 per week. The Croft DS0000023060.V301983.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the summary of the annual unannounced key inspection visit carried out by Nicky Cahill (inspector) on 22nd August 2006. The inspection took place over a period of twelve hours, this includes the pre-planning. The inspection consisted of the following; • An assessment of information available to The Commission since the last inspection visit. • 11 comment cards were received from relatives, 10 from service users and one from a GP. • An assessment was made against requirements made at the previous inspection visit in October 2005 and against the key standards. • Documentation was viewed, • Observations were made, • There were discussions with the deputy manager, service users and staff. A tour of the building was carried out. What the service does well: What has improved since the last inspection? Service users are assessed appropriately and receive information regarding the services offered by the home. This will ensure that the service users are placed appropriately and that they are aware of the service they will receive. The Croft DS0000023060.V301983.R01.S.doc Version 5.2 Page 6 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 Croft DS0000023060.V301983.R01.S.doc Version 5.2 Page 7 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 The Croft DS0000023060.V301983.R01.S.doc Version 5.2 Page 8 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): 2, 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users are assessed appropriately and receive information regarding the services offered by the home. This will ensure that the service users are placed appropriately and that they are aware of the service they will receive. EVIDENCE: This group of standards were assessed through discussions with the deputy manger, viewing documentation and evidence of service users involvement in the admission process. Pre-admission assessments were viewed for three service users admitted to the home since the last inspection visit. Two of the three assessments had been carried out by the deputy manager, who had then typed up the notes in the assessment format. The documents were detailed and had been completed in different colours to draw attention to particular areas of need. The service users and / or a representative had been involved in the assessment process. The Croft DS0000023060.V301983.R01.S.doc Version 5.2 Page 9 One of the assessments had been completed, however, not in as much detail. It was also unclear whether the assessment had been completed prior to the service user being admitted to the home and whether the service user had been consulted. Recommendations are made for further improvements in this area. All service users had a contract and terms and conditions of their stay. The Croft DS0000023060.V301983.R01.S.doc Version 5.2 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The detail contained in the care plans does ensure that service users’ personal health and social needs are met. There are weaknesses in the medication procedure, which are placing service users at high risk. EVIDENCE: This group of standards were assessed through discussions with the deputy manger, viewing documentation and evidence of involvement in the care planning process for five service users, observations of care delivery and discussions with some service users. Of the five care plans viewed all service users had a basic care plan highlighting capabilities regarding mobility, likes and dislikes, personal care assistance required and dexterity. However, other information recorded was erratic and did not include many references to health care needs, such as dentist visits, podiatry, district nurse The Croft DS0000023060.V301983.R01.S.doc Version 5.2 Page 11 intervention and occupational therapy. It was clear from medical intervention records, which were kept separated from the care plan information, that other health care practioners did visit the home, but it was incredibly difficult to track this to particular identified needs for individuals. Daily record sheets were scruffy; some were illegible and did not contain significant information regarding skin condition, personal care delivery, diet or social interaction and events. Entries made by care staff in the daily care notes did not correspond accurately to the daily notes made by senior staff in separate records. Risk assessments were poor in most areas and did not identify actions to eliminate risks or any review dates. A full feedback of findings and examples of shortfalls was given to the deputy manager at the end of the inspection visit. A requirement has been made for improvement in this area. One concern noted was the number of falls recorded within the home. One service user had, according to records viewed, fallen eighty-four times since admission in February. However, there was no evidence to suggest that any professional advise had been sought regarding falls prevention. A number of service users observed throughout the day had facial bruising, consistent with frequent falls. Records showed that many service users were ‘found’ having fallen. This would indicate that staff allocation must be reviewed to ensure effective prevention were necessary. Tissue viability and nutritional screening had not been assessed and, although one care plan indicated that weekly weights should be carried out, this was not recorded. Requirements have been made for improvements in this area. Medication storage systems, administration and recording were assessed in the two dementia care units on the ground floor of the home. On arrival in one of the units it was found that the medication cabinet key was hanging from the door. On examination of medication administration records, (MAR), one record had been hand written but had not been double signed. One medication had been signed into the home on 14th August 2006; however, the MAR sheet indicated that this was administered from 7th August 2006. A number of gaps were found within MAR sheets viewed. Medication storage was in disarray, with baskets containing medications for different service users scattered around the cupboard. The pharmacist had blistered most medications. Other examples of poor practice were fed back to the deputy manager at the end of the inspection visit. The team leaders handover book records showed that from 30th July 2006 to 17th August 2006, five medication errors had occurred. This would include the administration and recording of controlled drugs. It was confirmed by the deputy manager that care staff training was out of date in this area. The Croft DS0000023060.V301983.R01.S.doc Version 5.2 Page 12 A requirement was made during the inspection visit in October 2005 regarding weaknesses in the medication procedure which needed to be addressed and the competency of staff responsible for the safe handling and administration of medications. This requirement clearly has not been met. A further requirement has been made for improvement in this area. The Croft DS0000023060.V301983.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Activities organised within the home are not always adequate and do not ensure that lifestyle experience matches service users personal preferences and choices at all times. Service users are encouraged to maintain contact with family and friends who are welcomed in the home at all times. Service users receive a wholesome and nutritious meal, which takes into account different likes and dislikes. EVIDENCE: This group of standards were assessed through discussions with the deputy manger, service users and staff, viewing documentation and evidence of service users involvement in making choices regarding their lives and from direct observations. A number of comment cards were also received from service users and relatives. The home advertises the services of age concern advocacy that visit the home at set times each month. From discussions with some service users this service would be accessed if and when needed. The Croft DS0000023060.V301983.R01.S.doc Version 5.2 Page 14 The home employs two activities co-ordinators. There were adverts around the home for several activities and it was noted that some service users were going to Southend the day following the inspection visit. However, it was disappointing to note that during afternoon of the inspection visit, despite an activities co-ordinator being on duty, there was little interaction with service users. One member of staff was sitting in the lounge with service users but was not interacting. The television was playing children’s cartoons and no attempt was made to ask service users what they would like to watch, if anything. Service users were unable to make any comments when asked what the activities were like and whether they were regularly involved in choosing something suitable to occupy their time. One member of staff was questioned as to what the planned activity would be on the afternoon of the inspection. It was reported that a rail of un-named clothing would be wheeled around in order for service users to identify lost clothing. Requirements have been made for improvement in this area. It was confirmed that newspapers and magazines are ordered through the home for individual service users to enjoy. Service users also confirmed that they were able to receive visitors at any time, and relatives reported that they were made to feel welcome. Mealtime was observed in two areas of the home. Service users were given a choice of meal, which, on the day of the inspection was, bacon roll or chicken pie with vegetables and bananas and custard or rice pudding for desert. Soup was supplied for those not wanting a main meal. Service users needing assistance with meals were treated with dignity and respect. The deputy manager is reminded that serviced user choice must be further extended to whether they wish for condiments to be added to their meals. The Croft DS0000023060.V301983.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Poor procedures in the recoring of compliants and their outcomes and shortfalls in adult protection training do not ensure the safety of service users at all times. EVIDENCE: This group of standards were assessed through discussions with the deputy manger and service users and viewing documentation. A number of comment cards were also received from service users and relatives. The manager had reported that four complaints had been made in the last twelve-month period. Records viewed would indicate that the manager had addressed these complaints, however, it was unclear how the complainant had been made aware of any outcomes. Complaints had been recorded in a hardbound book and did not protect the confidentiality of service users. However, the deputy manager had recently obtained a complaints format produced by the organisation, which would be used in the future. It was disappointing to note that the quarterly complaint audit submitted to the organisation listed two complaints as ‘low importance complaints’. Both complaints were of a serious nature and were with regard to the care of individual service users. It was discussed with the deputy manager that all complaints were of the same importance. It was also interesting to note that The Croft DS0000023060.V301983.R01.S.doc Version 5.2 Page 16 the coding on this format indicated that the home were only partially responsible for one complaint, however, the nature of the complaint and the service user involved would clearly indicate that the home had not met the needs of a service user. Three service users reported that they would not necessarily tell anyone if they had a concern or complaint, as they did not wish to make a fuss. One comment card received showed dissatisfaction in the way that a compliant had been addressed. A requirement has been made for improvement in this area. The home has no reported protection of vulnerable adult issues recorded in the last twelve-month period. Policies and procedures are in place and staff have access to the ‘whistle blowing policy’. Staff training was sadly lacking in this area with the training matrix showing only 23 of the 51 staff having received an up date in the last twelve months. A requirement has been made for improvement in this area. The Croft DS0000023060.V301983.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Some areas of the home are not clean and hygienic and do not allow service users to live in a comfortable, homely environment suited to their individual needs. EVIDENCE: This group of standards was assessed through direct observation during a tour of the building and discussions with service users and the deputy manager. Some areas of the home were nicely presented in their decoration and cleanliness. However, it was disappointing to note that the some areas, in particular in the dementia care units, accommodation was not kept to a satisfactory standard. • A number of bedrooms had a strong odour of urine. • Care staff had made beds but some stained bedding had not been removed. The Croft DS0000023060.V301983.R01.S.doc Version 5.2 Page 18 One bedroom had received some filling to the cracks in the wall, however, had not received any further attention. • One service user had been living in the home for some time, however, pictures and personal belongings were still boxed on the floor. • Bedding, in particular, pillows, were misshapen and did not look at all comfortable. • Bathrooms around the home were used for the storage of a sideboard with activity items and other miscellaneous goods being stored. • Notices were on walls in service users bedrooms regarding intimate care procedures. • The front entrance of the home housed a desk for the designated responsible person. On arrival this was strewn with confidential records and other documentation. This list is not exhaustive. This list was feedback to the deputy manager and it was discussed that a full tour of the building must be carried out to identify other issues to be addressed. A requirement has been made for improvements in this area. • The Croft DS0000023060.V301983.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home operates robust recruitment, induction and supervision. However, significant shortfalls in training could have an impact on the health and safety of service users, potentially putting them at risk. EVIDENCE: This group of standards were assessed through discussions with the deputy manager and staff on duty, through observations and documentary evidence. Five staff personnel files were viewed. All documentation was in place. The staff training matrix showed a significant shortfall in most areas of training. Training certificates were also viewed and confirmed that training was out of date in a number of areas. A requirement has been made for improvement in this area. Four induction packs were viewed for new staff employed. These were found to be in order. Supervision records showed that most staff were receiving the required amount of supervision sessions required. The Croft DS0000023060.V301983.R01.S.doc Version 5.2 Page 20 A number of comment cards received prior to the inspection indicated that there were staff shortages; particular reference was made to staffing in the dementia care groups. At the time of the inspection visit it was noted from discussions, documentation and observations that there were three members of staff on each of the dementia care units during the day, two each on the residential care units, a team leader and the deputy manager and manager. It was noted that the home are using a significant number of agency staff at present, however, these staff are regulars to the home and appear to be aware of the service users needs. It was confirmed that recruitment is ongoing. Staffing appeared to be adequate at the time of the inspection visit. However, it was discussed with the deputy manager that the needs of the current service user group are ever changing and staffing numbers should be reviewed continuously. It was confirmed that extra staff would be on duty should the need arise. The Croft DS0000023060.V301983.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Service users are protected by the health and safety systems in place. However, the management does not ensure that the home is run in the best interests of the service users at all times. EVIDENCE: This group of standards were assessed through discussions with the deputy manager and staff on duty, through observations and documentary evidence. From the shortfalls highlighted previously within the report it is clear that the management of the home is not as efficient and effective as would be expected. Issues highlighted throughout the report must be addressed with The Croft DS0000023060.V301983.R01.S.doc Version 5.2 Page 22 some urgency to ensure that the home is run in the best interests of the service users. It was confirmed that a quality audit had not been carried out in the last twelve-month period. However, a representative of the organisation makes monthly visits to the home. The reports of such visits are forwarded to The Commission. Health and safety records were viewed as follows; • Fire records were found to be in order with servicing and regular fire call point checks being carried out. • Gas serving had been completed in 10/02/06 • Lifts had been serviced on 22/06/06 • Emergency lighting had been checked regularly with the last record showing a check carried out on 12/07/06. The Croft DS0000023060.V301983.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 2 X X X X X X 1 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X X 3 The Croft DS0000023060.V301983.R01.S.doc Version 5.2 Page 24 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 15 Requirement Timescale for action 30/11/06 2. OP8 12 3 OP9 13 4 OP12 12 It is a requirement that a plan of care is generated for each service user, which details their health, personal and social care needs. It is a requirement that the 30/10/06 registered person promotes and maintains service users health and ensures access to health care services to meet assessed needs. All staff who are responsible for 30/08/06 recording, handling, safekeeping, safe administration and disposal of medicines must be assessed as competent. The manager must continue to audit the home’s (MAR) sheets and systems in place for the safe handling and administration of medications. The manager must maintain staff competency records in the home. This is an unmet requirement from the previous inspection. It is a requirement that service 10/09/06 users are provided with regular activities in accordance with their own preferences and suited to DS0000023060.V301983.R01.S.doc Version 5.2 The Croft Page 25 5 OP16 22 6 7 OP18 OP19 18 23 8 OP30 18 (1) their individual needs. It is a requirement that service users, relatives and friends are assured that their complaints will be taken seriously and dealt with in an appropriate manner in accordance with the homes policies and procedures. It is a requirement that all staff are trained in adult protection. It is a requirement that service users are able to live in a clean, hygienic, safe and comfortable environment. It is a requirement that the manager must ensure that all staff are appropriately trained to meet service users needs. 10/09/06 30/11/06 30/11/06 31/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Croft DS0000023060.V301983.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR 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 Croft DS0000023060.V301983.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!