Inspection on 17/08/07 for The Lodge

This inspection was carried out on 17th August 2007.

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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Lodge 05/09/06

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood House

Whitwood Hall

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

CARE HOME ADULTS 18-65 The Lodge 207 Scar Lane Milnsbridge Huddersfield West Yorkshire HD3 4PZ Lead Inspector Cathy Howarth Key Unannounced Inspection 17 August and 11 September 2007 10:00 The Lodge DS0000065604.V343176.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Lodge DS0000065604.V343176.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Lodge DS0000065604.V343176.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Lodge Address 207 Scar Lane Milnsbridge Huddersfield West Yorkshire HD3 4PZ 01484 460051 01484 460400 CragsideHouse@valeoltd.co.uk 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) VALEO Limited Mr Martin Nicholson Care Home 7 Category(ies) of Learning disability (7) registration, with number of places The Lodge DS0000065604.V343176.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th September 2006 Brief Description of the Service: The Lodge is a residential home divided into two separate units. It is owned and managed by Valeo Community Projects, a private company. The Lodge provides a service for up to seven adults with learning disabilities and complex behaviours that challenge. The Lodge shares the site with Cragside House, also owned and managed by Valeo Community Projects, and was registered as a separate service from Cragside House in October 2005. The two units, one for three service users and one for four service users, is connected by a central office area. The home is close to community facilities including, shops, cafes, bank, post office and garden centre, and is on a major bus route. Information about the home is available at the home and Commission for Social Care Inspection reports are likewise available. The range of fees for this service is between £1500 and £2000 per week. The Lodge DS0000065604.V343176.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out using information supplied by the home’s manager in advance of the visit. This included information about people living there and their relatives so that surveys could be sent to them to ask their views about the home. Another survey was sent to health and social care professionals who are involved with people living at the home. The first visit to the home was unannounced. The inspector was at the home on the 17 August for a period of 7 hours from 10am until 5pm. During this time the inspector met with people who live at The Lodge, staff and the deputy manager. A tour of the environment was undertaken and records relating to care and management were examined. A second site visit was made on the 11 September to look at some records that were not available on the first visit because the manager was on leave. This visit lasted from 9:45am to 2pm. The inspector would like to thank all those involved for their welcome and assistance during this visit. What the service does well: People who live at The Lodge say they like it and the staff that support them. People who use the service know that their needs and aspirations are given full consideration before they are admitted to The Lodge People living at The Lodge are well supported by staff to live their own lives and to make choices. They have opportunities to choose their own lifestyle, within the constraints of the service. Individuals living at The Lodge are mostly well supported in meeting their personal care and health needs. The service has made positive improvements in the way it approaches safeguarding people who live there. The living environment is improving for people living at The Lodge. People using the service are supported by an experienced staff team who are themselves well supported by the management team. The service is well managed in the best interests of the people who live there. , The Lodge DS0000065604.V343176.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Lodge DS0000065604.V343176.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Lodge DS0000065604.V343176.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. People who use the service know that their needs and aspirations are given full consideration before they are admitted to The Lodge EVIDENCE: Since the last inspection three people moved into the home from the next-door home, Cragside. Unfortunately one of those people recently passed away. The remaining people’s files were examined. There was evidence that assessments had been completed and information had been updated on their move from the previous home. The Lodge DS0000065604.V343176.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7,and 9 People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. People living at The Lodge are well supported by staff to live their own lives and to make choices. EVIDENCE: Three people who live at The Lodge’s files were examined as part of this inspection. All had a good level of detail about their individual needs and support requirements. These included details such as preferences for food and for how they like to be supported with certain activities, such as bedtime or bathing. There were also good risk assessments for any activities or support that may pose a risk to the individual or others. Two people who live at The Lodge spoke with the inspector and said they felt that staff support them well generally. They confirmed that they are offered choices on a daily basis about how they live their lives. Relatives who responded to the surveys also confirmed that they felt their relatives receive a The Lodge DS0000065604.V343176.R01.S.doc Version 5.2 Page 10 good level of support from staff who know them well and that they are encouraged to make their own decisions. One area that has improved since the last inspection is in the development of behavioural management plans for individuals who may require extra support or physical intervention to keep themselves and others safe at times. The Lodge DS0000065604.V343176.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 People who use the service experience adequate quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. People living at The Lodge have opportunities to choose their own lifestyle, within the constraints of the service and how it operates. EVIDENCE: The case files examined showed that individuals do have a range of opportunities for following their interests and in participating in community activities. However the opportunities for this may be limited for some people by the constraints on staffing within the home. For those individuals who are able to go out alone, there is more freedom available. For some people choices may be severely limited by staff availability and in the way that the service operates. For some individuals this seems to mean that their weekly activities may be quite repetitive, for example trips to the garden centre next door. The Lodge DS0000065604.V343176.R01.S.doc Version 5.2 Page 12 People’s individual plans showed that there some regular activities arranged such as aromatherapy, hydrotherapy or attendance at day centres. The staffing makes it difficult however for ad hoc arrangements to be accommodated, such as an evening at the pub or going out for a meal. Through discussion with service users, staff and examination of records, it is clear that service users are supported to maintain links with their families and friends. One parent said they could not visit much and would very much like regular letters. This was raised in the last report and has apparently not improved since that time. Relatives who responded to the survey indicated that they felt staff supported people well to keep in touch and were made welcome when they visit. Menus were seen to be varied and fresh fruit was available within The Lodge for people to help themselves to as snacks. One person was keen to ensure that she could still be flexible in planning menus and this is achieved by simply recording meals as they are eaten rather than having a fixed menu for the week. This person also shops and cooks for herself with the support of staff. People living at The Lodge are supported to exercise choice and to have freedom and independence as far as possible. People who are able to go out unaccompanied have front door keys as well as keys to their own rooms. Where people are unable to keep keys safely, alternative arrangements have been put in place to ensure they can still exercise freedom to access their rooms as and when they wish. The Lodge DS0000065604.V343176.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the service experience adequate quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. Individuals living at The Lodge are well supported in meeting their personal care needs but a little more vigilance is needed in relation to monitoring health needs and in the administration of ‘as required’ medicines. EVIDENCE: The personal files of people living at The Lodge showed a great deal of care had been taken with individuals to establish their preferences in terms of how personal care is delivered, for example in bathing or meal routines. Medical appointments are recorded and tracked in general. One file was seen to lack detail in following up appointments and recording the outcome however. In this one case it meant that changes in medication were not recorded on the file. Another file showed that a person was overdue for an optician appointment. The Lodge DS0000065604.V343176.R01.S.doc Version 5.2 Page 14 Also weight is meant to be recorded monthly for each person. None of the files seen had regular weight checks recorded for some time. For one person this should have been monitored because weight gain is a known side effect of the medicine they were prescribed. Their weight had not been recorded since December 2006 when they had put on half a stone. Medication records were seen and found to be completed accurately, with stocks of medication tallying with the records. Records for PRN (as required) medication were found to be accurate also. There were protocols on individual files for the administration of these medicines. However it was noted that the protocols were not available in the medicine cupboard with the record sheets and this is recommended. Also where someone takes more than one PRN medicine, they were all written on one sheet without clear distinctions made about which directions related to which medicine. It is therefore recommended that this be done to save any confusion and risk to individuals. One person self medicates in a limited way, not keeping their own medication but taking it under staff supervision. The risk assessment for this was inadequate and did not clearly indicate what had been considered in the decision to manage this in the way it is being managed at the moment. Where possible people using the service should also sign the risk assessment to indicate their agreement with the process and outcome. The Lodge DS0000065604.V343176.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. The service has made positive improvements in the way it approaches safeguarding people who live there. EVIDENCE: The service has a complaints procedure, which includes concerns as well as formal complaints. Both types are recorded for management purposes. People using the service indicated that they are well aware of these processes and who to talk to if they have any issues to raise. The log showed that people do use the systems and they are looked into effectively. One area for improvement is in making sure that any outcome from a complaint is recorded and put on the individual’s file so that these issues can be picked up for reviews and so the person can look at these as part of their whole record. The service has had one safeguarding issue to deal with in the last twelve months, which resulted in a member of staff being referred to the list of people who are unsuitable to work with vulnerable adults. The service has demonstrated a commitment to avoid any repetition of such an episode by ensuring that all staff get refresher training in safeguarding issues. Another positive step has been the introduction of a role of ‘Watchdog’ to keep an eye on areas where people using the service may be at risk. The deputy manager currently fulfils this role which involves checking out on a regular basis that people have no worries or things they need to talk about. She also does the The Lodge DS0000065604.V343176.R01.S.doc Version 5.2 Page 16 same with staff. She routinely checks people’s monies and any incident reports to ensure that nothing is being hidden or patterns are not missed. The watchdog also takes a lead if there are any issues to be reported. This is a proactive approach and appears to work effectively at present. The Lodge DS0000065604.V343176.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. The living environment is improving for people living at The Lodge. EVIDENCE: The Lodge has had a significant amount of physical improvement within the building since the last inspection. In particular the Upper Lodge has been transformed from the rather desolate space it was to a homely pleasant environment. The area has been redecorated, new flooring fitted and new furniture brought in. There are now pictures on the wall too. The laundry has been moved into a separate room accessible without going into kitchen or living areas. The laundry now has commercial washing machine and dryer, this is an improvement. The lower lodge is now due for improvement also. Some areas are in the process of preparation for redecoration, notably the dining room and main The Lodge DS0000065604.V343176.R01.S.doc Version 5.2 Page 18 corridor. The lounge is due for redecoration also. It was noted that some areas of the kitchen needed cleaning such as the oven and around the freezer. The freezer also needed to be defrosted. People in the lower lodge can be supported to do their own washing and ironing. Two people living at The Lodge showed the inspector their bedrooms, these were seen to be personalised and all the beds seen ¾ size which gives individuals more space. All the beds were said to be the same. One person living there told me that they had chosen their own colour scheme for their bedroom. A positive about the building is the space available for people so that individuals do not have to live in each other’s pockets. There are two conservatories one on each floor, which were both in use at this visit. There is also a large outdoor space that seemed to be well used by certain individuals. The two areas function fairly independently the majority of the time so people do not have to spend time with more than two or three others. This environment helps people to exercise individual choice better. The Lodge DS0000065604.V343176.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. People using the service are supported by an experienced, but not qualified staff team, who are themselves well supported by the management team. EVIDENCE: The Lodge benefits from a mature and experienced staff team. There is little turnover in the staff team and the majority of staff have worked within Valeo and at The Lodge for some time. This offers consistency and continuity for people living there. People who spoke with the inspector and who returned surveys indicated that they had confidence in the staff to support them. One relative who responded said: “They understand my son’s needs and allow for any anxieties or insecurities he may have.” Valeo offer a comprehensive training programme both at induction, when staff complete the Learning Disabilities Award Framework induction and foundation training (LDAF) and on an ongoing basis for staff within the organisation. This The Lodge DS0000065604.V343176.R01.S.doc Version 5.2 Page 20 also includes NVQ2 training for support workers and appropriate qualifications for managers. Staff at The Lodge have undertaken a good range of basic in house training covering basics such as Emergency Aid, Food Hygiene, Fire Safety in addition to courses specific to the user group such as behaviour management and protection of vulnerable adults. One area of basic training that needs to be addressed is infection control. Only five staff have done this according to the manager. The service has made little progress in reaching the 50 target of NVQ2 qualified staff. This is again recommended. At present 5 staff have this and a further 4 are working towards the award. Staff recruitment records were sampled. All three files seen were for staff that had worked within the organisation for some time. Despite this the files were generally in good order, although previously complete work histories were not sought as part of recruitment. The organisation’s policy has now changed for new recruits. The staff team is mainly white British in origin and this reflects the user group. Staff support was generally seen to be good informally. The staff team have found it difficult to meet as a team in past times but a new rota has been introduced to address this issue, so the manager hopes this will improve. The Lodge DS0000065604.V343176.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service is well managed in the best interests in the people who live there. EVIDENCE: The manager of The Lodge has now completed his NVQ level 4 and is completing the Registered Manger Award. It was clear during these visits that the manager has a good overview of operational matters within the home and good relationships with people living there. People who spoke with the inspector expressed confidence in the managers and staff to listen to them and offer good advice and support. There are systems for monitoring quality within the service. The Director of Operations for Valeo visits monthly and carries out checks. The Deputy The Lodge DS0000065604.V343176.R01.S.doc Version 5.2 Page 22 manager carries out checks as the POVA watchdog and the manager himself monitors the quality of reports for reviews and care plans. There is an annual audit carried out by the company where stakeholders are sent questionnaires to give feedback about their views of the service. The last copy of this was not available on these visits. Health and Safety monitoring systems are well established within the home. Fire drills and test are recorded and there is a fire risk assessment completed as required. It was noted that the fire door on the lounge of the Upper Lodge was not functioning properly, during the first visit. This needs to be addressed. Also there were no window restrictors fitted to windows of upper floors. This is strongly recommended for the safety of people using the service. The Lodge DS0000065604.V343176.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 4 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 2 33 X 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 X 3 X 3 X X 2 X The Lodge DS0000065604.V343176.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO 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 YA20 Regulation 13(2) Timescale for action Protocols for each ‘as required’ 31/08/07 medicine should be written on separate sheets to avoid any risk of confusion to someone administering the medicine about which directions should be followed for each type of medicine. Requirement RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA12 Good Practice Recommendations The registered person should make arrangements for all service users living at the home to have regular access to community activities and recreational and daytime occupation/education opportunities consistent with their interests and wishes. The protocols for ‘as required’ medicines should be kept with medicines for ease of reference for staff administering these. DS0000065604.V343176.R01.S.doc Version 5.2 Page 25 2 YA20 The Lodge 3 4 5 6 7 8 YA20 YA21 YA32 YA32 YA42 YA42 Risk assessments for people who self medicate should be more detailed and signed by the person involved. The outcome of any complaint should be included in individual’s files so that they can see this information if they wish. All staff should have training in infection control. The registered person should continue working towards 50 of all care staff achieving NVQ level 2 or above. The fire door in the upper lounge needs to be repaired so that it closes effectively to prevent the spread of fire. Window restrictors need to be fitted to prevent the risk of users falling from height. The Lodge DS0000065604.V343176.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Lodge DS0000065604.V343176.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!