Inspection on 27/07/05 for The Mead

This inspection was carried out on 27th July 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 but made no statutory requirements on the home.

Other inspections for this house

The Mead 20/06/07

The Mead 07/04/06

The Mead 10/02/06

The Mead 03/02/05

The Mead 24/06/04

The Mead 26/09/02

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE The Mead Castleford Close Borehamwood Hertfordshire WD6 4AL Lead Inspector Alison Jessop Unannounced 27/07/05 & 26/08/05 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 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 Mead I52 s19580 The Mead v240927 270705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Mead Address Castleford Close, Borehamwood, Herts, WD6 4AL Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0208 953 8573 0207 313 3961 Quantum Care Limited CRH Care Home 60 Category(ies) of DE(E)-60, OP-60, PD(E)-60 registration, with number of places The Mead I52 s19580 The Mead v240927 270705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th July 2005 Brief Description of the Service: The Mead is a two storey, purpose built residential care home for older people. It is situated in a quiet residential area of Borehamwood. Access to local shops, public transport and other local amenities are a short walk away. The home is built in a horseshoe shape around a courtyard garden, there is ample off road parking. Four separate suites each offer accommodation to fifteen residents. Bedrooms are designed for single occupation and each has an en-suite toilet and wash hand basin. There are two communal lounges and a dining area in each suite. Communal bathrooms are spacious and accommodate assisted baths and showers. There is a hairdressing salon, service users smoking room and a guest room. The home also has a day centre however this is not inspected by the Commission for Social Care Inspection. The Mead I52 s19580 The Mead v240927 270705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days by four Regulatory Inspectors. A previous inspection, which was carried out on 7th July 2005 raised several areas of serious concern. Eleven requirements, four of which were immediate requirements were made. The first visit for this inspection took place on 27th July 2005 and the second on 26th August 2005. Two specialist pharmacy inspections were also carried out on 8th August 2005 and 26th August 2005. Feedback has been gained from service users, staff, visitors, a GP, District Nurses, Community Mental Health Team and Adult Care Services. Many serious concerns were identified during the first visit to the home so a serious concerns meeting was held and feedback from other professionals was also concerning. A new management structure has been implemented and since then an immense improvement was recognised during the second visit. A further inspection will be carried out in the near future to follow up the requirements made. What the service does well: Feedback from most of the service users was positive, particularly during the second visit to the home. One service user stated ‘I am happy here, the staff are friendly and approachable’. Feedback gained from relatives was satisfactory, none spoken to had made any complaints. Some good interaction was observed between staff and service users during the last visit to the home. Service users looked much happier and brighter. The new management team had organised reviews of service users whose needs could no longer be met and had arranged for them to be moved to more suitable accommodation. This has taken the pressure away from the care team who can distribute their time more evenly. During enjoys helped excess the second visit to the home a service user who has dementia who walking had returned from the local shops with the manager. This had the service user to enjoy some time in the open space and use up some energy. The Mead I52 s19580 The Mead v240927 270705 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Care plans contain basic information and do not appear to be used as a working document. Risk assessments are inaccurate and action to be taken to minimise or eliminate risks is unclear. There were no activities taking place in the home and although a new activity co-ordinator has started an activity programme was not yet in place. Minimal interaction between staff and service users was observed, and service users tend to congregate in hallway as little stimulation is provided in lounge area. No books, newspapers or other form of stimulation was available in the lounges. One service user stated ‘there’s not a lot to do here, I miss having a friend or someone to talk to’. Procedures relating to the receipt, administration, storage, recording, handling and disposal of medication are required to be reviewed. Several errors and gaps were identified. The specialist pharmacist inspector over two visits to the home during this inspection period has made several immediate requirements in relation to medication, some of which were outstanding from previous inspections. A further pharmacy inspection in the near future will determine if enforcement action will be taken. Sanigenic bins require lids as this will reduce unpleasant odours and increase infection control. The Mead I52 s19580 The Mead v240927 270705 Stage 4.doc Version 1.40 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Mead I52 s19580 The Mead v240927 270705 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Mead I52 s19580 The Mead v240927 270705 Stage 4.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3,4 & 6 Service user assessments had been carried out prior to admission however the registered person was unable to demonstrate the homes capacity to meet assessed needs. This eventually led to service users being moved onto more appropriate accommodation, which could have been prevented. EVIDENCE: One service user who had been admitted from the specialist mental health unit was re-admitted to the unit as the staff team were unable to manage his aggressive behaviour. This clearly suggested that this had initially been an inappropriate admission. The service user has since moved out of the home permanently. The registered person must ensure that specialist needs can be met prior to admission. Several other service users needs had changed over a period of time and the home could no longer meet their needs. Since the new management structure has been implemented the service users have undergone a multi-disciplinary review and have been moved to more appropriate accommodation. Staff are now under less pressure and can distribute their time more evenly. The home does not provide Intermediate Care. The Mead I52 s19580 The Mead v240927 270705 Stage 4.doc Version 1.40 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 standard(s) 7,8,9 & 10 Although care plans are in place, basic information was not available particularly in relation to risk. Care plans and risk assessments were not being used as a working document and therefore service users were not receiving individualised appropriate care. EVIDENCE: Evidence given below was gained during the inspection on the 7th July 2005. Most of these concerns have since reduced and improvement was observed during the inspection 26th August 2005. On arrival at the Mead on the first visit several service users were observed walking around in their night wear. Several had no slippers or dressing gowns, one service user was observed moving around in her wheelchair in the main reception area wearing a very short nightdress. She also had no footwear but had dressings on her heels which were covering pressure sores. Concerns were raised regarding the lack of understanding of pressure sore prevention and management. Although the district nurses were attending to this, staff at the home do not appear to be offering adequate care ie regular moving, fluid intake, monitoring, recording and reporting. One service user was observed sitting in the same position throughout the inspection. The Mead I52 s19580 The Mead v240927 270705 Stage 4.doc Version 1.40 Page 11 Most service users looked unkempt, their appearance did not suggest that care had been taken to ensure that basic needs such as hair brushing, oral care and hand washing and shaving had been encouraged. Several service users were still in bed at 10.30am. One service user was asleep, he was in his pyjamas, his mouth was dry and a large armchair had been pushed up to the side of the bed. The rationale for this was not recorded on the service users care plan or risk assessment. The service user would not have been able to get out of the bed had he wished to do so. The service user was later observed sitting in a reclining chair in the reception area on the unit. His chair was fully reclined and a foot stool had been placed under the foot rest of the chair preventing movement. Again the circumstances, including the nature of the restraint had not been recorded. Of the other service users found in bed, one who appears to spend a lot of time there, staff expressed that this was by choice and stated that this is documented in their care plan. On further investigation it appeared that the service user has depression and may require more encouragement to get up and would benefit from some stimulation. Staff appeared to accept that this was by choice too readily. No specialist interventions or advice had been sought in relation to his particular needs. Records observed by a district nurse stated that one service user had fallen the previous day and staff had applied a dressing to the service users injury. There was no evidence to show that the district nurse had given instructions on how to apply emergency dressings. Although jugs of water, juice and cups of tea were present, service users who required assistance with drinking their moths looked dry and the cups or jugs were full. Staff were not often observed offering drinks and fluid charts were either not available or did not evidence adequate fluid intake. One service user who had specialist Mental Health needs had been admitted to the mental health unit as he was expressing violent and aggressive behaviour and had attempted to jump out of a first floor window. On re-admission to The Mead, he returned to his first floor accommodation with no risk assessment completed. Medication procedures were inadequate and several errors in administration had been found. One of which was in relation to a controlled drug. Several requirements have been made by the specialist pharmacy inspector. The Mead I52 s19580 The Mead v240927 270705 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 & 15 The lack of activities and social stimulation in the home encourages service users to congregate in the reception areas of each unit. This did not create the impression that service users felt ‘at home’ and that they receive more interaction with staff as they are passing. EVIDENCE: There was no evidence of an activity programme at The Mead during the initial visit however a new activity co-ordinator has started and stated that she was planning an activity programme in consultation with the service users. She was also currently awaiting training on specialist dementia care. Although there is a varied menu and choices on offer, during the first visit to The Mead supper being served was sausage roll, it looked dry and no accompaniments were offered. During the second visit the lift was out of order and food trolleys could not be utilised to transport food upstairs. Meals were being served on plates directly from the kitchen however temperatures of food was not being tested prior to being served. The Mead I52 s19580 The Mead v240927 270705 Stage 4.doc Version 1.40 Page 13 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 standard(s) 16 & 18 Several serious concerns identified during the inspection appeared not to have been recognised by the staff and managers within the home or by Quantum Cares Quality Auditing systems. This has therefore jeopardised the protection of service users from abuse. EVIDENCE: Some service users and their relatives said that they were aware of how to make a complaint if necessary, although none had done so. Managers within the home had little insight into the serious issues within the home during the initial visit. Regulation 26 reports received prior to the inspection did not reflect the serious issues identified within the home at the time of the inspection. The Mead I52 s19580 The Mead v240927 270705 Stage 4.doc Version 1.40 Page 14 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 standard(s) 19,20,21, 22, 23, 24, 25 & 26 Improvements to the environment since the initial visit to The Mead appears to have already had a positive impact on the service users and staff. A large number of soiled armchair cushions were observed drying in the laundry room. This may suggest that continence is not adequately managed? EVIDENCE: Since the initial visit to The Mead, a programme of re-decoration and refurbishment has commenced. Two new kitchenettes have been fitted in two first floor units, decoration to all communal areas had been started and offer a brighter, more pleasant atmosphere. Further improvements have been planned in the near future. Carpets to most communal areas are heavily stained. A smoking area was situated on entry to one of the ground floor units. The chairs and carpet in this area were dirty and covered with cigarette burns. The chairs have now been removed and new carpet is due to be fitted. This area is no longer a smoking area and service users who wish to smoke can do so in their bedrooms. The home currently has two service users who wish to do this. The Mead I52 s19580 The Mead v240927 270705 Stage 4.doc Version 1.40 Page 15 During the first visit a member of staff had recently finished assisting a service user to bathe. A soiled incontinence pad and wet towel had been left on the floor of the bathroom. The care worker entered the bathroom wearing the same gloves that she had used to carry out personal care and stated that she was going to clean it up. This clearly demonstrated an understanding unacceptable universal infection control precautions. The Mead I52 s19580 The Mead v240927 270705 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 30 During the second visit to the home, staff appeared to act in a more dignified and respectful manner. The atmosphere was calmer and behaviour was more appropriate. This suggested that action had been taken to educate staff about appropriate conduct within the home. EVIDENCE: Throughout the day during the first visit inspectors observed the conduct of staff to be very disrespectful. Loud inappropriate music was being played on one of the units, this was clearly for the benefit of the staff. Staff were also observed shouting to each other down the corridors. This inappropriate behaviour was not addressed by the managers on duty. The Mead I52 s19580 The Mead v240927 270705 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 35, 37 & 38. The lack of insight into the issues identified during the first visit to the home by not only the staff but the management team was of serious concern. New procedures had been implemented without rationale and had mostly failed to improve practices or safeguard service users. Since the new management structure has been implemented an immense improvement has been observed. This appears to have reduced bad practices and has raised awareness of quality standards throughout the whole team. EVIDENCE: Financial procedures within the home have been reviewed and all financial transactions no longer take place in the reception room on entry to the home. This has reduced the risks in relation to financial abuse. A new Administrator has started and is being closely supervised by the companies internal auditor. External monitoring and auditing of The Mead also failed to recognise or deal with the issues occurring within the home. The Mead I52 s19580 The Mead v240927 270705 Stage 4.doc Version 1.40 Page 18 Generally the home was found to be in a poor state of disrepair. Risks to Health and Safety had not been recognised. A mirror in one of the communal bathrooms had shattered and shards of glass were protruding. Several radiator covers had fallen apart and the inner elements of the radiator was accessible to service users. Several door handles were broken and door plates missing. Carpets are stained and shabby however these are due to be replaced in the near future. At the base of one of the lifting hoists, the plastic coating has disintegrated leaving a rusty surface with potentially sharp edges. Infection control procedures observed during the first inspection were inadequate. For those rooms that had soap dispensers and hand towels, some of these were empty. Staff had been provided with alcohol gel to be used to prevent the spread of infection. Most of the staff said that they had been supplied with this however they were not carrying it with them. Staff were also observed moving from room to room wearing the same gloves or not washing their hands. Used gloves had also been discarded on the floor in the hallway. Whilst afternoon tea was being served staff were observed handing biscuits out of a tin to service users. During the last visit practices observed had improved immensely. Clinical waste bins being used are nappy disposal units and many did not have lids and were overflowing. The Mead I52 s19580 The Mead v240927 270705 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 1 1 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION 1 2 3 3 3 3 1 1 STAFFING Standard No Score 27 x 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 2 2 x x 3 x 1 1 The Mead I52 s19580 The Mead v240927 270705 Stage 4.doc Version 1.40 Page 20 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 3 Regulation 14(1)(a) Requirement Timescale for action By 30/9/05 and henceforth. By 30/9/05 and henceforth. Immediatel y and henceforth. 2. 4 3. 7.3 4. 8.8 5. 8.3 6. 8.9 7. 10 A thorough assessment must be undertaken and to which the prospective service user, representative and relevant professionals have been party. 14 Assessments of service user (2)(a)&(b) needs must be kept under review and be revised if necessary due to a change of circumstances. 13(8) Service users subject to physical 17(1)(a) restraint where this is the only Schedule practicle way of securing their 3 welfare, the circumstances (3)(p)&(q) including the nature must be recorded on a risk management plan. 13(7) Service users must not be subject to physical restraint unless this is the only practicable means of securing their welfare. 12(1)(b) The registered person must 17(1)(a) make proper provision for the Schedule health and welfare of service 3 users in relation to pressure (3)(n) care. 12(1) Service users must receive 16(2)(i) regular fluid intake and where necessary fluid intake and output recorded. 12(4)(a) The registered person must I52 s19580 The Mead v240927 270705 Stage 4.doc Immediatel y and henceforth. By 30/9/05 and henceforth. Immediatel y and henceforth. By 30/9/05 Page 21 The Mead Version 1.40 8. 8.7 13(1)(b) 9. 12 16(2)(m) &(n) 13(2) 10. 9 11. 18 13(6) 12. 19 23(2)(d) ensure that the care home is conducted in a manner that respects the dignity of service users, basic personal care and grooming must be provided. A review of a service user with depression must be held and specialist advice gained in relation to caring for someone who has depression. An appropriate programme of group and individual activities must be arranged in consultation with service user preferences. Procedures for the storage, administration, recording, and handling of medication must be reviewed. All staff must receive adequate training and evidence of this must be sent to CSCI. The registered person must make arrangements to prevent service users from suffering abuse or being placed at risk of harm or abuse. All parts of the home must be kept clean and reasonably decorated. Staff must follow universal precautions to control the spread of infection in the home. Staff must adhere to the Code of Conduct within the home and must act respectfully at all times. The registered person must ensure that all part of the home are hazard free and any unecessary risks to health and safety are identified and so far as possible eliminated. Immediatel y and henceforth. Immediatel y and henceforth. By 30/9/05 On receipt of this report and henceforth. By 31/10/05 and henceforth. Immediatel y and henceforth. On receipt of this report and henceforth. By 30/9/05 and henceforth. 13. 14. 26 29.4 16(2)(j)& (k) 18(4) 15. 38 13(4)(a)& (c ) The Mead I52 s19580 The Mead v240927 270705 Stage 4.doc Version 1.40 Page 22 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. Refer to Standard 8 10 22 Good Practice Recommendations A protocol sould be drawn up with district nurses on how to apply emergency dressings. Service users should have access to appropriate dress wear such as slippers and dressing gowns in order to protect their privacy and dignity. Regular checks of equipment in the home should be checked to ensure that they are asthtically sound. The Mead I52 s19580 The Mead v240927 270705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City, Herts AL7 3BQ 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 Mead I52 s19580 The Mead v240927 270705 Stage 4.doc Version 1.40 Page 24 - 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!