Inspection on 31/05/06 for The Old Rectory

This inspection was carried out on 31st May 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 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 Old Rectory 04/04/09

The Old Rectory 09/04/08

The Old Rectory 29/10/07

The Old Rectory 15/06/07

The Old Rectory 07/12/06

The Old Rectory 08/12/05

The Old Rectory 07/07/05

The Old Rectory 06/11/04

The Old Rectory 22/06/04

The Old Rectory 24/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE The Old Rectory 195 Wigan Road Standish Wigan Greater Manchester WN6 0AE Lead Inspector Judith Stanley Unannounced Inspection 31st May 2006 08:30 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 Old Rectory DS0000005756.V292453.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 Old Rectory DS0000005756.V292453.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Rectory Address 195 Wigan Road Standish Wigan Greater Manchester WN6 0AE 01257 421635 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (If applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Megraj Jingree Mrs Premila Jingree Mrs Premila Jingree Care Home 10 Category(ies) of Old age, not falling within any other category registration, with number (10), Physical disability over 65 years of age (1) of places The Old Rectory DS0000005756.V292453.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Within the maximum number of 10 registered places, there can be up to10, OP and up to 1 PD(E) place. 8th December 2005 Date of last inspection Brief Description of the Service: The Old Rectory is a large detached property in Standish. The home is situated on the main road to Wigan and Standish town centres and is approximately five minutes drive from local amenities. The Home offers 8 single rooms on the first floor, of which 3 have en suite facilities and 1 shared room on the ground floor. There is limited parking at the front of the Home and a small garden area at the rear. The Old Rectory Care Home provides care and support for up to 10 male and female residents over the age of 65 years. The current fee per week is on average £350.00 a £16.00 a week top up charged is incurred. The Old Rectory DS0000005756.V292453.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over a period of 7¾ hours over one day and was unannounced. Three care staff were on duty when the Inspector arrived. The owners of the home arrived shortly after and were available for the rest of the time to assist with the inspection. The first part of the day was spent looking at records the home keeps on residents (care plans), staff files and training records and a selection of health and safety certificates. The menus were inspected and the Inspector sampled the main meal at lunchtime. The rest of the time was spent talking with the residents and staff and relatives who were visiting the home. A full tour of the premises was also made. What the service does well: What has improved since the last inspection? What they could do better: The manager should make every effort to ensure the she employs the regular services of a hairdresser. Both residents and a relative have made comment about the lack of such facilities. This should not be classed as an activity, but part of the personal care required. The menus must be clearly displayed with the alternatives clearly shown, this will help residents to select their choice and inform relatives of what food is served. The Old Rectory DS0000005756.V292453.R01.S.doc Version 5.2 Page 6 The manager must purchase a dryer for the laundry. When the Inspector arrived at the home the radiators in the dining room and lounge were full of damp washing, and other washing and underwear was hanging to dry in the corridor leading to the kitchen. This looks unsightly and will cause dampness and condensation in the rooms. The home would benefit from the appointment of a domestic, the home was clean and tidy, but it was noted that care staff were vacuuming bedrooms, which is time that would be better spent with the residents. The exterior of the home requires painting and attention to the garden and grounds is required. Staff supervision is not being carried out as required. There were no records of supervision available. The home does not have any method to measure quality assurance. This was left as a requirement at the last inspection, and no effort has been made to put these systems in to place. On the day of the inspection, it was the half term holiday and the when the owners arrived at the home, three young children accompanied them. The children were very good and were playing in the flat upstairs but could plainly be heard running around which was distracting to residents who wanted to relax in their rooms. 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 Old Rectory DS0000005756.V292453.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 Old Rectory DS0000005756.V292453.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): 3. Standard 6 does not apply, as the home does not offer intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The admission procedure is satisfactory and systems are in place to ensure proper assessments are completed prior to people moving in to the home. EVIDENCE: Two care plans were inspected and showed that assessments had been completed to ensure that the home could meet the needs of the residents. There has been no new admissions to the home in the last twelve months, therefore it was not possible to check a very recent assessment. Assessments take place at the most convenient place for the person, either at their own home or in hospital. The Old Rectory DS0000005756.V292453.R01.S.doc Version 5.2 Page 9 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 &10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Care plans were detailed, up to date and reflected the care needed. The systems for the administration of medication are good with clear arrangements being made to ensure that resident’s medication needs are met. Personal support is offered in such a way as to promote residents’ privacy, dignity and independence. EVIDENCE: Two care plans were inspected. Both contained information relating to residents personal, social and health care needs. Details in the care plan showed other information, for example next of kin, GP, contact telephone numbers, social worker. Details of past and present medical history were available. Other information in the care plan covers the homes assessment, weights, waterlow – pressure prevention charts, risk assessments for falls and movement about the home and a record of GP visits. Other areas covered The Old Rectory DS0000005756.V292453.R01.S.doc Version 5.2 Page 10 personal hygiene, what assistance is required for dressing and undressing and other support and likes and dislikes. Resident’s hobbies and interests were documented for example, likes to do puzzles, read books of choice, likes to out, likes to listen to the radio. There was evidence to show that the plans had been signed and agreed by either the residents or their representatives and had been reviewed at least monthly as required. Visitors spoken with were happy with the care provided. Requirements made at the last inspection regarding some medication issues had been addressed. Procedures were available to demonstrate the safe handling and administration of medication. Drugs had been suitably dispensed and were recorded on the individuals MAR sheet (drug sheet). The MAR sheets were inspected and no errors noted. From observation, and from listening to how staff dealt with and spoke with residents, it was evident that residents were treated kindly and with respect. Residents spoken with said they got up when they wanted and went to bed when they were ready. It was observed that most residents had breakfast in their rooms, however three residents had come down in to the dining room. Staff were heard speaking with residents in a friendly, but respectful manner and were observed knocking on bedroom and toilet doors before entering. Residents were seen to be clean and well groomed. It was noted that clothes matched, were clean and had been nicely washed and ironed. The Old Rectory DS0000005756.V292453.R01.S.doc Version 5.2 Page 11 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 good. This judgement has been made using available evidence including a visit to the service. Daily activities within the home are satisfactory, however opportunities for outings and trips outside the home are too limited. Visiting arrangements are good ensuring that links between residents and family are maintained. Residents are help to maintain a good level of independence, and to exercise choice and control over their lives. The provision of meals in the home meets the needs and tastes of people living in the home. EVIDENCE: The home has an activities programme, which the manager organises. Recorded activities include bingo, memory games and topical discussions. On the day of the inspection three residents were entertaining themselves playing dominoes, one resident likes her morning paper and spends time in her room reading and listening to music. On the morning of the inspection two people The Old Rectory DS0000005756.V292453.R01.S.doc Version 5.2 Page 12 visited from the local church and gave communion to those residents who wanted to partake. The Inspector asked about trips and outings and it was confirmed by residents that this does not happen very often. The manager stated that residents when asked do not want to go out. However it was also commented that there was good family support and residents went out with family and friends. The activity programme must be made available to all residents and offer a full range of indoor and outdoor activities to suit resident’s preferences. Visitors were observed arriving at the home, there is no restrictions on visiting times. Residents are able to meet with visitors in the lounge or dining room, or in the privacy of their own rooms. Visitors spoken with said that were always made welcome whenever they called at the home. Residents spoke well about being able to maintain a good level of independence. Most said that their financial matters were being dealt with by the family. Residents said they had been able to bring in some of their possessions, sufficient to make their rooms feel more personal. A record of planned meals is available. Details of the meals served should be clearly displayed, including the alternative to the main meal shown. Breakfast is served from 07.00 until about 09.00. The staff on duty had prepared the breakfast on the day of the inspection. As previously stated, most residents had breakfast in their rooms, three had come down in to the dining room. There must be enough staff on duty to ensure that staff are not providing personal care to residents as well as cooking. Lunch is the main meal of the day and consisted of diced steak casserole, creamed potatoes, carrots and cauliflower, followed by rice pudding. All residents had the main choice of meal. The Inspector sampled the lunch, which was good and hot with adequate portions served. Two residents spoke with said the food was good, however choices at teatime could be better. The Old Rectory DS0000005756.V292453.R01.S.doc Version 5.2 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 the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgment has been made using available evidence and a visit to the service. A system is in place for recording complaints, but further development in this area is needed to ensure that residents and relatives can be confident that any complaints or concerns will be listened to, taken seriously and acted up on. Polices are in place to safeguard residents from abuse or harm, however staff have not been trained in this area therefore placing residents potentially at risk. EVIDENCE: The home has a complaints policy and a complaints file, however no information is recorded that indicates whether residents have voiced any concerns or complaints and how these were dealt with and resolved. Information collated prior to the inspection indicates there have been no complaints made to the manager of home. The CSCI have not received any complaints since the last inspection. Policies with regard to the Protection of Vulnerable Adults and whistle blowing are available and some staff have completed a module on abuse training when working towards their NVQ level 2. All staff must undertake full training in the Protection of Vulnerable Adults to ensure the safety of the resident living at the home. The Old Rectory DS0000005756.V292453.R01.S.doc Version 5.2 Page 14 The Old Rectory DS0000005756.V292453.R01.S.doc Version 5.2 Page 15 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 good. This judgement has been made using available evidence including a visit to the service. The standard of the environment is good, providing residents with a comfortable and homely place to live. Infection control procedures are good, making this a clean environment for residents. EVIDENCE: From a tour of the building, it was seen that the premises were being maintained to a good standard inside the home. The exterior of the home requires attention and painting. The grounds at the front need to be tided up to look more attractive. There was evidence of redecoration and some renewal of furnishings. The premises were clean and free from offensive odours throughout, and residents and relatives spoken with were complementary with regard to the cleanliness of rooms. The Old Rectory DS0000005756.V292453.R01.S.doc Version 5.2 Page 16 Systems were in place to control the spread of infection, staff were adhering to good hygiene practices. The laundry was inspected and residents spoken to had no complaints about the standard of the laundry service provided. It was noted that the home did not have a dryer; the manager said this was not a problem; however on the morning of the inspection it was noted that the dining room and the lounge radiators were full of washing and the corridor leading down to the kitchen was full of clothes and underwear. This looked unsightly and causes dampness and condensation. The manager assured the Inspector that a dryer would be purchased. The Old Rectory DS0000005756.V292453.R01.S.doc Version 5.2 Page 17 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 good. This judgment was made using available evidence including a visit to the service. Staffing levels are satisfactory but need to be kept under review to ensure that the resident cares needs continue to be met. Recruitment procedures for staff are good which ensures people living at the home are protected. A staff-training programme is in place, but further development is needed to ensure that staff are equipped with the skills and knowledge needed when delivering care. EVIDENCE: From a discussion with the manager, and through observation, it was evident that the dependency levels of the residents is low, for example the majority of people are independently mobile and require little assistance with personal care and feeding and during the night. On the morning of the inspection, three staff were on duty. One of the care staff had prepared breakfast in the absence of the manager who said she was normally on sight and cooked the breakfast. The manager was reminded that staff should not be assisting with personal care and preparing food. The home does not have any domestic staff; the owners said they did the cleaning and the cooking. The home was clean and tidy and one of the owners prepared lunch. However it was noted The Old Rectory DS0000005756.V292453.R01.S.doc Version 5.2 Page 18 that one of the care staff was vacuuming bedrooms. Care staffs time would be better spent with the residents by, for example walks out, or trips to the shops. Residents spoke favourably about the staff, saying how kind they were; one member of staff was described as “an absolute sweetheart”. Staff have been employed from different countries, the residents felt communication with staff was good. Three residents said they had no problems at all. One relative was asked the same question and again had no problems; she said the staff were very polite and friendly. There has been an improvement on staff training and from the information offered prior to the inspection the home now has 50 of staff trained to NVQ level 2 and 7 staff have completed first aid training. One staff file examined showed that Moving and Handling had been updated; Food Hygiene, Intermediate Safe Handling of Medication and an Introduction to Heath and Safety in the Workplace had been undertaken. Two staff files were examined, and showed that all the necessary recruitment checks had been undertaken. Files contained: written application forms, 2 written references, one had a Criminal Records Bureau (CRB) check and the other had a POVA check and was working under supervision awaiting the return of a full CRB. Other forms of identification were available. The Old Rectory DS0000005756.V292453.R01.S.doc Version 5.2 Page 19 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): 31,33,35, 36 & 38 Quality in this outcome area is adequate. This judgement was made using available evidence including a visit to the service. The manager provides a standard of care that is consistent and reliable for people using the service. Quality assurance systems are poor; there is no evidence to ensure the performance of the home is monitored or evidence to show that resident’s and relative’s views had been sought and acted up on. The manager has no involvement in residents; money, therefore no accounting system is in place. Staff have not received regular supervision as part of the normal management process. Health and safety practices are satisfactory to ensure the safety and welfare on both residents and staff living and working at the home. The Old Rectory DS0000005756.V292453.R01.S.doc Version 5.2 Page 20 EVIDENCE: The manager is qualified and experienced to run the home and the home benefits from her experience as a registered nurse. The administration systems need to be more organised to enable paperwork to be found when required. Quality assurance systems must be implemented to measure success in meeting the aims and objectives and statement of purpose of the home. There is no feedback from residents or relatives in the form of satisfaction questionnaires. There was however evidence to show that staff meetings had taken place and a residents meeting on the 24/03/06. The home does not manage resident’s personal monies. The family deals this with. Receipts are given for any items handed to the management for safekeeping. Staff supervision needs be carried out on a regular basis. Care staff must receive supervision at least 6 times a year. There was no evidence to demonstrate that any staff had received supervision. The homes accident book was looked at and accidents and incidents had been recorded. The manager is reminded that the CSCI must be notified of any accidents and complete the necessary forms (Regulation 37) of which a copy was left by the Inspector. The following safety and servicing certificates were examined and were found to be up to date, gas, water testing, electric, lift and fire appliances and alarms. The Old Rectory DS0000005756.V292453.R01.S.doc Version 5.2 Page 21 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 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 x x x x x x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 1 x 3 1 x 2 The Old Rectory DS0000005756.V292453.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 OP12 Regulation 16 Requirement The activities programme must be circulated to residents in a suitable format and include a range of trips and outings. The daily menus, including the alternative offered is to be displayed and given, read or explained to service users. All concerns and complaints, however minor must be documented and the outcomes recorded. All staff must be trained in the Protection of Vulnerable Adults. The outside of the home requires painting and the grounds need attention. The manager must purchase a dryer for the laundry. It is not acceptable to have washing over radiators in the lounge and DS0000005756.V292453.R01.S.doc Timescale for action 28/07/06 2. OP15 16 28/07/06 3. OP16 22 28/07/06 4. 5. OP18 OP19 13 19 28/07/06 28/07/06 6. OP26 16 28/07/06 The Old Rectory Version 5.2 Page 23 dining area. 7. 8. OP30 OP33 13 24 Staff must be trained in the Protection of Vulnerable Adults. An effective quality assurance system must be developed with the results of surveys published and made available to service users, significant others and the CSCI. (This is outstanding from the last inspection – timescale 31/03/06). All staff must receive formal supervision at least 6 times per year. Accidents, injuries, incidents and outbreaks of infectious illness are to be reported to the CSCI on the appropriate form left by the Inspector. 28/07/06 28/07/06 9. 10. OP36 OP38 18 37 28/07/06 28/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP18 OP19 Good Practice Recommendations A copy of the new local authority Protecting Vulnerable Adults procedure should be obtained. As part of the planned programme of renewal consideration should be given to replacing dining chairs and bedroom furniture. The Old Rectory DS0000005756.V292453.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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 Old Rectory DS0000005756.V292453.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!