Inspection on 10/01/07 for The Old Vicarage

This inspection was carried out on 10th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

The Old Vicarage 14/12/05

The Old Vicarage 30/08/05

The Old Vicarage 08/12/04

The Old Vicarage 25/05/04

The Old Vicarage 27/01/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE The Old Vicarage Reading Road Moulsford Wallingford Oxfordshire OX10 9JB Lead Inspector Annette Miller Unannounced Inspection 19th January 2007 10:00 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 Vicarage DS0000027181.V322622.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 Vicarage DS0000027181.V322622.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Vicarage Address Reading Road Moulsford Wallingford Oxfordshire OX10 9JB 01491 651429 01491 652635 manager@theoldvicarage.fote.org.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) Friends of the Elderly Carol Bourne Care Home 50 Category(ies) of Dementia - over 65 years of age (10), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (10), Old age, not falling within any other category (50) The Old Vicarage DS0000027181.V322622.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. On admission persons should be aged 60 years and over. The total number of persons that may be accommodated at any one time must not exceed 50 of which up to 10 may be in either the DE(E) or MD(E) category 14th December 2005 Date of last inspection Brief Description of the Service: The Old Vicarage is a care home owned and managed by the charity Friends of the Elderly. The home is situated in a residential area of Moulsford and is set in attractive grounds accessible to all the residents. Accommodation is provided over two floors in single rooms with en-suite facilities. Residents have use of the communal facilities, including two lounges and two dining rooms. The registered manager and her deputy manage the home, with a team of registered nurses, carers, kitchen and housekeeping staff. A physiotherapist and an activities organiser are also part of the care team. The fees for this home range from £571.00 to £880.00 per week. The Old Vicarage DS0000027181.V322622.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Since the 1st April 2006 the Commission for Social Care Inspection (CSCI) has developed the way it undertakes its inspection of care services. This inspection was an unannounced ‘Key Inspection’ and lasted from 10 am to 6 pm. It was a thorough look at how well the home is doing. It took into account detailed information provided by the manager and also any information that CSCI has received about the home since the last inspection. The inspector asked the views of the people who use the service and other people seen during the inspection or who returned ‘Have your say’ questionnaires provided by CSCI. Nine residents returned questionnaires and their feedback indicated a high level of satisfacton. During the inspection documents were examined and a tour of the building was undertaken. The inspector looked at how well the home was meeting the standards set by the government and has in this report made judgements about the standard of the service provided. What the service does well: What has improved since the last inspection? The home’s annual audit to obtain feedback from residents is summarised and displayed within the home. The Old Vicarage DS0000027181.V322622.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Old Vicarage DS0000027181.V322622.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 Vicarage DS0000027181.V322622.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 (Standard 6 does not apply to this home). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The personalised needs assessment means that people’s diverse needs are identified and planned for before they move into the home. EVIDENCE: The manager visits prospective residents to assess their care needs. Assessments are done in the person’s own home, or in hospital if that is their current situation, to enable the manager to decide whether or not the home can provide the care that is needed. The manager encourages family members to be involved if the prospective resident wants this. Assessment records are kept and the information obtained forms the basis of the person’s care plan. The inspector read one assessment and found that a good range of information about the person’s care needs had been obtained, indicating the assessment was thorough. The Old Vicarage DS0000027181.V322622.R01.S.doc Version 5.2 Page 9 Prospective residents are given an opportunity to visit the home to help them decide whether the home is where they want to live. The specialist needs of residents are well catered for through a good range of staff training ensuring staff members have the necessary knowledge and skills to provide good care of a specialist nature. One of the nurses spoken to praised the organisation for its commitment to staff training and for the range of training opportunities provided. She said she was starting dementia care training in February 2007 along with several other members of staff, including nurses and carers. From the evidence seen by the inspector and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. The Old Vicarage DS0000027181.V322622.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The health needs of residents are well met and personal support is offered in such a way that promotes and protects residents’ privacy, dignity and independence. EVIDENCE: Every resident has an individual plan of care to ensure that all aspects of the person’s health and personal care needs are identified and planned for. Three care plans were looked at, one in detail, and the standard of record keeping was good. The organisation carries out monthly audits on a sample of care plans to ensure care records are satisfactory, which is good practice and indicates commitment to ensuring good working practices are in place. The care team has a good handover at the start of each period of duty. This ensures staff are well informed of any changes or significant events concerning residents that need to be taken into account when providing care. The Old Vicarage DS0000027181.V322622.R01.S.doc Version 5.2 Page 11 The comments made by residents in the ‘Have your Say’ questionnaires indicated a high level of satisfaction with the home. One resident said, “The high standard of care at all levels is quite remarkable”. Several residents referred to being “happy” and “very well looked after”. One resident said the home was “first class”. The inspector spoke to a number of residents during the inspection, individually and in groups, and everyone spoke highly of their care. A relative said he observed carers treat residents with great respect whenever he visited. Doctors from a GP surgery in Wallingford visit the home regularly to provide medical care. A physiotherapist visits weekly and assesses all new residents for their level of mobility, as well as providing treatment to residents who are receiving a course of physiotherapy. The initial physiotherapy assessment is charged to the home, but subsequent treatments incur an extra cost to the resident. A chiropodist visits the home regularly to provide foot care, which also incurs an extra cost to residents. There are good medication procedures in place to ensure medications are stored and administered safely. Pain charts are used to monitor the effect of medication to ensure pain is well controlled. Every resident has a medication administration chart on which the date and time that medication is administered is recorded with the initials of the person giving the medication. This means that any queries about administration can be checked against the record and also with the person who administered it. The inspector found medication records to be in good order. The Old Vicarage DS0000027181.V322622.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The recreational and social activities within the home provide residents with good opportunities for mental stimulation and to meet with other residents to build friendships. EVIDENCE: There was a nice buzz of activity and this helped to create a pleasant atmosphere in the home. Residents can choose to stay in their rooms or spend time in the public rooms. They take part in activities if they want to and have a say in the activities provided. The regular Friday morning chapel service was held and afterwards residents made their way to a lounge where cakes and coffee were served, assisted by the priest who had led the morning service. Following coffee the activity organiser led a group crossword and residents were happy to call out the answers. This event generated a lot of talking and laughter with residents clearly enjoying themselves. 6 of the 9 residents who returned ‘Have your say’ questionnaires said there was “always” enough activities to choose from, 3 said “usually”. The Old Vicarage DS0000027181.V322622.R01.S.doc Version 5.2 Page 13 The activity organiser visits all new residents to find out if they have any particular activities they would like included in the programme of events. The activity programme is put together to take account of residents preferences whenever possible. Local children visit the home as part of their community service award and during the recent Christmas festivities held a concert in the home. There is a ‘Tuesday club’ in the nearby village and local people provide transport for residents who choose to attend. The home does not have its own transport and this restricts the number of outings that can be arranged by the home. One resident said more trips would be nice. A resident said she had made good friends with a group of other residents and that they met to play cards, or sat and talked together. One resident said on a questionnaire, “This is an outstandingly excellent home and we are lucky to be here”. Two visitors thought that activities for some of the highly dependent residents on the dementia care unit were limited and that this led to some people not having sufficient mental stimulation. These comments were discussed with the manager and the activity organiser so that this concern could be taken account of. Mealtimes are well managed and food is served in the spacious and attractively decorated dining room, as well as to residents in their rooms if this is what they prefer. The inspector saw table lamps situated next to some place settings in the dining room and was told these were provided for people with poor sight. This indicates an excellent understanding of the individual needs of residents. A number of residents are unable to feed themselves and the inspector observed staff providing one-to-one assistance in a sensitive and unhurried way. Meals are served first to people who need assistance to ensure sufficient staff members are available, followed by a meal service to the dining room. The ‘Have your say’ questionnaires showed that 2 residents “always” liked the food, 5 “usually”, 2 “sometimes”. A minority of residents made critical comments, for example, saying vegetables were undercooked and meat was tough. The manager said she would look into these concerns. Menus showed that a nutritious balanced diet was provided and that a choice of main course at lunchtime was always available. The comment book situated in the dining room had good comments about meals, as well as some criticisms. Comments are taken seriously, such as providing jugs for custard when one resident pointed out he preferred to pour the custard himself. The Old Vicarage DS0000027181.V322622.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a good complaints system with evidence that residents feel their views are listened to and acted upon. EVIDENCE: A copy of the complaints procedure is displayed in reception and a copy is also provided with the admission pack given to prospective residents. The manager keeps a log of concerns/complaints and there was evidence of prompt action being taken to deal with issues as they arose. No complainant has contacted the Commission with information concerning a complaint made to the home since the last inspection. The registered manager and other staff have attended training on the protection of vulnerable adults and a copy of the Oxfordshire adult protection multi-agency codes of practice was available at the home. Training was last held in October 2006 attended by 14 staff. This training is repeated regularly. The abuse policy dated 2003 has information for staff about the action that needs to be taken in the event of any allegation of abuse and this is discussed with new employees during induction. The Old Vicarage DS0000027181.V322622.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The standard of the environment within this home is excellent providing residents with an attractive and homely place to live. EVIDENCE: Redecoration of bedrooms and public rooms occurs on a regular basis and the inspector saw that the home was well maintained. There is a full time maintenance person and also a part-time gardener. The grounds are kept in good order and provide excellent outdoor facilities for residents and visitors. A routine environmental health inspection was carried out in August 2006 when it was found that good food hygiene standards existed. Oxfordshire fire service last inspected the home in 2005 and found that fire safety was well managed. The Old Vicarage DS0000027181.V322622.R01.S.doc Version 5.2 Page 16 On the day of inspection the home looked spotlessly clean and there were no unpleasant smells. 8 out of 9 residents said on the ‘Have your Say’ questionnaires that the home was “always” fresh and clean; one said “usually” with a comment that windows were not cleaned often enough on both sides. The home has its own laundry and residents raised no concerns about this service. Disposable aprons should be worn by staff in the laundry when dealing with soiled/infected linen to minimise the risk of spreading infection. There was no indication from the staff members spoken to that these aprons are worn and none was seen in the laundry. Disposable gloves should also be worn and the staff spoken to said they used them. Consideration should be given to using red alginate bags for soiled/infected linen that are put unopened into washing machines. The bags dissolve during the wash, reducing handling risks and the possible spread of infection. At present the home uses bags that are put into washing machines with soiled/infected laundry inside, but these do not dissolve and therefore need to be opened before being put into the machines. This potentially increases the risk of spreading infection. The Old Vicarage DS0000027181.V322622.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are sufficient to safeguard the welfare of residents living in the home. EVIDENCE: There were 46 residents in the home at the time of inspection. 2 nurses and 9 carers were on duty over the morning period; 2 nurses and 6 carers over the afternoon and evening periods; 2 nurses and 4 carers overnight. The registered manager was also on duty together with an activity organiser, administrator, catering and domestic staff, maintenance person and a gardener. From the observations of the inspector and comments received this level of staffing appeared adequate to meet residents’ needs. 4 residents said on the ‘Have your Say’ questionnaires that there was “always” enough staff available; 5 said “usually”. One resident said that sometimes there was a delay in answering call bells at busy times. The manager should monitor this. It is the government’s expectation that care homes have a minimum of 50 of carers with at least level 2 NVQ in care. At present 7 out of 19 carers have this qualification and five carers have started the training. This means that the home will soon meet the level of NVQ training needed for standard 28 to be assessed as fully met. The Old Vicarage DS0000027181.V322622.R01.S.doc Version 5.2 Page 18 There are good recruitment procedures in place. The inspector looked at 3 recruitment files and found that the necessary information and checks to safeguard residents had been obtained. It is preferable to obtain a recent photograph of the employee that is not a photocopy to place on file for the purposes of identification. Photocopies of photographs can be blurred, although this was not the situation on this occasion. The manager said she would obtain original photographs whenever possible. All new staff members have induction training to prepare them for their work. They are allocated a senior member of staff to mentor them and this provides a good level of support as they settle into their role. The company has recently produced a detailed induction pack for new staff to work through with the help of their mentor. New employees do not at present keep a record of induction training and therefore there is no evidence that the Skills for Care training standards are being met. It is recommended that workbooks are provided for this purpose. The Old Vicarage DS0000027181.V322622.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and is run in the best interests of the residents. EVIDENCE: The inspector received extremely good comments from residents, relatives and staff about the way the home is managed. These comments were made on the ‘Have your say’ questionnaires and also during conversation with people on the day of inspection. A nurse said she thought staff were very well supported and praised the organisation for its commitment to staff welfare. A number of residents said they were very happy living in the home and one said, “I would like to say the staff are very helpful and kind and are led by a wonderful matron”. The Old Vicarage DS0000027181.V322622.R01.S.doc Version 5.2 Page 20 The registered manager (matron) is a registered nurse and has managed the home since September 2003. She regularly attends training updates relevant to her role and is planning to start management training in February 2007, which is needed for Standard 31 to be assessed as fully met. The manager obtains feedback from residents about the standard of the service through annual questionnaires. The last survey was held in February 2006 when 30 out of 48 questionnaires were returned. The organisation analysed the results and found that overall the majority of residents thought staff did a good job and that the environment was well maintained. The outcome of the survey was displayed in reception. Residents control their money except when they do not wish to or are unable to do so. Staff members are not allowed to act on behalf of residents and if residents need assistance with their financial affairs a relative or representative takes on this responsibility. On request, the manager will arrange to look after small amounts of pocket money for residents to their day-to-day expenses. The pocket money accounts of 3 residents were looked at and accounting procedures were found to be good. Safety checks are regularly carried out to ensure residents’ safety and records are kept. Maintenance records provided evidence of good health and safety procedures within the home. Staff members attend fire training twice a year as well as other mandatory training such as manual handling. The staff spoken to confirmed this and training records provided details of when the training occurred. The Commission for Social Care Inspection is aware of one incident involving a resident’s safety that the manager is investigating. The Commission is being kept informed of the situation. The Old Vicarage DS0000027181.V322622.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 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 The Old Vicarage DS0000027181.V322622.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action 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 OP26 OP26 Good Practice Recommendations Disposable aprons should be provided for laundry staff to use when dealing with soiled/infected linen to reduce the risk of spreading infection. Soiled/infected linen should be placed into alginate bags that can be put directly into washing machines without being opened to minimise risk of spreading infection. This type of bag dissolves during the wash cycle. New employees should keep a record of their induction training to have evidence that the Skills for Care training standards have been satisfactorily completed. 3 OP30 The Old Vicarage DS0000027181.V322622.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 Old Vicarage DS0000027181.V322622.R01.S.doc Version 5.2 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!