Inspection on 20/07/05 for The White House

This inspection was carried out on 20th 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 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 White House 19/06/07

The White House 05/07/06

The White House 25/01/06

The White House 08/12/04

The White House 17/05/04

The White House 09/02/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 The White House 4 Walpole Road Boscombe Bournemouth Dorset BH1 4EZ Lead Inspector Stephanie Omosevwerha Unannounced 20 July 2005 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 White House D55 S32243 The White House V239032 200705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The White House Address 4 Walpole Road Boscombe Bournemouth Dorset BH1 4EZ 01202 399471 01202 390473 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) Steadway Care Limited Mrs Sheila Mary Stimpson CRH PC - Care Home Only 7 Category(ies) of LD Learning disability (7) registration, with number of places The White House D55 S32243 The White House V239032 200705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Further work needs to be undertaken to the window in Bedroom 8 prior to the registration of this room. 2. Following the recommendation made by Dorset Fire & Rescue Service in their letter dated 28 August 2002, careful consideration needs to be given to the choice of service user who can be accommodated in the top floor rooms such that these service users should be able to evacuate the building unaided. 3. Service users who have significant personal care needs or who present with very challenging behaviour will not be offered places. 4. One named person (as known to the CSCI) to be accommodated in the category LD to be provided with 1 to 1 care. Date of last inspection 8th December 2004 Brief Description of the Service: The White House is a large property on a corner plot in a residential area of the Boscombe. It is conveniently located for all the amenities of Boscombe that includes shops, restaurants, cafes, post office, library and places of worship. These are within a few minutes level walk of the home. Public transport is readily accessible close to the home and Bournemouth town centre is approximately 1 mile from the home. The home has its own transport that enables service users to conveniently access some of the town’s leisure facilities, particularly when group activities are arranged. The home’s mission statement states that that it aims to “support and care for adults with autism along the path towards independence”. The White House has three floors and there is bedroom accommodation on the first and second floors i.e. 2 on the second floor and 5 on the first. All bedrooms are single rooms and have ensuite WCs and baths and the décor and furnishings are the choice of the person occupying the room. Communal space is on the ground floor and comprises two lounges, a dining room, a large kitchen and a WC. Recent extension work has provided a larger managment office, additional staff office and separate laundry room. The paved external garden area is accessible from one of the lounges and the dining room and contains a summerhouse. The facilities of the home and its décor and furnishing are domestic in character. The property is inconspicuous ensuring that its function as a care home is not obvious facilitating the promotion of the home’s “mission”. The White House D55 S32243 The White House V239032 200705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was an unannounced inspection of the home and took place over 6 hours. It was carried out as part of the planned inspection programme for care homes undertaken by CSCI. Evidence for this inspection was gathered from a variety of sources including discussion with one service user and 3 members of staff; accompanying a service user and member of staff on their morning activity; sitting down with all the service users over the lunchtime period; a tour of all communal areas of the home and 4 service users bedrooms; sampling records and documentation e.g. service user contracts, medication, finances, quality monitoring, menus and staffing; information gathered from previous inspection reports and monthly review reports sent to the Commission by the responsible individual of the home. The deputy manager was also present throughout the day and assisted the inspector. Due to the nature of autism, it was difficult to get verbal feedback from service users about their impressions of the home. In fact only one service users was able to talk verbally to the inspector. The outcomes for service users living in the home were largely assessed by the inspector spending time with them and observations made throughout the day. What the service does well: The home is well organised and good practices are in place to ensure the effective management of a whole range of procedures such as administration of medication, service users finances, self-review and staff recruitment. An important emphasis is placed on staff recruitment and training and this ensures service users are supported by a competent and effective staff team. Staff morale is good and the management are described as being approachable with members of staff feeling able to contribute ideas for improving the service. This results in an enthusiastic work force that works positively with service users to improve their quality of life. Observation of practice further demonstrated that staff have developed excellent negotiation skills reinforcing positive behaviour to effectively manage difficult situations in the home. Service users benefit from good facilities and all have single bedrooms with ensuite facilities offering maximum personal privacy. The home currently has 2 vacancies. The home makes full assessments prior to admission and also considers the needs of its current residents prior to accepting any prospective resident ensuring only those whose needs can be met are admitted. There were no requirements made at this inspection meaning the home is meeting all the regulations required by legislation. The White House D55 S32243 The White House V239032 200705 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The White House D55 S32243 The White House V239032 200705 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection The White House D55 S32243 The White House V239032 200705 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 and 5. The home makes thorough assessments of prospective service users’ needs taking into account information from other professionals and families/carers to ensure any new residents needs can be met. Due consideration is also given to the current group of residents to ensure any prospective resident will not impact negatively on the collective needs of service users living in the home. Service users and their representatives are made aware of their rights and responsibilities whilst living in the home, which are clearly set out in a written contract. EVIDENCE: There had been no new admissions to the home since the previous inspection when 2 new service users had been admitted to the home. Evidence was seen at the inspection carried out on 8th December 2004 that full care management assessments and care plans were in place for all service users prior to admission. The home has clear procedures for admission including carrying out their own assessments for prospective service users. These are very thorough and involve meeting the service user; their families/carers and relevant professionals involved in the service users’ current care packages. The deputy manager told the inspector that the home had had one referral for a prospective service user, however, the home’s assessment process determined the behaviours displayed by the prospective service user would be too disruptive to the current group of residents so they had to turn down the application. The White House D55 S32243 The White House V239032 200705 Stage 4.doc Version 1.40 Page 9 A sample of service users’ contracts was seen. It had been recommended at the previous inspection that contracts specify the bedroom that the service user will occupy. This had been implemented and contracts clearly specified the terms and conditions setting out the providers’ and the service users’ rights and responsibilities. There was evidence that relatives had supported service users where appropriate in signing these documents. The White House D55 S32243 The White House V239032 200705 Stage 4.doc Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7. The home has developed a range of communication tools to enable service users to make decisions, although some residents can only do this to a limited extent due to the nature of autism. Local and national service user led groups may provide the home with additional information about developing service user consultation in the home. EVIDENCE: There was evidence that the home encouraged service users to make decisions about their lives. Due to the nature of autism and the communication needs of some residents it was often difficult to get them to make choices, however the home had developed tools to enable different methods of communication to be used in the home e.g. using a picture menu to enable service users to make choices about their meals. The home had developed a notice board to display information in accessible formats making good use of pictures/photographs to explain fire procedures, daily activities and staff on duty to residents. Some residents choices had to be limited at times e.g. one resident would excessively collect various items if no limits were put on this behaviour. This was well documented in care plans and the limitations were clearly known and agreed with the service user. Observation on the day showed how members of The White House D55 S32243 The White House V239032 200705 Stage 4.doc Version 1.40 Page 11 staff were able to use boundaries/negotiation and positive reinforcement to very effectively manage behaviour. It was noted that 2 service users currently have advocates although only one resident sees their advocate on a regular basis. It was recommended that the home explores other forms of advocacy possibly approaching service user led groups both locally or nationally for information about how they could promote service user feedback in the home as some of the service users living in the home can only do this to a very limited extent. During the inspection a sample of 3 service users financial records was checked. These were up-to-date, accurate and counter-signed by a second member of staff. The manager is currently appointee for one resident, other service users are assisted by relatives. All service users need support with managing their money. The home has a clear policy on the Management of Finances and responsibilities for making payments are clearly identified e.g. if service users go swimming, the home will pay for the activity but the service users are responsible for any refreshments they buy. The White House D55 S32243 The White House V239032 200705 Stage 4.doc Version 1.40 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 17. Service users are encouraged to participate in the daily running of the home and their responsibilities for chores are clearly set out. Dietary needs of service users are well catered for with a balanced and varied food selection available that takes into account service users tastes and choices. EVIDENCE: Service users responsibilities within the home are clearly set out in the Statement of Purpose and Service User Guide e.g. “service users will be expected to take care of their personal hygiene and to keep their own space to an acceptable standard.” Staff support is available for service users that have difficultly in these areas and more specific needs are detailed on their individual care plans. Weekly rotas are drawn up in the home to ensure everyone does their fair share of chores such as cleaning, washing up, laying the table and shopping. The inspector accompanied one service user and a member of staff during the inspection to the local shop to buy bread and milk for the home. Observation during the lunchtime period also evidenced service user helping to lay and clear the table. Service users ate an omelette and had a choice of fruit and The White House D55 S32243 The White House V239032 200705 Stage 4.doc Version 1.40 Page 13 yoghurt for their lunch. A sample of weekly menus was also viewed. These were varied, offering a balanced diet taking into account individual service user choice. One service user told the inspector he liked the food and all service users appeared to enjoy their lunch. The White House D55 S32243 The White House V239032 200705 Stage 4.doc Version 1.40 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20. The systems for the administration of medication are good with clear and comprehensive arrangements in place to ensure service users medication needs are met. EVIDENCE: A comprehensive policy and procedure concerned with the management and administration of medication was seen. Additional policies were in place concerned with the management of specific conditions such as epilepsy. No service users were assessed as being able to self-administer their medication. Medication was stored securely in a locked metal cupboard in the staff office. Records were checked and these were found to be accurate and up-to-date. A specimen of all staff signatures was kept so these could be easily identified. There were also clear procedures for recording out/in medication for service users absent from the home e.g. whilst they were staying with relatives. All medically related visits were recorded on the file and any allergies noted e.g. penicillin, hay fever. The White House D55 S32243 The White House V239032 200705 Stage 4.doc Version 1.40 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22. The home had clear procedures for dealing with complaints including regular verbal reinforcement, although the extent to which some service users could participate in the process was limited due to the nature of autism. EVIDENCE: The home had a detailed written policy and procedure about complaints in its operations manual. A leaflet had been produced both in written format and an accessible format using pictures. A copy was prominently on display on the home’s notice board. There had been no complaints to the home since the previous inspection. The extent to which service users could feedback on the service and complain was discussed. This is difficult due to the nature of autism. The deputy manager said service users were given verbal prompts about their rights to voice concerns and reminders were also given at reviews in front of relatives and care managers. The White House D55 S32243 The White House V239032 200705 Stage 4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24. Recent investment has improved the appearance of the home and extension work has maximised the use of space in the home creating a comfortable and safe environment for those living there, working there and visiting. EVIDENCE: The inspection included a tour of all communal space and 4 service users bedrooms. Since the previous inspection extension work has finished that includes a bigger management office, a new staff office and a separate laundry room. The dining room, middle lounge, kitchen and hallway have all been redecorated. Service user bedrooms were seen to be individually decorated with space for personal possessions. Observation during the inspection showed service users were able to freely access all communal areas. The White House D55 S32243 The White House V239032 200705 Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 34, 35 and 36. The staff have a very good understanding of their roles and the service users support needs and this is evident from the positive relationships that have been formed. Service users benefit from a high staffing ratio offering them excellent opportunities for individual attention. Service users are protected by robust recruitment procedures ensuring a high calibre of staff are employed. The home is committed to training and staff have good access to a range of courses designed to improve their skills and enable them to work effectively with service users. Good arrangements are in place for staff supervision and service users benefit from a well supported staff group. EVIDENCE: Job descriptions were in place and these were detailed specifying both “staff centred” and “service user centred” responsibilities. Staff spoken with during the inspection were clear about their roles and observation of practice confirmed detailed handover instructions were given ensuring staff knew what they were doing and the shift was well run and organised. Staff said they had access to care plans and demonstrated a good knowledge and understanding of service users needs. The inspector was impressed with the use of negotiation skills and reinforcing positive behaviour for managing potentially The White House D55 S32243 The White House V239032 200705 Stage 4.doc Version 1.40 Page 18 difficult behaviour. Analysis of staffing rotas showed that there was a minimum of three staff on duty from 7.30 am to 3.00 pm and three staff on duty from 2.30 pm to 10 pm allowing a 30 minute handover period. The home also employs 2 waking night staff and additional management hours are worked between 9.00 am to 5.00 pm Mondays to Fridays. This means there is a high level of staffing hours provided and service users benefit from individual support. On the day of the inspection 2 service users had one-to-one support for their morning activities and 2 members of staff supported the other 3 service users. Observation throughout the day showed there was a high level of interaction at all times between staff and service users. The home employs senior support workers, support workers and night support workers, in addition there is a member of staff employed to co-ordinate staff training and another member of staff employed to co-ordinate day time activities for service users. Comprehensive recruitment policies and procedures are in place and a sample of 2 staff records was viewed. These contained all the necessary information/documents required by regulation and were robust and thorough ensuring the protection of service users living in the home. Staff are issued with contracts specifying terms and conditions and a copy of these were on staff files. The home has a grievance and disciplinary procedure and subscribes to a professional organisation that is able to give advice on employment matters. All staff are subject to a six month probationary period and there was evidence that this was reviewed in supervision sessions and the outcome recorded, i.e. whether to extend it or if it had been passed. The home has a training and development plan and a dedicated member of staff co-ordinates this. There was evidence that staff had completed a number of courses and this was noted on the training plan and certificates were kept in individuals’ records. Examples of courses completed included adult protection, person centred planning, infection control, food hygiene, personal development, medication and first aid. A member of staff told the inspector that they were also able to access training to pursue areas of personal interests that was relevant to service users living in the home. Supervision records were seen. All staff had a supervision agreement and there was evidence that annual appraisals were being carried out. Regular staff meetings were held and the staff rota included hours available for all staff to attend. Members of staff told the inspector they enjoyed working in the home and felt the management were approachable enabling them to contribute ideas about the running of the home. The White House D55 S32243 The White House V239032 200705 Stage 4.doc Version 1.40 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39. The home has good systems of self-review in place for monitoring various aspects of its performance. It would benefit from exploring ways to involve other interested parties to provide external feedback about how the service is performing. EVIDENCE: The home has a quality assurance system in place. The inspector was shown a sample of questionnaires designed for service users, staff and relatives. Most service users living in the home would find it difficult to respond to a questionnaire and this is an area where the input of an advocacy service would be useful. The manager has consulted with local advocacy groups who were unable to provide a service, however, it may be worth trying to contact service user led groups both locally and nationally who may be able to give information/advice concerning service users giving feedback. Staff have responded to questionnaires and there has been a limited response from relatives. It was suggested that relatives/care managers might be given an opportunity to provide comments/feedback at service users reviews to increase The White House D55 S32243 The White House V239032 200705 Stage 4.doc Version 1.40 Page 20 availability of responses from external interested parties. The manager carries out monthly management checks that look at service user issues, general issues and personnel issues. These checks form the basis on a six monthly report that the manager completes. The Commission also receives monthly reports from the responsible individual of the home, which provides further information about the quality of the service provided. There was evidence that the management regularly reviews the policies, procedures and practices and these are signed and dated. The home works hard to meet the regulatory standards and no requirements were made at this or the previous inspection. The White House D55 S32243 The White House V239032 200705 Stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x 3 Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score x 2 x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x x Standard No 11 12 13 14 15 16 17 x x x x x 3 3 Standard No 31 32 33 34 35 36 Score 3 x 4 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The White House Score x x 3 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x x x D55 S32243 The White House V239032 200705 Stage 4.doc Version 1.40 Page 22 No 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 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. Refer to Standard 7 Good Practice Recommendations It is recommended that the home seeks advice from service user led groups both locally and nationally to explore ways to provide more opportunities for service user consultation/feedback in the home. It is recommended that the views of other stakeholders such as care managers, community nurses, staff from voluntary organisations are sought to provide independent feedback on the performance of the home. 2. 39 The White House D55 S32243 The White House V239032 200705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Unit 4 New Fields Business Park Stinsford Road Poole Dorset BH17 0NF 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 White House D55 S32243 The White House V239032 200705 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!