Inspection on 25/11/05 for The Worthies

This inspection was carried out on 25th November 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 Worthies 01/04/09

The Worthies 02/04/08

The Worthies 03/05/07

The Worthies 27/06/06

The Worthies 04/05/05

The Worthies 11/01/05

The Worthies 28/06/04

The Worthies 11/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The Worthies 79 Park Road Stapleton Bristol BS16 1DT Lead Inspector Sandra Jones Unannounced Inspection 09:30 25 & 28 November 2005 th th 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 Worthies DS0000026524.V263773.R01.S.doc Version 5.0 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 Worthies DS0000026524.V263773.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Worthies Address 79 Park Road Stapleton Bristol BS16 1DT 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) 0117 9390088 0117 9655881 The Worthies Residential Care Home Ltd Ms Shenaz Seehootoorah Care Home 24 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (19) of places The Worthies DS0000026524.V263773.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 24 persons aged 65 years or over Date of last inspection 4th May 2005 Brief Description of the Service: The Worthies is a 24-bedded home registered to accommodate 19 people who are elderly and 5 older people with dementia. The home is situated on a bus route, fairly close to shops, libraries and health centres. The accommodation is arranged over three floors, with shared space on the ground floor and bedrooms on all floors. Accessible to all floors by a passenger lift. The Worthies DS0000026524.V263773.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted on an unannounced basis over two days in November 2005 with a second inspector on the first day of the inspection. Since the last inspection, additional visits have taken place as a result of concerns raised about staffing issues. The service provider has notified the CSCI though Regulation 37’s of incidents and occurrences at the home. During the inspection, the feedback was sought from residents and relatives about the standards of care and about the conduct of the home from the staff. Their findings were used to support the documentation held at the home. A tour of the premises took place during the inspection. What the service does well: What has improved since the last inspection? The Worthies DS0000026524.V263773.R01.S.doc Version 5.0 Page 6 It is evident from the inspection that the service provider is developing systems and processes to raise the standards of care at the home. Since the last inspection the service provider has taken steps to specify the intended services through the Statement of Purpose and Service User Guide. The care planning process has been reviewed and further improvements in terms of a person centred approach are expected. 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 Worthies DS0000026524.V263773.R01.S.doc Version 5.0 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 Worthies DS0000026524.V263773.R01.S.doc Version 5.0 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): 1&2 The Statement of Purpose must contain specific information about the admission procedure and bathroom and toilet ratios to enable potential residents to make a choice about the home. The Terms and Conditions of residency ensure that there is a clear agreement between the service provider and resident about the fees, facilities and rules. EVIDENCE: The service provider has taken steps to provide potential residents through the Statement of Purpose with specific information about the home. This will enable potential residents, their relatives and placing agencies to make decisions about living at the home. However, the procedure for admission must incorporate the arrangements for assessments, introductory visits and trial periods. The Worthies DS0000026524.V263773.R01.S.doc Version 5.0 Page 9 The ratio of people sharing toilets is under 7 and ten people share the bathing facilities. As the ratio of people sharing bathrooms is less than the NMS, potential residents must be informed through the Statement of Purpose that bathing facilities are below NMS. There is a standard format for Terms and Conditions of residency, which is used for self-funded and local authority placements. Within the contract the complaints procedure, rules and expectations of both parties are described. Signed copies that include the name of the person, the fees and room number are in place for each person accommodated. The Worthies DS0000026524.V263773.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 The service provider has taken steps to develop the care planning system but the action plans must be more specific about the person, to develop continuity of care. For residents that have a history of pressure sores, care plans must guide staff on the actions to be taken to prevent reoccurrences of pressure sores. Residents have access to health care services. Risk assessments must be completed for locking the front and back door to ensure that the actions taken reflect the level of risk. Safe practices of recording and administration exist for medicines in the monitored dosage system. For medications administered on a “when required” basis, guidelines on their administration must be developed. The practice of re-dispensing “when required“ medication from its original bottle must cease. Within the Privacy and Dignity policy is the Confidentiality policy and residents confirmed their rights are protected at the home. For the Confidentiality policy to be complete, entries about access to, storage of and recording of information must be incorporated. The Worthies DS0000026524.V263773.R01.S.doc Version 5.0 Page 11 EVIDENCE: The care planning process was updated to guide the staff to meet residents’ needs. While the information about the need is described, the information is not yet specific enough about the person - for example, their likes, dislikes, preferred routines and abilities. In terms of residents with mental health care, their communication and safety needs must be included. There are no risk assessments for locking the front and back door. This practice is done with the knowledge of the fire brigade in response to the location of the home and the consequent risks to those residents with dementia. The Community Physiotherapy team was contacted to assess one resident that may require a hoist for lifting. Slide sheets and handling belts are available on each floor for staff to assist residents with moving around the home. Risk assessments are completed for residents that require assistance with moving and handling. Equipment and assistance needed from staff is listed within the assessments. There are residents currently accommodated that have a history of pressure sores and care plans must incorporate symptoms of deterioration. The actions that must be taken by the members of staff must be described to prevent a reoccurrence of pressure sores. Medications are administered through a monitored dosage system and the records indicated that sign the medication sheets immediately after administration. Homely remedies are administered from a stock supply when required and the records reflected the balances held. It transpired during the inspection that medications are re-dispensed for one resident that has “when required” medications administered by the staff. As this practice is open to errors and the daily frequencies cannot be predicted, the procedure must cease. Where “when required” medications are administered on a daily basis, GP’s must be contacted for a review. Guidelines must also be formulated to ensure members of staff clear on administering “when required” medications. The Privacy and Dignity Policy sets the approach for promoting residents rights. The Confidentiality policy supplements the Privacy policy and describes the commitment towards maintaining confidentiality. Sharing information, with the implications to staff for breaches in confidentiality, is described within the policy but issues of accessing, storing and recording information are not yet incorporated into the policy. The Worthies DS0000026524.V263773.R01.S.doc Version 5.0 Page 12 Residents giving feedback confirmed that their right to privacy and dignity is protected at the home. Conducting personal care with the door closed, knocking on bedroom doors before entering and conducting private visits with visitors were examples given by residents. The Worthies DS0000026524.V263773.R01.S.doc Version 5.0 Page 13 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): 14 Residents’ comments confirmed that opportunities to exercise choice exist at the home. However, three residents sit in the dining room during the day where smoking is permitted. Residents that sit in the dining room during the day must be asked whether they would like to sit in a non-smoking area. EVIDENCE: Residents gave feedback on the opportunities that exist to make choices. It was reported that outside entertainers visit monthly and in-house activities are organised by the staff. One relative visiting at the time of the inspection confirmed that activities take place regularly. In terms of the meals provided, residents consulted stated that the meals served were very good. Residents made additional positive comments regarding the choices available at each mealtime and variety of the meals. Residents that have visitors confirmed that the staff at the home made their visitors welcome and for additional privacy, bedrooms were used. It was noted during the inspection that the residents use the dining room for smoking. While the Statement of Purpose describes the arrangements for The Worthies DS0000026524.V263773.R01.S.doc Version 5.0 Page 14 smoking, the residents that sit in the area were not asked about the smoking arrangements. The Worthies DS0000026524.V263773.R01.S.doc Version 5.0 Page 15 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 Residents expressed their confidence that their complaints would be taken seriously and acted upon. Protecting residents from abuse once concerns are raised is an issue taken seriously by the provider. EVIDENCE: There were no complaints received at the home for investigation since the last inspection. Two individuals raised concerns about the home with CSCI, one was based on inappropriate lifting by a staff member and the other was about gross misconduct by a member of staff that has left. Regarding the inappropriate lifting, CSCI and subsequently the service provider investigated the concerns raised. The concern was unsubstantiated and the member of staff will attend refresher manual handling training. Concerning the allegation of gross misconduct, the service provider will make a referral to the POVA list for this person. From this incident, the service provider must attend POVA training, which is aimed for managers and service providers. Members of staff must receive copies of the General Social Care Council Code of Conduct and the staff must sign to indicate receipt and understanding of the expectations. Terms and Conditions of employment must The Worthies DS0000026524.V263773.R01.S.doc Version 5.0 Page 16 be clear on use of mobile phones during working hours. The CSCI office must be notified of this incident through a Regulation 37. Residents consulted about raising concerns and complaints stated that the service provider would be approached. Residents’ comments indicated their confidence that their complaints would be taken seriously and acted upon. The Worthies DS0000026524.V263773.R01.S.doc Version 5.0 Page 17 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, 20, 21, 23 & 26 The Worthies is homely and comfortable. Privacy is promoted but to ensure that residents benefit from their environment, the locks on bathroom and toilets must be repaired. To confirm safety, the fire officer must be consulted about an alternative escape route to room 1. The combined communal areas provide residents with sufficient seating to socialise in groups. The premises are kept clean and free from unpleasant smells. EVIDENCE: The Worthies is located in Stapleton Village close to bus routes and fairly close to shops and library. The accommodation is arranged over three floors with bedrooms on all floors and shared space on the ground floor. The Worthies DS0000026524.V263773.R01.S.doc Version 5.0 Page 18 Shared facilities of three lounges are sited at the front of the property. Overall there were twenty individuals sat comfortably in the three lounges with a further three people sat in the seating area within the dining room. In the dining room there is sufficient seating for the residents to have their meals together. There are toilets on each floor and a bathroom on the second and third floor. The two double bedrooms have are en-suites with showers. It was noted during the tour that the locks on bathrooms and toilets required attention. Equipment and aids are provided to assist less mobile residents with moving around the home. Residents have access to bedrooms and shared space by the provision of a passenger lift to the first and second floor and level access into the building. With two exceptions, bedrooms are single. The double bedrooms are en-suite offering privacy with personal care. Bedrooms contain a combination of the home’s furniture and personal belongings and are furnished and equipped to meet the needs of the individual. Privacy is promoted through lockable doors with additional lockable space in bedrooms. There is a fire exit from room 1 and during the tour of the premises, it was noted that the exit is blocked by an easy chair. To ensure the comfort of the resident, the service provider must consult with the fire authority on the number of exits required and to assess whether an alternative route can be found. The laundry room is sited away from the kitchen. The floor covering and walls are impermeable making surface readily cleanable. The washing machine has a specific programme for sluicing and there is a tumble dryer. The Worthies DS0000026524.V263773.R01.S.doc Version 5.0 Page 19 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, 29 & 30 The current staffing levels are adequate to meet the needs of the current residents. To ensure residents’ protection, the references from the most recent or current employer must be sought and their authenticity established whenever request for references are used. The training scheduled for the service provider and staff will ensure competency to meet residents’ needs. EVIDENCE: The rota in place indicates that there are three members of staff rostered throughout the day and two staff awake at night. As the service provider takes on the day-to-day management of the home, the hours worked must be included within the rota. Catering and cleaning staff are also employed at the home. The personnel files of the most recently employed staff were examined. They contained completed application forms, which seek personal information, employment history and the names of two referees. In terms of the names of the referees, the application form must request the name of the current or most recent employer. Where request for reference formats are used, The Worthies DS0000026524.V263773.R01.S.doc Version 5.0 Page 20 additional information on disciplinary procedures and the validity of the referee must be sought. For example, stamp or complement slip. The service provider and deputy are undertaking the assessors training and four members of staff will be undertaking NVQ level 2 with them. It was understood from the service provider that dementia training, First Aid, Manual Handling and POVA training is scheduled for the staff from Bristol City Council. The Worthies DS0000026524.V263773.R01.S.doc Version 5.0 Page 21 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): 32, 34, 35 & 38 Residents, staff and visitors comments about the ethos of the home supported an open and inclusive culture. Insurance cover in place confirmed that the service provider protects the interest of the residents and staff. Facilities for the safekeeping of cash and valuables exist at the home. Systems for maintaining and monitoring cash records must be introduced to safeguard residents’ financial interests. Safety procedures are in place in the event of a fire, which protects residents and staff. EVIDENCE: The Worthies DS0000026524.V263773.R01.S.doc Version 5.0 Page 22 Members of staff consulted made constructive comments about the conduct of care at the home. Members of staff reported that the service provider takes on board suggestions made. It was further stated that the service provider and deputy are approachable and listened to their comments and suggestions. Regarding procedures that protected residents from abuse, the members of staff were clear on their responsibilities to report poor practice. Staff meetings and training were examples given by the staff about systems that maintained high standards of care. Two relatives at the home during the inspection were consulted and confirmed that whenever they were made welcome whenever they visited the home. They felt informed about their relative’s welfare and have observed consistency of care whenever they visited the home. Residents consulted during the inspection commented that the staff were respectful and friendly, that routines were led by residents wishes and were made to feel well looked after by the staff. Displayed in the foyer of the building is certificate of registration and public liability insurance certificate. The records of the fees charged at the home were examined. The home currently accommodates local authority placements and self-funded residents. For residents funded by the local authority, individual schedules that denote the sources that contribute towards the fees. Contracts between the residents and service provider are in place for residents that self fund their placements. From the records of fees indicate that the weekly charge ranges from £339.00 -£400.00 per week. Facilities for the safekeeping of cash and valuables exist at the home and the recording process requires updating. While records contain the signature of the resident withdrawing cash from safekeeping, the staff should countersign the cash sheet. For one resident the cash records sheet was not balanced and indicated that there was cash in safekeeping, although the resident had withdrawn the cash. A system of monitoring and checking cash held in safekeeping must be introduced to ensure safe handling of residents’ cash and valuables. Service certificates for the lift, portable equipment, with heating and boiler documentation of checks conducted by contractors, indicates that residents and staff’s safety are promoted. The Worthies DS0000026524.V263773.R01.S.doc Version 5.0 Page 23 The records that relate to fire safety procedures, checks and practices were examined and indicated that checks and practices are conducted at the stipulated frequencies. The Worthies DS0000026524.V263773.R01.S.doc Version 5.0 Page 24 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 2 3 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 3 3 x 3 x x 3 STAFFING Standard No Score 27 3 28 2 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 3 x 3 2 x x 3 The Worthies DS0000026524.V263773.R01.S.doc Version 5.0 Page 25 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 15 Requirement An action plan must be developed to guide staff to meet residents’ needs. For residents with dementia, care plans must detail communication and safety needs. Within the care plans residents’ likes, dislikes, preferred routines and abilities must be incorporated. Recreational activities must be included within the care plans and reviewed. (Previously required 4/5/05) Members of staff must attend POVA training (Previously required 4/5/05, but timescale not lapsed) The Statement of Purpose must contain specific information about the admission procedure. Risk assessments must be completed for locking the front and rear entrance to the home The practice of re-dispensing “when required” medications must cease. The Confidentiality policy must describe the arrangements for access, storage and recording of DS0000026524.V263773.R01.S.doc Timescale for action 30/03/06 2 OP18 13.(6) 30/12/05 3 4 5 6 OP1 OP9 OP9 OP10 4.(1)(c) Sch.1.8 13(4)(a) 13.2 12(4)(a) 30/03/06 30/12/05 30/11/05 28/02/06 The Worthies Version 5.0 Page 26 7 OP12 12(3) 8 9 10 OP29 OP29 OP29 13(6) 37 18(4) 12 OP21 4(1)(c) Sch1 13 OP29 19 14 OP35 17(2) Sch.9 information. Residents that sit in the dining room during the day must be asked whether they would like to sit in a non-smoking area. Refer one member of staff for inclusion onto the POVA register for gross misconduct. The CSCI must be notified of the incident of gross misconduct involving one member of staff. Members of staff must be provided with the GSCC Code of Conduct and must sign for the Code to indicate receipt and their understanding. To increase potential residents awareness of the facilities, the ratio of bathrooms must be included in the Statement of Purpose. The references from the current/most recent employer must be sought and their must authenticity established. (Previously required 04/04/05) A system of monitoring and checking cash held in safekeeping must be introduced to ensure safe handling of residents’ cash and valuables. 30/12/05 01/12/05 30/12/05 30/01/06 30/03/06 30/12/05 30/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Worthies DS0000026524.V263773.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Worthies DS0000026524.V263773.R01.S.doc Version 5.0 Page 28 - 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!