Inspection on 04/04/05 for Tower House

This inspection was carried out on 4th April 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Tower House 28/07/08

Tower House 28/08/07

Tower House 22/06/06

Tower House 18/11/05

Tower House 10/11/04

Tower House 19/05/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Tower House 10 Tower Road Willesden London NW10 2HP Lead Inspector Julie Schofield Announced 4 April 2005 9.50am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tower House Version 1.10 Page 3 SERVICE INFORMATION Name of service Tower House Address 10 Tower Road, Willesden London NW10 2HP 020 8933 7203 020 8930 3681 towerhouse6@hotmail.com Mrs Mary Mundy 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) Mrs Mary Mundy CRH, PC 7 Category(ies) of OP (7) registration, with number of places Tower House Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 10th November 2004 Brief Description of the Service: Tower House is a care home providing personal care for 7 elderly residents and at the time of the inspection there were no vacancies, although 1 resident was in hospital. The home is situated in a quiet turning behind Willesden Lane and is close to bus routes, Willesden High Road and local underground stations, Dollis Hill and Willesden Green. The proprietor of the home is also the registered manager. The home consists of 2 houses which have been converted into one property and there is an open plan lounge and dining area on the ground floor with access from both houses. The first floor areas are still separate and each has its own staircase. There are 2 bedrooms on the ground floor and 5 bedrooms on the first floor areas. There is a garden at the front and at the rear of the property. There is off street parking space available for 2 cars. Parking in the street outside the home is restricted to permit holders (and their visitors) only. There is level access, via a portable ramp, to the front of the house. Tower House Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 2 visits to the home in April 2005 and lasted a total of 8 hrs and 40 minutes. During the inspection the Inspector had discussions with the manager, 2 members of staff, a visitor and 5 residents. Staff and care records were inspected. The Inspector would like to thank them for giving their comments. Two relatives returned a comment card to the CSCI and they confirmed their satisfaction with the overall care provided in the home. What the service does well: What has improved since the last inspection? There has been an improvement in the recording systems in the home e.g. the development of more comprehensive residents’ case files. The newly drafted statement of purpose and service user guide is informative and has illustrated covers. Care plans are been developed and now address the personal care, health care and social care needs of the resident. All service users go to a daycentre once a week and some go on two days per week. A collage of photographs taken at the day centre was on display in the entrance hall and residents confirmed that they enjoyed going there. The manager has arranged this outside activity. Tower House Version 1.10 Page 6 What they could do better: An immediate requirements feedback form was issued during the inspection and a letter of serious concern was sent to the home after the inspection in relation to staffing issues. The home needs to recruit permanent members of staff, with students on placement being supernumerary. The rota must be an accurate record of staff and students on duty and the recruitment practices of the home must include thorough checks. Also staff need individual supervision sessions to encourage personal development. As part of the pre-admission procedure the home must obtain a copy of the assessment of the prospective service user from the placing authority and the resident’s case file must include a copy of the manager’s own assessment. After admission the needs of residents need reviewing on a six monthly basis and risk assessments should be reviewed on a regular basis. It is recommended that where possible residents sign their contract, care plan etc. To provide a wholesome and varied diet the lunch must be freshly prepared and not prepared in advance and then reheated. It must include a choice of dishes and be the meal listed on the menu, which is on display. Where service users with disabilities need special plates to eat their meals these must be provided. Medication records must be accurate and the number of staff trained to administer medication should be increased. Information for prospective service users and their families needs to be comprehensive and should refer to the correct regulatory body for care homes. To enhance the quality of life for residents a varied and stimulating programme of activities needs to be developed, based on the wishes and suggestions of residents and when necessary referrals should be made to the “talking book” service. To ensure that the home is safe for people living and working there confirmation that the requirements identified by the Environmental Health Officer and the LFEPA have been complied with is necessary. Staff must undertake training in safe working practice topics. There must be a qualified first aider on duty at all times. Tower House Version 1.10 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Tower House Version 1.10 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Tower House Version 1.10 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3 Information is now available to help prospective service users in their choice of care home and the contract between the home and the service user informs the resident of what facilities and services they are entitled to receive. The manager is unable to give an assurance, before admission, that the home is able to meet the needs of the prospective service user. EVIDENCE: The home has produced a new statement of purpose and service users’ guide and these are written in plain English and contain most of the information listed in the National Minimum Standards. Both documents refer to the CSCI and give contact details. They would benefit from being available in large print. The same form of contract is used for residents who are privately placed and for those who receive assistance with funding from the local authority. The contract contains the information listed in the National Minimum Standards and should be signed by either the resident or their representative. Tower House Version 1.10 Page 10 Two case files were inspected and neither contained a pre-admission assessment undertaken by the manager of the home. Although the first resident had been referred by the local authority, the manager had not received a copy of the care management assessment. The second resident was self-funding and there was a copy of the continuing care assessment form. Tower House Version 1.10 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 Without the regular review of care plans and risk assessments the changing needs of service users are not identified and recorded and the home is unable to demonstrate that the service provided meets the current needs of service users. Service users are treated with respect and their dignity and privacy is maintained. EVIDENCE: Case files were inspected. An assessment of need was completed the day after admission. From this a care plan was developed and it included personal care, health care and social care needs. The plan set out the assistance to be given by staff. Care plans had not been signed by the service user or their representative. Monthly evaluations of the care plans were brief and these had only recently been introduced. Reviews of the care plan, to include the placing authority and representatives of the service user were overdue. Risk assessments for falling were present on the case file. Carers confirmed that they assisted residents with their personal care needs and service users said that they received the assistance that they required. Case files contained risk assessments for the development of pressure sores and these should be reviewed on a regular basis. Some residents go out for a Tower House Version 1.10 Page 12 walk and the manager said that other residents are encouraged to walk around inside the home or do gentle exercises while seated. There are nutritional risk assessments on the case files and these should be reviewed on a regular basis. Residents who are able to stand unaided are weighed on a monthly basis. Residents have access to optical, dental and chiropody services. The manager said that she is the main person to administer medication to the residents and that if she is not on duty the person who takes over this task is a nurse. No other staff have received medication training. The storage of medication was satisfactory. The home uses a blister pack system of administration and it would be helpful if all blister packs started on the same day of the week. Records were inspected. Although a service user was in hospital the record of administration had still been initialled. Residents said that they were treated with respect and that when assistance was given with personal care their privacy was maintained. Staff knocked on the door of the resident’s room and waited for the resident to invite them in. They discreetly offered assistance with toileting. Tower House Version 1.10 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 standard(s) 12, 13, 15 The current programme of activities on display is not consistently implemented and does not provide service users with a stimulating lifestyle. Service users are supported in maintaining their relationships with family members. The practice of reheating cooked food puts the health of service users at risk. EVIDENCE: Two residents said that they went out for a walk or to the shops etc, accompanied by a member of staff. They said that all service users went to a day centre on a Thursday and there were photographs in the entrance lobby of residents at the centre. The manager said that some of the residents attend the centre on a Wednesday as well as a Thursday. In the dining area a programme of activities was on display for the week but no organised activities took place during the inspection. The programme mainly included exercises and watching videos. On the second visit some residents were watching the television programme, which covered the funeral of the pope. Students were sitting with other residents and talking with them. A blind resident said that staff read aloud the bible to him and that he was escorted to church, when he wished to attend. He said that he did not receive the “talking book” service. The manager said that although there are board games in the home they are rarely used. Residents should be asked what games or activities they would like to take part in. Tower House Version 1.10 Page 14 During the inspection a resident received a visitor. The relative said that they were made welcome by staff when she visited the home and residents said that they could entertain visitors in their rooms, if they wished. This was confirmed in completed relatives’ comment cards. The visitors’ book is in the entrance lobby. Meals are taken in one of the two conservatories attached to the open plan lounge area. There is sufficient space for all the service users to dine together and the view across the garden is pleasant. The manager confirmed that the meals served did not always follow the meals listed on the menu, which was on display. Lunch was prepared on the second visit of the inspection (Friday) and fish was served as an alternative to chicken for a Catholic resident. Both dishes had been cooked prior to the start of the visit (10am) and were to be reheated prior to the mealtime. Food records were kept and there were a few gaps in the recording. Records showed that some African-Caribbean foods were served in the home for the African and African-Caribbean residents. Records did not confirm that residents exercised choice of dish at lunchtime. One resident is blind and they would benefit from a raised rim around the plate to enable them to eat without using their fingers to check whether the food was in danger of falling off the plate. Residents said that the food served in the home was good and a relative said that although she purchased food for the resident when they lived in another care home there was no need to do this since the resident had been admitted to Tower House. A resident said that they could have their meal when they want. Tower House Version 1.10 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 standard(s) 16 Service users who are articulate and demonstrate an awareness of their surroundings are aware of their right to complain and are clear about the role of the manager. EVIDENCE: In the entrance lobby there is a complaints procedure, which refers to the NCSC and Brent Inspection Unit as the regulatory body, although the address and telephone number given is for the CSCI local office. The procedure is simple and clear and includes timescales for each stage of the process. The manager said that no complaints have been recorded since the previous announced inspection. Residents confirmed that if they had any concerns or complaints they would speak to the manager. Two completed relatives/visitors comments cards confirmed that the person was aware of the home’s complaints procedure. Information about advocacy services should be available in the home. Tower House Version 1.10 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 25, 26 Service users live in a home that provides a comfortable environment. The time taken to service laundry does not give service users readily available changes of clothing. EVIDENCE: During the inspection the level of heating and lighting was comfortable. There is a system of emergency lighting. Rooms have natural ventilation and are centrally heated. The manager confirmed that pre-set valves have been fitted in the remaining rooms in the side of the building where the main entrance is situated, although has not forwarded confirmation from the plumber within the timescale previously set. Some radiators are guarded and the manager said that other radiators have guaranteed low surface temperatures. The home was clean and tidy. The home does not have laundry facilities and the manager uses the services of a local laundry. A resident said that it takes too long for clothes to be laundered and returned to the home. Tower House Version 1.10 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 There are insufficient numbers of care staff working in the home to meet the needs of the service users. The recruitment practices of the home do not promote and protect the welfare of service users. EVIDENCE: An immediate requirements and feedback form was issued during the inspection and a serious concerns letter issued following the inspection in relation to staffing and recruitment issues. The rota did not include the names of all staff or students present in the home. There are only 2 permanent members of staff. Students placed by a college and by an agency were being used as carers. As these placements are for approximately 12 weeks at a time residents do not receive continuity of care and for those residents whose memory is failing the Separate domestic staff are not employed and the manager said that the part time chef was on sick leave during the week that the inspection took place. Personnel records were inspected. Two files did not contain valid documentation relating to a work permit. There were no enhanced CRB disclosures for the college students on placement in the home. There was a file of enhanced CRB disclosures for agency students but no record of which students were working in the home at the time of the inspection. Tower House Version 1.10 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35, 36, 38 The service users’ financial interests are safeguarded by their family members or are under their own control. The absence of individual supervision sessions reduces the overall support available to staff and an opportunity to encourage personal development is missed. Until the home has complied with the requirements of the Environmental Health Officer and the LFEPA the health and safety standards in the home are below those needed to ensure that residents and staff are safe. EVIDENCE: Two of the service users manage their own finances and have control of their pension books. The manager said that each of the remaining residents has a member of their family who manages their financial affairs. The manager said that she was developing a programme of individual supervision sessions for staff and intended to share the role with a senior Tower House Version 1.10 Page 19 member of staff. Staff confirmed that they received support from the manager on a day-to-day basis. The home does not have a written statement of the policy, organisation and arrangements for maintaining safe working practices. There were valid certificates for the servicing of fire precautionary equipment and systems and portable electrical appliances. The Landlords Gas Safety Record was not available for inspection. Recent visits by the Environmental Health Officer and by the LFEPA had identified a number of requirements and recommendations. There was evidence that staff had received training in some safe working practice topics. However, there was not a qualified first aider on duty in the home at all times and not all staff working in the kitchen had undertaken food hygiene training. There was an ant on the dining table in the conservatory and this was brought to the attention of the manager, during the inspection. Tower House Version 1.10 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 3 1 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 1 COMPLAINTS AND PROTECTION x x x x x x 2 2 STAFFING Standard No Score 27 1 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x x x x x 3 1 x 1 Tower House Version 1.10 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4.1 S.1 Requirement That the statement of purpose includes the qualifications and experience of the provider/manager and of the staff. That the service users guide contains a copy of the most recent inspection report. That the manager obtains a copy of the assessment by the placing authority, as part of the preadmission procedure. That the manager conducts a pre-admission assessment of the service user to enable them to confirm in writing to the prospective service user that the home is able to meet their needs. That six monthly reviews of the care plan take place and that the service user, their representative(s) and placing authority are invited to attend. That the minutes of the review meeting are kept on the case file. That the record of administration of medication to service users is accurate and that the code for in hospital is Version 1.10 Timescale for action 01 August 2005 2. 3. OP1 OP3 5.1 14.1 01 August 2005 01 June 2005 01 June 2005 4. OP3 14.1 5. OP7 15.2 01 July 2005 6. OP9 17.2 Schedule 3.3 01 June 2005 Tower House Page 22 used, when needed 7. OP12 16.2 That the manager asks residents what activities they would like to take part in and uses this information to draw up a weekly activities programme. That the programme is implemented. That the menu on display matches the meals that are prepared. That food is freshly prepared and served immediately. That residents are offered a choice of dish at lunchtime and are encouraged to exercise choicel. That suitable crockery is provided for residents who have a disability. That the complaints procedure refers to the CSCI as the regulatory authority. That the manager forwards confirmation to the CSCI that pre-set valves have been fitted to prevent the risk of scalding. (Previous timescale of 01 September 2003 not met) That the time taken in collecting, washing and returning of clothes to residents is reduced. That the names of all staff working in the home and all students on placement are recorded on the rota. That confirmation of satisfactory CRB disclosures is obtained from the college for students before their placement commences. This information is to be forwarded to the CSCI for current students on placement. That individual supervision sessions take place with members of staff, at least 6 times per year, and that these Version 1.10 01 June 2005 8. 9. 10. OP15 OP15 OP15 12.4 17.2 Schedule 4.13 16.2 01 June 2005 01 June 2005 01 June 2005 01 June 2005 01 June 2005 01 June 2005 11. 12. 13. OP15 OP16 OP25 23.2 22.7 13.4 14. 15. OP26 OP27 16.2 17.2 Schedule 4.7 19.4 01 June 2005 11 May 2005 12 May 2005 16. OP29 17. OP36 18.2 01 August 2005 Tower House Page 23 18. OP38 13.4 19. 20. OP38 OP38 13.4 16.2 & 23.4 21. 22. OP38 OP38 13.4 16.2 23. OP38 16.2 are recorded. (Previous timescale of 01 May 2003 not met) That the home has a written statement of the policy, organisation and arrangements for maintaining safe working practices. (Previous timescale of 01 September 2003 not met). That a copy of the Landlords Gas Safety Record is sent or faxed to the CSCI. That the manager complies with the requirements identified by the Environmental Health Officer and the LFEPA in their reports and informs the CSCI when completed. That there is a qualified first aider on duty in the home at all times. That all staff involved in the preparation and serving of food to service users have undertaken food hygiene training. That ants are removed from the conservatory. 01 August 2005 01 July 2005 01 August 2005 or before. 01 August 2005 01 September 2005 01 June 2005 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 OP1 OP1 Good Practice Recommendations That the statement of purpose and service users guide are available in large print. That the statement of purpose contains details of the terms and conditions of the home and that the service users guide includes details of the qualifications and experience of the proprietor/manager and staff. That the contract/statement of terms and conditions with the home is signed by the resident or their representative. That where possible the care plan is signed by the resident or their representative. That risk assessments for falling and for nutrition are Version 1.10 Page 24 3. 4. 5. OP2 OP7 OP8 Tower House 6. 7. 8. 9. 10. OP9 OP9 OP12 OP16 OP36 reviewed on a 3 monthly basis, or sooner if required, and that the review is recorded. That the number of staff who are trained to give medication is increased. That all blister packs start on the same day of the week. That contact is made with the talking book service on behalf of the blind resident. That information about advocacy services is available in the home. That senior members of staff giving individual supervision sessions to carers are trained in this task. Tower House Version 1.10 Page 25 Commission for Social Care Inspection 4th Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 Tower House Version 1.10 Page 26 - 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!