CARE HOMES FOR OLDER PEOPLE
Westy Hall Marsden Avenue Latchford Warrington Cheshire WA5 1UB Lead Inspector
David Jones Announced Inspection 11th October 2005 01:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Westy Hall DS0000027014.V253535.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. Westy Hall DS0000027014.V253535.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Westy Hall Address Marsden Avenue Latchford Warrington Cheshire WA5 1UB 01925 637948 01925 651420 Janice.Johnson@clsgroup.org.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) CLS Care Services Limited Janice Helen Johnson Care Home 39 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (10), Old age, not falling within any other of places category (29) Westy Hall DS0000027014.V253535.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 29 service users to include: * Up to 29 service users in the category of OP (old age not falling within any other category). * Up to 10 service users in the category DE(E) (dementia over the age of 65) may be accommodated. * Up to 2 service users in the category DE (dementia over the age of 55) may be accommodated. The registered provider must, at all times, employ a suitably qualified an experienced manager who is registered with the Commission for Social Care Inspection. Service users with dementia shall only be accommodated within the designated dementia care section of the establishment. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidance which may be issued through the Commission for Social Care Inspection. 7th July 2005 2. 3. 4. Date of last inspection Brief Description of the Service: Westy Hall is a care home, which is in located Latchford, a residential area of Warrington. It is close to bus routes, local shops and other public amenities. It is registered with the Commission for Social Care Inspection to offer personal care for up to 39 older people. The home is divided into two parts. One part of the home provides personal care for up to 29 older people whose needs are associated with old age and the other section of the home provides for ten older people with a diagnosed dementia. Two of the residents accommodated on the dementia unit may be 55 years of age or older. It is owned and managed by CLS Care Services Group. The premises are a purpose built twostorey property with access to the second floor provided by one passenger shaft lift and three stairways. Accommodation includes 39 single bedrooms, all having hot/cold water washbasins and door locks fitted. Communal facilities include five separate lounge areas, two dining rooms, one smoking room and one quiet room. There are four bathrooms, one shower room and 12 WC’s. There are also kitchen and laundry facilities on the ground floor, and the home has its own “hairdressing salon”. The home is set within its own grounds and residents have access to internal gardens.
Westy Hall DS0000027014.V253535.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This visit is a routine announced inspection. It took place on one day the 11th October 2005, over a 7-hour period. Thirteen residents and five members of staff including the manager were spoken with during the inspection. Inspection Comment cards were received from two social work teams and thirteen residents. We looked at some parts of the building, inspected medication systems, looked at some records and read the case notes of four residents. What the service does well:
Westy Hall is well managed and run in the best interests of residents. The manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. Residents speak highly of the home and the standard of care and facilities and services provided. Accommodation is comfortable, well equipped and decorated in accordance with residents’ expectations and personal preferences. The home’s assessment and care planning processes are based on good practice and involve the resident and their representatives in the continuing development of effective arrangements for care and support. Effective quality assurance procedures are in place. Residents and their relatives are listened to and their views respected and acted upon. The management and staff team continue to learn from experience and develop care practice. Guidance from the Alzheimer’s society and the National Institute of clinical Excellence is incorporated in the home’s methodology. The management and staff team have good working relationships with other associated health and social care professionals who comment that the staff have a good working knowledge of residents needs and indicate overall satisfaction with the standard of care provided. Communication is good and the manager responds favourably to constructive criticism. The atmosphere in the home is sociable and visitors are made welcome. Residents are able to choose from a number of activities and are assisted to visit the local shops and other places of interest. The vast majority of residents are satisfied with the standard of catering. Choice is offered with every meal, and likes, dislikes and special dietary needs are known and catered for. Westy Hall DS0000027014.V253535.R01.S.doc Version 5.0 Page 6 There is a skilled and dedicated team of staff who are caring and considerate in their approach. They show dedication to duty and deal with problems in an open and constructive manner. There is an effective staff training and development programme in place. Staff are unanimous in their support for the manager who provides leadership direction and support. What has improved since the last inspection? What they could do better:
Action must be taken to ensure that medicines are administered and recorded properly. This will ensure the safety and well being of residents’. The registered persons should make sure that at least 50 of the staff group have an NVQ in care at level 2 or above and the home’s arrangements for dementia training should be reviewed to ensure that staff training needs are met. Care plans for people with dementia should be developed to confirm how their dementia care needs including orientation and stimulation are being met. A separate section in the care plan that addresses dementia care needs would help to provide focus and improve access to information for the benefit of review. Westy Hall DS0000027014.V253535.R01.S.doc Version 5.0 Page 7 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. Westy Hall DS0000027014.V253535.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Westy Hall DS0000027014.V253535.R01.S.doc Version 5.0 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 the following standard(s): 3. Standard 6 is not applicable. New residents are admitted to the home on the basis of a full assessment undertaken by persons with appropriate training. Assessment and admissions procedures put the new resident and their representatives at the centre of decision-making. They are able to visit the home and receive written confirmation that the home is suitable to meet their needs before they move in. This helps them to make an informed choice about the home. EVIDENCE: Reading of the case records confirms that the home uses appropriate assessment and admissions procedures that involve the new resident and their representatives. All new residents have their needs assessed by the placing agency or by senior staff before moving in. They are able to meet with senior staff to discuss how the home would meet their needs and they receive written confirmation as to the suitability before they move in. Westy Hall DS0000027014.V253535.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 and 10. The home’s assessment and care planning systems ensure that residents’ identified and developing needs are met. Risk assessment and prevention of falls procedures make sure that risks of falling are minimised. The home works closely with other health and social care professionals and residents are assured that their health care needs will be addressed. Arrangements for the recording and administration of medication require improvement to ensure the protection of residents. EVIDENCE: The home’s care planning processes are based on good practice. Residents are involved with the development of their care plans and arrangements for care and support are developed according to the individual’s needs, interests and preferences. Risk of falls assessments are in place where required. Discussion with the manager confirmed that guidance provided by the National Institute for Clinical Excellence on the prevention of falls is used to analyse hazards and implement appropriate control measures. Four care plans were read as part of a case tracking exercise. In each case the care plan provides confirmation as to how the respective resident’s needs are being met and includes details of what the resident is able to do for them self. However, there is no section on
Westy Hall DS0000027014.V253535.R01.S.doc Version 5.0 Page 11 that care plan that confirms how the needs of residents with dementia are met and one of the care plans seen would benefit from further development to confirm that alternative arrangements are made when the resident refuses assistance to bathe. See recommendation 1. Records seen and discussion with the manager of a visiting social work team indicated that the home enjoys good working relationships with visiting health and social care professionals. Comment cards from visiting social care professionals indicate that staff demonstrate a clear understanding of residents needs and social workers are satisfied with the overall standard of care provided. Care staff monitor residents’ health and well-being and know what action to take when they are unwell. The home’s medication systems were checked by random sampling. Errors were identified in the administration and recording of medicines. See requirement 1. Inspection of arrangements for the administration of controlled drugs confirmed appropriate recording and administration in accordance with the home’s policies and procedures. There is evidence of good relationships between residents and staff. Care staff carry out their duties in good humour and with respect for residents. Residents express satisfaction with the standard of care indicating that privacy is respected. One resident said that she could not fault the home, she is treated with respect and she has privacy when required but living in someone else’s property affected her dignity. Residents are encouraged to personalise their rooms to help them to identify with the home. Discussion with the manager indicated that the issue of residents identifying with and feeling at home in the home would be addressed in the care planning and review processes. Westy Hall DS0000027014.V253535.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 14 and 15. The lifestyle in the home reflects the expectations and personal preferences of residents and choice is promoted. Visitors are made welcome, the standard of catering is good and residents have access to a range of appropriate activities. EVIDENCE: Residents speak highly of the home indicating satisfaction with facilities and services. Residents said there are no rules other those relating smoking. They are able to please themselves including the time they get up and go to bed. Visitors are made welcome, choice is promoted and the vast majority of residents are of the view that a range of suitable activities is on offer. An activities programme is posted on the notice board and the activities coordinator consults residents on an on-going basis. The home’s recent quality assurance exercise confirmed that the vast majority of residents are satisfied with the activities on offer and twelve of thirteen residents who completed inspection comment cards also confirmed satisfaction. Westy Hall DS0000027014.V253535.R01.S.doc Version 5.0 Page 13 One of the residents said that the biggest problem they have is having no problems. There are no ongoing problems to sort out and they find they have little to think about, nothing to sort out. Information provide by visiting social workers indicated that they are of the view that care staff need to develop an awareness of residents’ social skills in the interest of capitalising on these and developing the range of activities on offer. The manager advised that this had been identified in discussion with care staff and action is being taken to develop staffs’ awareness and appropriate care plans to meet residents’ needs. All but one of the residents praised the standard of catering and the home’s recent quality assurance survey found that 94 of residents are satisfied with the standard of food. The cook consults residents on an ongoing basis as to the standard of catering in the home. The menu offered a varied and nutritious diet and special dietary needs are catered for. One resident said that staff know that she likes Kippers and salt in her porridge, and this is appreciated. Westy Hall DS0000027014.V253535.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18. Arrangements for the protection of residents are effective. EVIDENCE: Robust procedures for responding to suspicion or evidence of abuse or neglect are in place including whistle blowing as in accordance with the Public Interest Disclosure Act 1998. Staff have received a booklet providing guidance on the implementation of adult protection procedures. Further training needs identified via the home’s staff appraisal systems will be addressed in accordance with each staff member’s personal development plan. Westy Hall DS0000027014.V253535.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Residents live in well-maintained, comfortable, clean and hygienic accommodation with access to appropriate indoor and outdoor communal facilities. EVIDENCE: Westy Hall is located in Latchford, a residential area of Warrington with easy access to the local shops and general amenities. The home is well maintained with good quality furnishings and fittings. It is set within its own grounds and there is an internal garden, which has been divided to provide a safe enclosed area for people with dementia. Residents speak highly of the home and state satisfaction with facilities and services provided. The home is clean and hygienic. Westy Hall DS0000027014.V253535.R01.S.doc Version 5.0 Page 16 The interior of the home has not been decorated for some time and paintwork and wallpaper is chipped and worn in some areas. Visiting social work staff commented on the décor stating that the home is in need of refurbishment and redecorating. Residents are happy with the standard of interior decoration. The manager advised that there are plans to close the home and rebuild in a number of years and therefore CLS are reluctant to redecorate the home in the mean time. The manager confirmed that if standards of interior décor deteriorate remedial action would be taken to maintain satisfactory standards. Westy Hall DS0000027014.V253535.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Staff are employed in appropriate numbers and skill mix sufficient for the well being of residents. Thorough recruitment procedures ensure the protection of residents. EVIDENCE: Discussion with the manager and a social work team manager confirmed that the home is accommodating four people on the Dementia Unit who have been assessed as requiring nursing care. The manager raised staffing levels at the time of the inspection to ensure that there are sufficient staff to meet residents needs in the interim of the residents moving to appropriate accommodation. Information provided by the manager and worked rotas seen during the inspection confirmed that staff are employed in following numbers: Westy Hall DS0000027014.V253535.R01.S.doc Version 5.0 Page 18 1. The main part of the home. • • A minimum of 3 and on occasion 4 and 5 members of care staff including a Care Team Leader are on duty 8am to 3pm. A minimum of 3 members of staff including a Care Team Leader are on duty in the afternoons and evenings from 3pm to 10pm. 2. The 10-place Dementia Unit: • A minimum of 3 members of care staff including one Care Team Leader are on duty throughout the day from 8am-10pm. ( These numbers will reduce to 2 members of care staff including one Care Team Leader when residents assessed as requiring nursing care move on.) At nighttime there are three members of staff on duty including a night care team leader. One member of staff is based in the Dementia Unit and the other in the main part of the home. Information provided by the manager indicated that five of the 25 members of care staff had achieved an NVQ in care to level two or above and a further eleven are working towards the qualification. When 13 have this qualification the standard regarding at least 50 of the home’s care staff team achieving an NVQ level 2 in care will be met. See recommendation 2. Training records provided by the manager indicated that CLS continue to operate a comprehensive staff-training programme that incorporates “Skills For Care” staff training standards. All the staff on the dementia unit have received training in the care of people with the Dementia. In the last 12 months the staff training programme has covered a number of subjects including, Manual Handling, Basic Food Hygiene, Fire Awareness, First Aid, Induction and Foundation Training provided by Warrington Borough Council, Abuse in The Care Home, Dementia, Medication, Care Planning, Infection Control, Continence Management, and “Nutircia” Dietary Support. The manager of a visiting social work team said that staff demonstrate a clear understanding of residents needs but need further training in meeting the needs of people with dementia. Staff confirmed that the training they had received regarding dementia care had been of benefit to them but they believed that further training is required. The staff team at Westy Hall are keen and enthusiastic. They aim to provide excellent standards of care. The manager advised that the home had acquired guidance and care planning documentation on working with people with the dementia from The Alzheimer’s Society. This is to be implemented with training where appropriate in the near future. The manager advised that staff training needs are identified through appraisal on an annual basis and subsequently personal development plans are
Westy Hall DS0000027014.V253535.R01.S.doc Version 5.0 Page 19 produced that are designed to meet all training needs. See recommendation 3. Reading of staff files and discussion with the manager confirmed that CLS operate effective recruitment procedures. Westy Hall DS0000027014.V253535.R01.S.doc Version 5.0 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Westy Hall is a well managed home that is run in the best interests of residents. Residents are safeguarded by the home’s accounting procedures and staff receive regular supervision. Health and safety of residents and staff is promoted. EVIDENCE: The manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. Effective quality assurance monitoring is in place based on seeking the views of residents and other interested parties. Resident and relatives surveys have been completed and reports on quality issues have been drafted and made available to residents, relatives and the CSCI. A questionnaire to asks visiting health and social care professionals about quality of care in the home has been developed and will be used on the next qualty survey.
Westy Hall DS0000027014.V253535.R01.S.doc Version 5.0 Page 21 Residents may manage their own money and facilities are available for them to deposit small amounts of money with the home for safekeeping. Written record of all transaction are maintained and audited on a regular basis. All staff are supervised as part of the normal management process and discussion with care staff indicated that they receive formal supervision on a regular basis. Staff are unanimous in there support for the manger who is held in high regard. The staff team on the dementia unit are working under very difficult circumstances with four residents presenting with nursing care needs. They said that the work is exhausting but despite this morale is good; there is a sense of teamwork amongst the staff group and the manager listens to them and takes action to address issues. The company seeks to ensure the health and safety of all employees and residents. Risk assessment and risk management is central to the conduct of the home. The registered manager ensures that risk assessments are carried out for all safe working practice topics and significant findings are recorded and reviewed. Fire prevention procedures are reviewed on a weekly basis and the lift, fire equipment, and fire alarm systems are serviced at appropriate intervals. There are no records available as to when electrical installations were serviced. See requirement 2. Westy Hall DS0000027014.V253535.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Westy Hall DS0000027014.V253535.R01.S.doc Version 5.0 Page 23 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 OP9 Regulation 13 and 17 Requirement The registered persons must ensure that appropriate arrangements are made for the administration and record of medicines in the home. The registered persons must ensure that the home’s electrical installations are checked and if necessary serviced by an appropriately qualified electrician. Timescale for action 11/10/05 2 OP38 13 and 23 30/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations The registered persons should develop care plans for people with dementia to confirm how their dementia care needs including stimulation and orientation are being met and confirm in the respective person’s care plan arrangements to meet her needs when offers of assistance to bathe are refused. Westy Hall DS0000027014.V253535.R01.S.doc Version 5.0 Page 24 2 OP28 The registered persons should ensure that at least 50 of the care staff team achieve an NVQ in care at level 2 or above. The registered persons should review arrangement to provide dementia training to ensure that staff training needs are met. 3 OP30 Westy Hall DS0000027014.V253535.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 Westy Hall DS0000027014.V253535.R01.S.doc Version 5.0 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!
