Care Home: Boxgrove

Similar services:

• Hillview Farm
• Dalewood Respite Care
• Orchard,The
• REACH Upton Court Road
• Fairways
• Treloar College
• Pinta
• Kestrel House, St Anne`s Opportunity Centre,

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Boxgrove Little Heath Road Tilehurst Reading Berkshire RG31 5TY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kerry Kingston     Date: 1 9 0 6 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Boxgrove Little Heath Road Tilehurst Reading Berkshire RG31 5TY 0118 943 1019 0118 945 4669 judiclark@choiceltd.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Choice Ltd Miss Judith Clark care home 10 Conditions of registration: Category(ies) : People with Learning disability Additional conditions: The maximum number of service users to be accommodated is 10. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). Number of places (if applicable): 0 Date of last inspection Brief description of the care home 0 6 0 6 2 0 0 7 Boxgrove is a purpose built care home for 10 adult men with severe learning difficulties. It is situated on the outskirts of Tilehurst a few miles from Reading Town Centre.There is an extensive garden and a separate day care building which are used to provide varied activities to the people who are supported by the service.The staffing ratio is high to meet the complex needs of the service users.Fees are a minimum of £1,695 per week and may vary considerably depending on the needs of the individual and the care package agreed. Care Homes for Adults (18-65 years) Page 4 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support peterchart Concerns, complaints and protection Environment Staffing Conduct and management of the home Poor Adequate Good Excellent How we did our inspection: The last Key Inspection for this service was completed on 6th June 2007. This is a report for the key inspection, carried out by Kerry Kingston,which included a routine unannounced site visit to the service. This took place between 11.00 and and 6.00 pm on the 19th June 2008. The curent fees of the service are from £1695.00, they vary considerably dependant on the needs of individuals and agreed care packages. The information was collected from an Annual Quality Assurance Assessment, a document sent to the service from the Commission for Social Care Inspection and completed by the manager. Surveys were sent to the people who are supported by the service. Discussions with the manager, the service manager , two staff members and the two people, who are able to verbally communicate took place. Observation of other Care Homes for Adults (18-65 years) Page 5 of 26 people took place during the visit to the home. Reviewing records of the people who use the service and other records and procedures was also used to collect information on the day of the visit. All information received by the Commission since the last inspection, about this service was also taken into account when producing this inspection report. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk.You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line – 0870 240 7535. Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection care home Page 8 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home would follow their admissions procedures and processes before admitting a resident, these include comprehensive assessments to ensure the home can meet their needs. Evidence: There have been no new admissions to the home since the last inspection, the last admission was in 2005. The people who live in the home are regularly assessed to ensure that the home is still meeting their needs. Care Homes for Adults (18-65 years) Page 9 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home make sure that care plans are regularly monitored to reflect peoples assessed and changing needs. Areas of development are included and the individual nature of the plan ensures individuals diverse needs are met. A robust risk assessment process means that people can be as independent as is possible. Evidence: The care plans for three people who use the service were seen, they included people with specific needs and requirements relating to their religion, physical ability and sensory abilities. Care plans are reviewed monthly by key workers, six monthly by the manager and annually by a multi-disciplinary team. People are regularly re-assessed at other times such as illness, behaviour changes or Care Homes for Adults (18-65 years) Page 10 of 26 signs of distress/unhappiness. Personal goals are looked at monthly by key workers and individuals have a meeting with key workers to attempt to ascertain their views on monthly progress/ well being. One to one resident meetings are one method used to try to ensure residents participation in making the decisions that affect their everyday life. Most people have communication passports and descriptions of how they present their feelings and make their views known. Regular house meetings are held and discussions include informing people about what is happening, in general, planning daytime trips,activities and choices around menus or other daily living issues. The home uses various methods to communicate with people in the meetings, such as a picture board, objects of reference and cards. The last meeting was held in May, the manager advised that staff use information if appropriate, from the meeting in peoples one to one key sessions. All the meetings cross reference and staff are , consequently able to accurately chart peoples progress and future needs. The manager has developed a system called new assessment for life, which is an observational technique that will be used to give a clearer understanding of what makes people happy and content or distressed and unhappy and may demonstrate more clearly peoples choices and preferences. Residents have comprehensive risk assessments that are detailed and ensure risks are minimised but taken to improve the independence and experience of people. One staff member said that one of the most positive developments over the last year was considered risk taking, this he believed had enhanced peoples lives by offering them more varied and rewarding experiences. Risk assessments were seen to be compatible with behavioural programmes for those people who may, on occasion display difficult behaviours. Risk assessments included community activities,presence in the kitchen and daily activities. Specific assessments were in place so that individuals could access activities such as swimming and boat trips. care home Page 11 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home makes sure that people can have an interesting and rewarding lifestyle, by giving them opportunities to experience different activities and supporting them to access the community. People are offered a health and varied diet and are encouraged to be as involved as possible in their food choices and preparation. Evidence: The activities part of the care plans reflect the individual and diverse needs of the people who are supported such as a more elderly man who chooses not to participate in activities as much as others. Another person is supported to attend religious and cultural festivals and celebrations, in the local community and in the wider religious Care Homes for Adults (18-65 years) Page 12 of 26 community. People are supported to access the community but it was discussed with the manager and service manager that there needs to be a review of why staff, on occasion buy peoples clothes without them being physically present. There is a weekly time table for all residents, but these are not very detailed and are often changed to accommodate peoples needs or preferences on the day. Other evidence was available such as daily reports, which are quite detailed and note where people have been and what they have been doing. People also choose special activities such as one person has chosen two special day trips so far this year, these trips are often one to one or two to one staffing. The home has employed a day care organisor and a day care support worker to ensure people can access rewarding day time activities. Staff and two people who are supported said that people had plenty to do and they did not get bored. The home recognises and notes that motivation can be an issue for people so they work hard to present different and interesting experiences for people to choose from. There are several systems of recording activities which could be reviewed so that it would be easier to track and cross reference activities with goals noted in care plans. Five of the people who are supported by the home do not have contact with families, the manager is continuing to try to find advocates for them. A self advocacy group is being started (externally) to the home and two people are interested in attending. Those people who have contact with their families are supported to maintain the contact and enhance their relationships. Staff gave a good account of how they respect peoples rights and talked about how they respect people and their choices, including the balance between risk taking and duty of care. One staff member described how senior staff had advised him about tone of voice and attitude when talking to the people he was supporting and how he had recognised that he had not have been showing the appropriate respect or recognising peoples rights. Menus seen were varied and wholesome, the home has a cook who prepares the main meal. One main meal a week is chosen by a resident. People choose and prepare their own breakfast and tea, with the support of staff. Peoples diverse food needs are recognised such as one person who eats only chicken and vegetarian food. Food monitoring charts and individuals likes and dislikes are clearly noted in menu file. care home Page 13 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers people support in the way they prefer and makes sure that they are helped to keep as healthy as possible. Medication is safely administered. Evidence: Three full care plans and several Health Action plans were seen. The support to be given to people to ensure their personal care needs are met is clearly recorded and includes, peoples preferences and choices and specific diversity needs. Communication methods are recorded so that staff are able to more accurately interpret behaviours, that may suggest how people are feeling about their care. A new assessment for life observational technique is to be used to improve understanding of how people show preferences/choices and what improves their wellbeing. Those who are able to, sign an agreement of how staff are to help them with difficult or distressing behaviours. All individuals have a health action plan which includes health review dates and is Care Homes for Adults (18-65 years) Page 14 of 26 signed by the G.P. Any necessary records are kept such as seizure charts for epilepsy, behavioural incidents charts for those who may need psychology/psychiatry input and weight charts for anyone who has any nutritional issues. People are provided with specialist equipment to assist staff to maintain their good health. Robust risk assessments are in place to safeguard privacy and dignity if this could be compromised by using the using the equipment. Visits to consultants such as psychologists, psychiatrists and specialists and regular health checks are well recorded. The primary care team is contacted when necessary. One person has had an improvement in his health because of new medication prescribed. The organisation employs an assistant psychologist who is able to visit individuals weekly, if necessary. None of the people are able to self medicate, staff administer medication. Records seen were accurate and the manager confirmed that there had been no medication errors since the last inspection. Staff receive in-house medication training and competence assessment prior to them being allowed to administer medication to the people they support. A senior staff member records the staff members training and competence assessment and signs the records to evidence that they are able to administer medication. Some staff are also authorised to administer emergency epilepsy medication, receiving training from a validated trainer who signs off their competence on behalf of the primary health care team. The pharmacist visits the home, the last visit was in November 2007 when they were happy with the medication procedure. care home Page 15 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a robust complaints procedure and is adopting innovative ways of hearing the views of thos people who are not able to communicate verbally. The people who are supported by the service are, generally, protected from all forms of harm or abuse. Evidence: Complaints procedure presented in pictorial /user friendly format. Manager recognises that most people would not be able to make a complaint unaided, the use of the new observational tool is seen to be an enhancement of the complaints procedure for those who are not able to verbally communicate their concerns/unhappiness. Only one complaint has been recorded in the last year, this did not relate to care issues. The manager confirmed that there had been no other complaints but that they had received a compliment from another professional stating that the staff were friendly and work well with service users. All staff receive safeguarding training as soon as possible after they have begun work in the home. Disciplinary action was taken against one staff member to ensure there was no potential threat to residents financial well being. Staff members spoken to had a good grasp of safeguarding issues and how to protect the people in their care. One staff member had not yet received the training but was ver clear about what he would do if peoples safety or well being was compromised. The manager and staff confirmed that they do not use restraint Care Homes for Adults (18-65 years) Page 16 of 26 and behavioural plans for those who need help to maintain positive behaviour were seen to be detailed and effective. Four financial records were seen, it was noted that staff take peoples cash off the premises, it was discussed with manager and service manager that this was not a secure practice and had potential for abuse of peoples finances and presented possible difficulties for staff. It was also noted that the people supported by the service pay staffs out of pocket expenses when participating in social occasions in the community (mainly meals and drinks). These payments are made directly by residents and are not detailed on receipts. The manager agreed to stop these direct payments until the practice had been reviewed by the provider, in relation to the safety (potential for abuse) and equity of the practice (people who have limited funds could be seen as discriminated against because of their financial status.)The manager also agreed to record peoples choices and how they made them in relation to people buying their own soft furnishings and bedding. care home Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a pleasant homely environment which is well maintained and meets the needs of the individuals and the group who live there. Evidence: The kitchen has been refurbished and it is practical, clean and hygienic. The garden is well used and sunshades are provided so that it can be used safely in hot , sunny conditions. A contractor keeps the large garden maintained and tidy. Most of the bedrooms were seen, all are well maintained with individual touches reflecting peoples choices and personalities. One person has a room specifically adapted to meet his diverse needs. People who are supported by the home have moved to rooms that better meet their individual diverse needs. The home has a good laundry facility sited appropriately and seen to be clean and tidy on the day of the visit. One bathroom has been fitted with a special toilet to address issues of odour. The home was seen to be very clean and tidy. Staff receive infection control training and suitable soap dispensers and protective clothing is provided, as necessary. Care Homes for Adults (18-65 years) Page 18 of 26 care home Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team are competent and are supported by the management team to meet the needs of the individuals in their care. The home has a robust recruitment process that ensures people are protected from the appointment of inappropriate or unsuitable staff. Evidence: Training records for three staff were seen all staff had received the core training or were booked on a course. All staff complete the core training within six months of starting work and up-dates are done as necessary. Training is generally up-to-date or booked for the next available course. Courses specifically related to the needs of the resident group are provided such as, makaton and epilepsy. Eight of the 22 staff have NVQ 2 or above, two staff have nearly completed it and two are embarking on it. There has been a substantial turnover of staff, in part because many of those who were recruited in a block from overseas have left to return home or take up other work. The home now has only two vacancies after a successful recruitment drive. The home, generally, covers any shortfall in staffing by bank personnel or staff doing Care Homes for Adults (18-65 years) Page 20 of 26 overtime. The home operates with five staff during the morning shift and four in the afternoon with two waking night staff, at weekends there are five staff per shift. During the daytime in the week there is also a day care co-ordinator, a day care support worker and the manager who work 9-5 to increase the staff and afford more opportunities for people to participate in external activities. The records for the three newest staff members were seen and included all the necessary information.The manager keeps the notes form interviews and completes the induction process with new staff. The induction includes a system of new staff shadowing experienced staff, the manager decides when new staff are competent in various areas of the work. Staff are supervised a minimum of six times a year and the management team have begun the completion of appraisals for those staff that have been in post for a year. Staff spoken to felt that they had good training opportunities and were helped to give a better standard of care to the people who they support. care home Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and the manager works hard to establish the views of the people who are supported in the service. People are kept as safe as possible in the home. Evidence: The manager has been in post for approximately 18 months, she was registered by the Commission in November 2007. She is nurse trained, has 25 years experience in social care and is completing her Registered Managers Award which she hopes will be completed in July 2008. Staff said that the home was well managed with the needs of the people who live there as the priority of the manager. The home has a Quality Assurance system that includes detailed and regular regulation 26 visits, house meetings with action points and annual questionnaires to other professionals, families and the people who live in the home. The results from the Care Homes for Adults (18-65 years) Page 22 of 26 surveys are incorporated into the Annual development Plan but this is not, as yet produced in conjunction with the provider organisation. The home is trying to set up imaginative ways of seeking the views of the people who are supported by the service, but who do not have mainstream communication skills, to ensure that their views are heard and acted upon, in regard to the development and improvement of the service. Staff members and the manager said that some of the improvement areas since the last inspection were, communication with people who use the service, day care activities, giving people choices and respecting their rights and responsibilities and the general well being of people. These and other areas of improvement were evidenced throughout the inspection visit. The manager confirmed that all Health and Safety maintenance checks had been carried out. An external Health and Safety inspection was completed on the the 18th June 2008 and a visit by environmental health on the the 16th November 2007 resulted in a satisfactory rating. care home Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 23 13 To review the practice of service users paying staffs out of pocket expenses, directly. To make sure that service users are not being placed at risk of financial abuse or at risk of discrimination because of their financial status. 01/10/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 15 12 To review the appropriateness of staff buying peoples clothing without their presence because it does not recognise peoples adult responsibilities or offer opportunities for skill and choice development. Review the safety of the practice of staff taking service users money off the premises for long periods of time. 16 23 Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 26 of 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!