Care Home: Eastwood House Care Home

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What the care home does well Eastwood House provides a homely environment with a stable staff team who are sensitive to the needs of the people who live there. People have their needs assessed by appropriately trained staff and are able to be involved in the planning of their care. Health and personal care is delivered in a timely and sensitive manner that ensures the privacy and dignity of the residents. The residents are encouraged and supported to maintain their optimum level of ability and retain control over their own lives. What has improved since the last inspection? There has been an improvement in the care planning, which involves people in the planning of their care and demonstrates good practice in timely responses to any changes in a persons condition. Progress has been made on developing a quality assurance system that seeks the peoples views and provides feedback to them. The requirements and recommendations made at the last key inspection have been addressed and implemented. What the care home could do better: The environment could be improved in a number of areas including re-decoration and replacement of furnishings and carpets. Some of this could be undertaken prior to the planned extension being built, particularly peoples bedrooms that will be unaffected by any building work. Increased numbers of staff could be on duty at busy times of day to enable people to receive more `person centred` care. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Eastwood House Care Home 24 Church Street Eastwood Nottingham NG16 3HS     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: Angela Starr     Date: 3 0 0 3 2 0 0 9 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. that people have said are important to them: They reflect the things 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 Older People 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 Older People 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 © (2009) 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Eastwood House Care Home 24 Church Street Eastwood Nottingham NG16 3HS 01773712003 01773530386 info@ruackcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Forthmeadow Ltd care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: That service users shall not be accommodated at Eastwood House Care Home unless they come within one of the following categories:- (OP) Old age, not falling within any other category People with a primary care need of Dementia over 65 years of age is restricted to 3 service users That the category of service users to be included on the register at Eastwood House Care Home shall be (OP) Old age, not falling within any other category (14) That within this number a maximum of 3 service users at Eastwood House Care Home can be included aged 65 years and over with a primary care need of Dementia DE(E) The total number of people to be accommodated at Eastwood House Care Home shall not exceed 14 at any one time Date of last inspection 0 Over 65 14 Care Homes for Older People Page 4 of 26 Brief description of the care home Eastwood House provides care for up to 14 men and women over 65 years, with the exception of one named person under 65years. The entrance is accessible for wheelchairs. The accommodation is on two floors and there is a passenger lift. There are twelve single bedrooms, four of which have an en-suite facility and there is one double bedroom. There is a bathroom on each floor and toilet facilities are within easy access of the communal and private accommodation. There are car-parking facilities and a garden area with benches. The home is situated close to the facilities and amenities that Eastwood has to offer including a wide range of shops, public houses, a library and market place, churches and a community centre. The range of fees are: 294.00 pounds to 400.00 pounds per week Care Homes for Older People Page 5 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of Inspections undertaken by the Care Quality Commission is upon outcomes for people who use the services and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. We have introduced a new way of working with owners and managers. We ask them to fill in a questionnaire called an Annual Quality Assurance Assessment, which tells us about how well their service provides for the needs of the people who use it and how they intend to improve their service. We received this back from the manager within the required timescale and the form was completed in a satisfactory manner, providing us with information to assist in planning our visit and deciding what areas to look at. We also reviewed all the information we have received about the service since we last Care Homes for Older People Page 6 of 26 visited on the 9th August 2006 and we considered this in planning the visit and deciding what areas to look at. The main method of Inspection we use is called case tracking which involves us selecting a number of people who use the service and looking at the quality of the care they receive by speaking with them, observation, reading their records and asking staff about their needs. We also sent Have Your Say questionnaires to a random selection of people who use the service, some relatives and some staff members. The information provided in the replies we received, was also a contributory factor in the focus of our inspection visit. We spoke with two members of staff and three people who use the service to form an opinion about the quality of the service being provided. We read documents as part of this visit and medication was inspected to form an opinion about the health and safety of people who use the service. A copy of the latest inspection report can be seen at the service or by visiting the Care Quality Commission web site at www.cqc.org.uk 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. People who wish to live at the home have their needs assessed to ensure their needs can be met. People are given information about the service to assist them in making a decsion about their choice of home. Evidence: The manager told us in the written information she provided, People who consider moving to Eastwood House have an opportunity to experience a trial period of up to four weeks in order to inform their decision. Any person wishing to move to Eastwood House has a thorough pre-assessment completed to ensure that we have the skills required to meet that persons needs. We looked at files for three people living at the home as part of our case tracking Care Homes for Older People Page 10 of 26 Evidence: process. All three files contained a full assessment of need, a care plan and where relevant, risk assessments were in place. The assessments were thorough and it was evident that a lot of the information had been obtained prior to a person moving to the home. All three files contained a contract and where relevant, there was a copy of a community care assessment completed by a social worker. We sent out ten questionnaires to people living at the home, ten to relatives and a further ten to staff. Only one person living at the service returned a completed questionnaire and where we asked Did you receive enough information about the home before you moved in? they replied yes. Two relatives responded and they said they had all the information they needed. Four staff responded and where we asked Are you given up to date information about the needs of the people you support? all four replied Always. The Statement of Purpose and Service User Guide are comprehensive and informative. They contain information about the accomodation and the support that is available to people living at the home and are detailed enough to help people make an informed choice. They have been reviewed and updated as recently as March 2009. During our partial tour of the home, we saw copies of these documents in peoples bedrooms. People we spoke with told us that they either already knew of the service or that they looked around and chose to live at the home. One person we spoke with who lives at the service told us I am very happy here and wouldnt go anywhere else. Care Homes for Older People Page 11 of 26 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. Personal and healthcare needs are assessed and provided for in a way which shows respect for the privacy and dignity of people who live at the service whilst meeting their identified needs. Evidence: The manager told us in the written information she provided We include the person in the care planning process to ensure that we take into account their decisions about how they wish to live their lives and what we need to do to meet their needs. We respect peoples dignity, privacy and independence. We encourage and support people to manage and administer their own medications wherever possible. We looked at the care plans for three people who live at the home, including the last person to be admitted. These were thorough and did show evidence of having been developed in conjunction with the person or the persons relative thus enabling the delivery of consistent and reliable person centred care. Care Homes for Older People Page 12 of 26 Evidence: We found the healthcare needs of people living at the service are being assessed and there is clear evidence in the records that they are referred for specialist advice and treatment as needed. People told us that the staff treat them with respect, The staff are lovely. If I want to be alone I can, if I want privacy thats ok. The carers really look after me and comfort me. We observed staff knocking on peoples doors before entering and speaking with people in a respectful manner. A questionnaire returned from a member of staff said, The staff cater for all the peoples needs. They always look smart and clean. We spoke with staff and they demonstrated a good understanding of the principles of respect and dignity. They told us, I have never seen anyone behave in a negative way towards residents. We looked at storage arrangements for medication and medication records. We found the records to be well maintained and the storage appropriate. Staff we spoke with who administer medication told us that they feel confident to undertake this task and have had training to do so. The training records we looked at confirmed that staff have had training to administer medication and that this training is regularly reviewed. Care Homes for Older People Page 13 of 26 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. People living at the service experience a flexible lifestyle which is in accordance with their needs, abilities and preferences. Evidence: The questionnaires we sent to people living at the home asked Are there activities arranged by the home that you can take part in? Only one was returned and it said Always One person we spoke with told us that there is nothing for them to do as their condition prevents them from joining in. This person said they would like it if staff had some time to spend with them on a one to one basis, even if it was just reading the newspaper with them and talking. In the lounge area we observed a group of people enjoying movement to music with a person who comes into the home from the local community. The notice board in the corridor had several posters on it advertising forthcoming events at Eastwood House, including entertainers who visit on a regular basis. Care Homes for Older People Page 14 of 26 Evidence: Staff we spoke with demonstrated a good knowledge of the individual routines of people living at the home, including visits from family and friends. The staff also confirmed that relatives are welcome to come to the home whenever they wish and are encouraged to ask any questions and to become involved in any activities. Relatives are also encouraged to take people out when possible. We observed lunch being served in the dining room. Choices were offered and people who needed assistance to eat were supported by staff in a discreet, caring and supportive manner. The meal time was quiet and relaxed. People living at the service told us, we get a choice in what we would like at mealtimes which I find nice. and we get lots to eat, good, hot food. The standard of the meals is good. The staff we spoke with demonstrated a good understanding of the importance of choice and a healthy intake of food and drink. They know if someone is losing weight and this is monitored to identify any action that needs to be taken. Care Homes for Older People Page 15 of 26 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. People know how to complain and are confident that any concerns would be acted upon and responded to. The people living at the service are safeguarded from harm and abuse by robust policies and procedures. Evidence: The manager told us in the written information she provided We have developed a new complaints procedure and we have adopted an open door policy so that staff, people living at the home and relatives can contact us at any time. The manager ensures that there is a clear and effective complaints procedure which includes the stages, timescales and processes. People know how and who to complain to. We looked at the records of complaints as part of our inspection process. Six complaints had been recorded since our last visit and these had been thoroughly investigated and all stages recorded by the manager of the service. We saw the complaints procedure on display in the home, and the people we spoke with all knew they could complain and how to do this. In the questionnaires we sent to relatives, we asked Do you know how to make a complaint about the care provided by the home? Two completed surveys were returned and both said yes We asked people living at the home Do you know who to speak to if you are not Care Homes for Older People Page 16 of 26 Evidence: happy? One person told us The staff. I am never made to feel apprehensive about approaching them if I feel there is a problem. All four questionnaires returned to us by staff said Yes when we asked if they know what to do if someone raises a concern. The manager told us that all the staff understand the Whistle Blowing policy and would respond appropriately if they witnessed something of concern. Whistle Blowing is a means for staff to feel supported to report anything of concern that they may witness. Staff that we spoke with confirmed that they were familiar with the whistle blowing procedures and that they have received training in Safeguarding Adults. The training records that we saw did show that some Safeguarding Adults training has taken place and further training has been arranged, with the dates to be confirmed. Since the last Key Inspection that took place on 9th August 2006 we have received one complaint about the service. This was investigated by the Directors of the service and the outcome was that it was unsubstantiated. Care Homes for Older People 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, 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. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely environment that has some potential risks to their health and safety. Evidence: Eastwood House provides a homely environment for the people who live there. However, there are a number of areas requiring refurbishment and the service would benefit from having some new furniture. We conducted a partial tour of the home where we looked at communal areas, bathrooms and some bedrooms. We also looked at the treatment room and laundry room. Since the last inspection, both of these rooms have been painted and the walls are now easy to clean and maintain. The communal areas consist of a large lounge/conservatory area, a dining room and a small seating area in the entrance. On the day of the inspection, all these areas were being utilised and people were moving freely around the home. We observed the home to be relatively clean and odour free although some of the carpets were stained. The cleaner had been absent from work for some time and the Care Homes for Older People Page 18 of 26 Evidence: acting manager informed us that the staff are managing the cleaning between them until the cleaner returns. People we spoke with told us that they are very comfortable and warm. No one had any concerns about the cleanliness of the home. Staff we spoke with did comment on the decoration and the condition of some of the furniture saying that they have been asking for work to be done to improve the environment for some time. One staff member pointed out a frayed area of carpet in the lounge which could pose a hazard to peoples mobility. We discussed this with the proprietor who informed us that there are plans in place to extend the home and it is the intention to complete a full refurbishment of existing areas when this is complete. At the last key inspection that took place on the 9th August 2006, it was identified that a programme for the renewal of the fabric and decoration of the home was in place but this has not yet been instigated due to the plans to extend the building. Peoples bedrooms that we saw were furnished in a suitable manner and personal items were present, but some of the furniture was shabby and in need of replacement. People we spoke with told us that they like their rooms but would like some new furniture and in some cases, new carpets. Care Homes for Older People 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. Recruitment practices, training and support for staff are well managed providing good outcomes for people living at Eastwood House. Evidence: Most of the staff employed at Eastwood House have worked there for more than six years, providing reliable and consistent care to the people who live there. The written information provided to us by the manager told us that the home does not have a high turn over of staff and this was confirmed on the day of the inspection when we spoke with staff on duty and looked at staff records. On the day of the inspection there were two care staff on duty caring for fourteen people and the manager was present. The people living at the service have varying levels of need and some people requiring the assistance of two staff are cared for in their bedrooms. This means that there are times when no staff are present in the lounge or available to respond to other people who may need assistance. Staff we spoke with told us that they would benefit from having a third member of staff at certain times of day, including getting people up in the mornings and meal times. Care Homes for Older People Page 20 of 26 Evidence: People we spoke with who live at the service told us that staff are very busy and do not always have time to spend with them. People also told us that the staff are very good, kind and patient. Two relatives returned surveys to us and where we asked Do the care staff have the right skills and experience to look after people properly?, one replied Always and one replied Usually. Comments included They try their best to keep everyone safe and happy. Look after my relative to the best of their ability. One person living at the service completed a questionnaire and told us that they Always receive the care and support they need. Four members of staff returned questionnaires and all were very positive. As part of our case tracking process we looked at the files for three members of staff. All had the required Criminal Record Bureau checks in place and all had two written references that had been obtained prior to the person commencing employment. These files also showed us that staff have had a variety of relevant training including Safeguarding Adults, Medication training, moving and handling and other mandatory training. The recruitment procedures followed by the service are robust and new staff have a period of induction before working unsupervised. The training matrix showed us that all staff have had mandatory training and a number of other relevant training courses have been scheduled. Staff we spoke with told us that they have regular supervision with the acting manager and find this to be supportive and useful. Records that we saw confirmed that all staff are having regular supervision. Care Homes for Older People Page 21 of 26 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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 is being run in the best interests of the people who live there. Evidence: The Annual Quality Assurance Assessment was completed by the manager in a satisfactory manner and was returned to us within the required timescale. This provided us with some information about Eastwood House but some areas lacked detail. The acting manager has been in post since July 2008 and she is now applying to the Care Quality Commission to become a registered manager. As part of the inspection we looked at Health and Safety records and documentation and we found that testing and servicing has been undertaken on equipment and services as required. Staff told us that their Health and Safety is well protected as well as the people who live at the service. They told us that they are up to date with all statutory courses and this was confirmed by training records. Care Homes for Older People Page 22 of 26 Evidence: We looked at the accident book and saw that all accidents and incidents are documented and relatives are informed. There have been thirty eight entries since the last key inspection in August 2006, all of which were appropriately acted upon. Relatives told us Staff at Eastwood House are excellent with communications. Immediate contact when necessary. Regulation 37 notices are completed where appropriate and sent to the Care Quality Commission. (This is a regulatory process which informs us of any reportable incidents that occur at the service.) There is good evidence of improvement in care planning and care delivery. The manager is also reviewing all the homes policies and procedures and has commenced staff supervision and training records. Staff we spoke with told us that they have regular supervision and the files we saw confirmed this. Staff we spoke with said Since the acting manager has been at the home it has been a lot better. It is nice to have someone you can go to if you have a problem. The manager is really good. We are having a lot of training. We looked at the arrangements for peoples finances and found the records to be well maintained, with receipts for any expenditure. People are encouraged to manage their own monies and only small cash floats are managed by the home. Systems are now in place to quality assure the service provided through questionnaires, newsletters and resident meetings. Care Homes for Older People 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 Older People 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 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 1 19 The carpet in the lounge has a frayed area which poses a risk to people. This should be remedied at the earliest opportunity and not when the extension programme is complete. Peoples bedrooms could be redecorated and refurbished before the completion of the extension as any building work would not impact on individual rooms. 2 19 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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 © (2009) 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 Older People 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!