Care Home: Henesy House

What has improved since the last inspection? This was the first inspection of the newly registered service. What the care home could do better: No requirements or recommendations were made. Key inspection report CARE HOMES FOR OLDER PEOPLE Henesy House Sudell Street Collyhurst Manchester M4 4JF Lead Inspector John Oliver Key Unannounced Inspection 19th May 2009 09:30 DS0000072948.V375261.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Henesy House DS0000072948.V375261.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Henesy House DS0000072948.V375261.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Henesy House Address Sudell Street Collyhurst Manchester M4 4JF 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) 0161 834 0276 0161 834 0623 Inspirit Care Limited Miss Martina Callan Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17), Physical disability (17) of places Henesy House DS0000072948.V375261.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home only Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories Old age, not falling within any other category - Code OP Physical disability - Code PD The maximum number of service users who can be accommodated is: 17 Date of last inspection Brief Description of the Service: Henesy House is leased by Inspirit Care Limited and is a care home providing services for those people who have been assessed by a nursing assessor from a hospital as requiring Intermediate Care prior to returning to their own homes. The home is registered to provide a maximum of 17 places for people that require an intermediate care service. Bedroom accommodation is provided on the ground and first floor levels. All rooms are single and have en-suite facilities. The Intermediate Care service is funded by the Primary Care Trust and no fees are charged. Individuals do have the responsibility for paying for their own personal items of shopping and things such as hairdressing, newspapers and magazines. Henesy House DS0000072948.V375261.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 stars. This means the people who us this service experience excellent quality outcomes. This inspection was undertaken as part of a key inspection, which includes an analysis of any information received by us (the Care Quality Commission) in relation to the home prior to the site visit. This visit, which the home did not know was going to happen, took place over the course of 6 hours on Tuesday 19 May 2009. During the course of the site visit we spent time talking to the people using the service, the registered manager, visitors to the home and staff on duty to find out their view of the home. Before the site visit we sent the manager of the home an Annual Quality Assurance Assessment (AQAA) document for them to complete and return to us with information about the service they provide. This was returned to us before the visit took place and contained some information that helped us to assess the service being offered by the home. We also spent time examining various files and written information and spent some time looking around the building. What the service does well: The way in which people were admitted into the home was a very positive experience for those people we spoke to. They told us, “I was told all about the service and what to expect whilst I was still in hospital”, “I had a marvellous admission into the service” and “I was told everything I needed to know and all my questions were answered, I felt as though I had already been there”. People spoken to during the inspection visit were extremely positive about the service being provided at the home and comments included, “Staff, food and atmosphere are wonderful”, “Nothing is too much trouble”, “You cannot fault the service, the staff or the environment, it’s absolutely excellent” and “Can’t wish for any better, the support and service you receive is excellent”. Henesy House DS0000072948.V375261.R01.S.doc Version 5.2 Page 6 Continuing care was seen as important to ensure the person felt confident that their needs would continue to be met once they returned home. The fact that the service had a dedicated care manager linked to the service helped to minimise any potential risk of a person leaving the service without the correct package of care being in place once they returned home. Mealtimes were very important to people especially when getting to know each other. The people spoken to during the visit all mentioned the quality of the food and the choices made available. Comments included, “The food is very, very good and you get a choice offered to you”, “You cannot fault the food, it’s excellent”, “Food is excellent, choice and variety” and “Families are encouraged to stay and have meals with us for a small donation”. Staff who were spoken to during the visit and who returned surveys to us felt supported by the management. Comments included, “The manager is there if we need her”, “(We have) a good manager, you can go to her at any time”, “We get good management support, there is an open door policy” and “There is nothing I can think of to improve the service”. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. Henesy House DS0000072948.V375261.R01.S.doc Version 5.2 Page 7 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Henesy House DS0000072948.V375261.R01.S.doc Version 5.2 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 Henesy House DS0000072948.V375261.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive an assessment of their needs prior to receiving a service. EVIDENCE: The manager described the referral and initial assessment process. A Nursing Assessor would carry out an assessment of needs whilst the person was still in hospital and would then provide the home with full details of the outcome of the assessment. If, following the assessment, it was felt that Henesy House could provide the right type of service; arrangements would then be made for the person to be admitted into the home. Henesy House DS0000072948.V375261.R01.S.doc Version 5.2 Page 10 Information about the service was provided to the person before admission so that they were informed of what they can expect once they are admitted and what will happen to them on once their stay at the home is over. Once admitted, a welcome pack is provided that includes a Service User Guide and full details about how the home is staffed and managed. It is important that such information is provided to a prospective user of the service both before and after admission to enable them to make a positive choice about the service and whether they think it will be suitable for them. If it is found that the placement is unsuitable within the first 48 hours, a referral back to the Nursing Assessor can be made and appropriate action would be taken. We saw examples on files of the information gathered prior to a person being admitted into the home and these contained comprehensive information in relation to physical, emotional and mental health. We spoke to a number of people about their admission into the home and their comments included, “I was told all about the service and what to expect whilst I was still in hospital”, “I had a marvellous admission into the service” and “I was told everything I needed to know and all my questions were answered, I felt as though I had already been there”. Henesy House DS0000072948.V375261.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Henesy House have their needs met and their care is provided in a manner that protects their privacy and dignity. EVIDENCE: Each person had a care plan on file in their bedroom. These had been drawn up from the initial assessments and had been written by the Primary Care Trust (PCT) staff with input being offered by support staff working in the home. Reviews of the care plans took place as often as needed but were usually on a weekly basis. People using the service had the opportunity to input to their care plans during reviews and those we examined during the inspection contained the signatures of the person whose care plans they were. It is important that people using the service are fully involved in developing their Henesy House DS0000072948.V375261.R01.S.doc Version 5.2 Page 12 care plans so that they are aware of how they should be supported by staff in the home. The manager told us that the service has a dedicated care manager linked to the home that attends the multi-disciplinary meetings held each Thursday and is fully involved in monitoring an individuals’ progress from admission to discharge. Once the person is discharged the care manager will then carry out a review in the persons own environment and, subject to everything being alright will then close the case. Good, consistent support is necessary to ensure people feel confident that their needs will continue to be met on returning home. Each person using the service had their current needs reviewed and discussed at a multi-disciplinary meeting held each week and information was then cascaded down to the support staff to ensure continuity of care. The manager told us that other meetings such as ‘Henesy House Leadership’ meetings were held on a monthly basis. These meetings included the manager, physiotherapist, occupational therapist, practitioners, senior support workers and nursing staff and are held to discuss what is happening in the service and to ensure everyone is working as a team. We examined two files and found them both to contain comprehensive care plans giving full details of how the individuals’ needs were to be met. Medicines were stored in each person’s room within a locked metal cabinet. Only senior support workers administered medicines and had received appropriate training. They received the support of a Pharmacy Technician from the PCT who maintained a regular audit of medication, monitored stock levels and re-ordered medicines and raised any concerns with the manager of the service. Where people were responsible for administering their own medicines the Pharmacy Technician would monitor this. During our time at the service numerous visitors came into the home, some even participating in therapies being provided to their relatives. This was to enable people to continue to be supported when they returned home. People spoken to during the visit offered the following comments, “Everything has been fine during my stay – I’m exercising like mad”, (The staff) are very, very kind, very caring, could not fault one of them”, “They give you confidence, you are not afraid to ask for anything to be done” and “I wouldn’t be back on my feet so soon if it wasn’t for the care and attention I have received whilst I’ve been here”. One relative told us, “You cannot fault the service, the staff or the environment, it’s absolutely excellent”. Henesy House DS0000072948.V375261.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People using the 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 were provided with a range of activities to meet social and therapeutic needs. Contact with family and friends could be maintained and the service provided a well balanced nutritious diet. EVIDENCE: During their stay in Henesy House people were offered various opportunities to participate in activities that are not only therapeutic but also recreational. We saw people playing card games, reading books and newspapers, watching television or just talking with each other. The manager told us that meetings are held on a monthly basis for those people using the service and opportunities are provided for people to attend various community resources such as local churches during their stay at the home. Henesy House DS0000072948.V375261.R01.S.doc Version 5.2 Page 14 Various individual therapies were seen taking place throughout the visit and we also saw one person being taken by a physiotherapist and an occupational therapist for a home visit for assessment purposes. On the day of our visit there was a constant flow of visitors to the home and all were seen to be made very welcome. We had the opportunity to speak with two visitors who told us, “We need more services like this one to keep us in our own homes, I don’t want to go into a home” and “All the staff are wonderful, the carers, physios, doctors, nothing is too much trouble”. Food is prepared in the home by a qualified and experienced cook who had successfully achieved a National Vocational Qualification (NVQ) at Level 3. Menus were planned over a four week menu cycle and offered various alternative choices to the main meals on offer. When asked about the food, people told us, “I lost over a stone in hospital but I’m well on the way to putting it back on with how well I’ve been looked after here”, “The food is very, very good and you get a choice offered to you” and “You cannot fault the food, it’s excellent”. Henesy House DS0000072948.V375261.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the 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 policies, procedures and staff practices were present to protect vulnerable people from abuse and protect their wellbeing. EVIDENCE: The formal Complaint Procedure set out the stages, timescales and the procedures for people to follow if they want to make a formal complaint. The procedure was made available to people and was on display in communal areas. No formal complaint had been made during the past six months. Any informal concerns and worries that people raised would be dealt with by the staff at the time. Comments from people spoken to suggested that they were aware of the complaint procedure and who they would speak to if they had any concerns. The Adult Protection Policy and procedure set out the role of the management and staff in protecting people. The manager was aware of the process to Henesy House DS0000072948.V375261.R01.S.doc Version 5.2 Page 16 follow in the event of an allegation or incident of abuse. Staff spoken to were also aware of their role in protecting people and what they would do if they had any concerns. No safeguarding referrals had been made or received during the last twelve months. Henesy House DS0000072948.V375261.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the 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 using the service are provided with an environment that is clean, safe and comfortable to live in. EVIDENCE: At the time of our visit the home was extremely clean, tidy and well maintained. Those bedrooms we saw were furnished to a good standard and a number had been refurbished within the last six months. Henesy House DS0000072948.V375261.R01.S.doc Version 5.2 Page 18 Communal areas were comfortably furnished and people had the benefit of a large wall mounted flat screened T.V. that had been purchased with funds raised by the staff. Procedures and measures were in place to monitor and maintain appropriate infection control and laundry was dealt with appropriately. The manager told us that very little laundry was done on site and most families took laundry home to do. We saw that various aids and adaptations were available throughout the home and the home maintained a large selection of equipment that could be used to support people using the service. People spoken to during our visit told us, “The home is kept spotless”, “Never any unpleasant odours or such like” and “Your room is very comfortable and is cleaned every day, what more could you want?” Henesy House DS0000072948.V375261.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient numbers of staff are employed in the home and a robust recruitment and selection process helps to protect people from unsuitable people working in the home. EVIDENCE: Discussion with the manager and information supplied in the Annual Quality Assurance Assessment (AQAA) returned to us before the visit took place demonstrated that 14 members of the care support staff team had successfully completed a National Vocational Qualification (NVQ) at Level 2 and 1 carer and all senior support workers Level 3. A staff development ‘training matrix’ was available and individual records identified all training that had been completed by individual members of the staff team. When asked about training staff told us, “We have had lots of training”, “Not so much in the last six months but a new training system is being introduced”, Henesy House DS0000072948.V375261.R01.S.doc Version 5.2 Page 20 “Depending what the training is we sometimes get better training off the physio’s” and “Training covers most subjects”. Before this visit took place we received five completed survey questionnaires back from staff working in the home and all confirmed that they were being given training that was relevant to their roles, helps them to meet the individual needs of people using the service and kept them up to date with new ways of working. One new member of staff had joined the team in the last six months and all relevant pre-employment and employment checks had been carried out and fully completed. It is important that such checks are carried out to minimise the potential risk of unsuitable people being employed to work in the home. We looked at staffing rotas and these indicated that enough staff appeared to be deployed throughout the home to meet the current needs of the people using the service. The manager told us that the Primary Care Trust (PCT) was responsible for monitoring and maintaining their own staffing levels. The manager told us that she was happy with the staffing levels in the home. Staff spoken to told us, “There are usually enough staff on duty and we all work as a team so any shortfalls can be covered, especially short notice sickness cover”, “The therapy staff (PCT) are very good, they help if we have staffing problems” and “No real problems with staffing”. Henesy House DS0000072948.V375261.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 People using the 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 using the service benefit from having the support of a manager with skills to provide a good quality. EVIDENCE: The manager of the service had sixteen years experience in supporting older people and was able to demonstrate a good knowledge and understanding of the services relating to intermediate care. The manager told us that in order Henesy House DS0000072948.V375261.R01.S.doc Version 5.2 Page 22 to keep her skills and knowledge updated she regularly attended training that has included, Infection Control, Developing Risk Assessments and Deprivation of Liberty (DOL’s) training. To obtain the views and opinions of those people using and visiting the service the manager requested that they complete a ‘Patient Experience Survey’ and a ‘Henesy House Visitor’s Survey’. Comments seen in a number of returned surveys demonstrated that people were extremely pleased with the service they received and the way in which they were welcomed when visiting the home. Information in relation to health and safety issues was gathered on site and via the AQAA provided by the home. Evidence was seen of the passenger lift and hoist being serviced, up-to-date Landlords Gas Safety checks, electrical wiring checks and portable appliance testing. We saw evidence that the fire alarm was being tested on a weekly basis. No finances were managed on behalf of people using the service other than small amounts of cash that may be given for safekeeping. Where this was the case, appropriate records and receipts were maintained and kept. Staff spoken to confirmed that they received regular support from the manager not only in one to one supervision but with everyday situations in the home and comments included, “The manager is there if we need her”, “There is nothing I can think of to improve the service”, “(We have) a good manager, you can go to her at any time” and “We get good management support, there is an open door policy”. Visitors spoken to said, “This is an unbelievably good service with an excellent management and staff team in place” and “You can speak to the manager at any time, she always makes herself available to talk to you”. Henesy House DS0000072948.V375261.R01.S.doc Version 5.2 Page 23 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 4 x x 4 HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 4 x 3 x x 3 Henesy House DS0000072948.V375261.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Henesy House DS0000072948.V375261.R01.S.doc Version 5.2 Page 25 Care Quality Commission North West Regional Office PO Box 1245 Newcastle upon Tyne NE99 5AF National Enquiry Line: Telephone: 03000 616161 Email: enquiries.northwest@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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Henesy House DS0000072948.V375261.R01.S.doc Version 5.2 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!