Care Home: Kingsleigh Resource Centre

What the care home does well The manager ensures that all people wishing to use the service have a through preadmission assessment to ensure that the staff at the home can meet their needs. A variety of activities takes place in the dedicated activity room. There are two activity organisers and the manager hopes to recruit another member of staff to support this team. The staff were observed to be interacting and speaking appropriately to the people using the service in a calm manner. The standard of catering is good and people using the service were observed, on the day, to be offered choice by the staff. The chef holds records of people`s preferences and any weight losses are recorded by him so that if necessary diets can be adjusted or improved. Regular training takes place and this includes the NVQ (National Vocational Qualification),which all staff have access to. What has improved since the last inspection? During the last inspection in May 2009 one requirement was made and this has now been met. The staff at the home try to now keep the home free from offensive odours. In October 2009 three requirements were made following a random inspection by the pharmacy inspector and these too have now been met. Care plans now include detailed information and instructions for staff for the administration of medicines to be given when `needed` or when `required`. All controlled drugs are stored in a cabinet that meets the requirements of the Misuse of Drugs (Safe Custody) Regulations 1973. Medicines are given to people at the dose and frequency prescribed. What the care home could do better: One requirement was made following this inspection regarding infection control procedures this was to ensure that suitable arrangements are in place to to prevent the spread of infection within the home. Key inspection report Care homes for older people Name: Address: Kingsleigh Resource Centre Kingsleigh Kingfield Road Woking Surrey GU22 9EQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lesley Garrett     Date: 1 9 0 5 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 26 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Kingsleigh Resource Centre Kingsleigh Kingfield Road Woking Surrey GU22 9EQ 01483740750 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): manager.kingsleigh@careuk.com www.careuk.com Care UK Community Partnerships Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 67 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 67. The registered person may provide the following category 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: Dementia (DE). Date of last inspection Brief description of the care home Kingsleigh Resource Centre is run by Care UK Community Partnerships Ltd. The home caters for the needs of older people and can provide permanent and respite care for people with dementia and a day care service. Residential accommodation consists of five self-contained units, each with varying numbers of single bedrooms, some of which have en-suite facilities. Each unit also has Care Homes for Older People Page 4 of 26 Over 65 0 67 0 9 1 0 2 0 0 9 Brief description of the care home a lounge/dining room, a kitchenette, a bathroom and toilets. The home has spacious communal areas and has safe, well-maintained gardens. The home is situated near to local shops and community facilities and is approximately two miles from Woking town centre. There are car parking facilities within the grounds of the home. 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: This inspection of the care home was an unannounced Key Inspection. Mrs Lesley Garrett and Mrs Vera Bulbeck, Compliance Inspectors, carried out the inspection and the unregistered manager and the deputy manager represented the service. We arrived at the home at 07:55 and were in the home for seven hours. It was a thorough look at how well the home is performing. It took into account information provided by the home and any information that CQC has received about the service. CQC had been supplied with an AQAA (Annual Quality Assurance Assessment) and this document was used to assist with the inspection. We spent time talking with and observing some of the people using the service and also speaking with some staff members. We looked at how well the service was meeting the key national minimum standards and complying with the regulations and have in this report made judgements about the standard of the service. Documents sampled during the inspection included the homes care plans, risk assessments and Care Homes for Older People Page 6 of 26 daily records, training records and the homes safeguarding and complaints policies and procedures. For the purposes of this report the unregistered manager will be referred to as the manager throughout this report. From the evidence seen by us and comments received, we consider that the home would be able to provide a service to meet the needs of individuals who have diverse religious, racial or cultural needs. Care Homes for Older People Page 7 of 26 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 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 use the service benefit from a pre-admission assessment from a suitably trained person to ensure that the home can meet their needs. Evidence: We sampled the service user guide and statement of purpose both documents had been reviewed and updated recently. The service user guide was also available in large print. The manager told us that all prospective people wishing to use the service benefit from a pre-admission assessment. Two people carry out this assessment which is the manager and her deputy. The pre admission assessment document allows the person who carries out the assessment to make the decision about the needs of the person they are assessing. The manager told us that as part of this assessment she will ensure that the staff at the home have the skills needed to ensure they can look after the new admission adequately. Care Homes for Older People Page 10 of 26 Evidence: The home does not accommodate people who require intermediate care. 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. The care plans and medication procedures have been improved to ensure that the stems now in place meets the needs of the people using the service. Evidence: We sampled three care plans for the people using the service. Staff have access to these records as there are terminals in each unit and there is an expectation that staff will keep the records updated. When a member of staff adds to the daily records the time that the records have been added to also appears. This allows the reader to know when records are being updated. The manager told us that when the care plans are discussed with the people using the service and their next of kin the records are printed so that they can be agreed and signed. We observed a variety of care plans which recorded the activities of daily living along with risk assessments. It was discussed with the manager and deputy that the care plans are not person centred, but this is something that they are addressing to ensure the care records are individualised for each person using the service.During the last inspection in May 2009 we were shown the new person centred style care plans and Care Homes for Older People Page 12 of 26 Evidence: the management at the time told us this would be introduced at the home. This still needs to be completed but there has been a change of manager since that inspection. People who use the service and their next of kin who completed surveys for us all confirmed that they were happy with the level of care and support they received. One person told us they treat residents as individuals in a caring way. Residents are well cared for in respect of their personal care. Another person who completed a survey told us the staff make my relatives welcome and talk to them about my week. I am well cared for and safe. Staff spoken to during this inspection had a good knowledge of the care needs of the people they were looking after that day. It was observed that people who use the service had call bells available to them so that they were able to call for assistance if required. On the day of the visit the engineers were in the home replacing the current call bell system. One person who completed a survey when asked what could the home do better told us sort out the alarm system as the buzzer always seems to be going off for no apparent reason. The manager told us they hope this problem will now be addressed. Aids and equipment are provided to encourage maximum independence for people using the service and these are reviewed and replaced to accommodate peoples changing needs. The manager told us that the GP visits every week to see those people using the service who need a visit or who have requested one. The manager told us that the majority of people using the service are registered with this GP, but other GPs will visit when requested to. The manger told us that if the people using the service originally lived locally on most occasions they could retain their GP if the practice agrees to this. The home also has the support of the district nurses who visit those people with specific health care needs identified by the staff or GP during a visit. They always attend the home twice a week. The home also has the support of the opticians, dentist and chiropodist and these health care professionals are also regular visitors to the home. In October 2009 the home had a random inspection by the commissions pharmacy inspector. Three requirements were made at this time and the outcomes from these requirements were followed up during this inspection. They have now all been met. Originally the manager believed that the metal plates had not been fitted to the back of the controlled drugs cabinet. We spoke to the facilities manager during the day who assured us that he would look into this requirement without delay. The next day the manger called us to confirm the cupboards had been removed from the wall and it was found that the metal plates had been fitted when the original work had been carried out. Care Homes for Older People Page 13 of 26 Evidence: Care Homes for Older People Page 14 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 who use the service are able to take part in a variety of social and recreational activities. The quality of the meals are good which means nutritional needs should therefore be met. Evidence: The home currently employs two activity organisers and we met both of these people on the day of the inspection. The manager told us that it is their intention to recruit another person to support this department. Activities are mainly provided in the day centre and in the newly appointed room that people who use the service can visit to have beauty treatments which include manicures, pedicures and the men can have a wet shave. The activity organisers assess the needs of each person using the service and record their interests and participation in events. Life histories are also recorded and some of this information can be used during the 1-1 sessions. When we spoke with the activity organisers they told us that people who use the service are encouraged to attend the day centre but activities could be provided in a smaller group or on a 1-1 basis. One person who completed a survey for told us the activities are brilliant. Another told us There are always plenty of things going on wheather its films in the day centre or even table tennis. Care Homes for Older People Page 15 of 26 Evidence: Outside entertainers are also booked to attend the home every month and details of these events can be seen on the notice board and they are included in the activity programme for that month. The manager told us that visitors are welcome at the home at any time. During the day we saw many people visit the home and staff were observed to greet them and make them feel welcome. One person told us staff make my family feel welcome and they talk to them about my week. Another person told us visitors are always welcomed with a smile and a cup of tea. During the day we looked at many of the homes bedrooms and observed that people who use the service are encouraged to bring personal items into the home to ensure their bedroom is personalised. We met the chef on the day of inspection. He told us he was very involved in the health and well being of the people who use the service. He ensures that he is made aware of those people using the service who have an identified nutritional need for example diabetics. He is also informed of those people using the service who have or who are loosing weight. This ensures that in consultation with the carers that persons diet can be adjusted if necessary. We looked at the menus which were displayed in the dining rooms of the units and on each dining room table. We spoke to the chef about cooked breakfasts. This appears on the menu but we did not observe one person eating a cooked breakfast. One person using the service told us that he would enjoy a bacon sandwich with brown sauce if that was available. The chef told us that staff should inform him if people using the service choose a cooked breakfast and this is always possible as eggs, bacon and sausages are always available in the kitchen. Lunch time service was observed. People were given choices about the meal they would like and also desserts that were available. Tables were laid with tablecloths and napkins and drinks were available. Staff were assisting the people who use the service and also a relative was in at lunchtime to support her mother. Care Homes for Older People Page 16 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 who use the service can be confident that their complaints are listened to and that they should be protected from abuse as the staff team have received training in safeguarding adults. Evidence: The manager told us that during the last year they had received four complaints. These had all been investigated and resolved. There is one ongoing complaint that remains unresolved and this has been investigated by the home and the local authoritys safeguarding adults team. The home logs all complaints onto the computer, where any complaint received by the home is placed with outcomes of investigations documented. The complaints policy observed during this inspection had been been reviewed and updated. Apart from the ongoing complaint there have been no other referrals to the local authoritys safeguarding adults team. Documentation seen on the day of inspection confirmed that staff had received training in safeguarding adults procedures and refresher training takes place every year. The home has an internal policy on safeguarding adults and this is in line with the local authoritys and the home also has a copy of that procedure. 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. The home does not benefit from a regular programme of refurbishment and infection control procedures within the home need to be improved. Evidence: We undertook a tour of the building during this inspection. It was observed that the home is now in need of refurbishment as some of the bedrooms and communal areas need upgrading. The home employs two maintenance people who are responsible for the decorating of the bedrooms and communal areas when needed.The garden was a little overgrown and weeds were appearing between the paving slabs. During the tour of the building some infection control issues were identified.Night staff told us when we arrived that the unit was closed, but we did not understand what they were trying to tell us. We walked along one corridor into one unit and were told by staff that the unit had a diarrhoea and vomiting outbreak. There was no evidence of this unit being closed as the corridor doors remained opened and there was no evidence of hand gel or aprons. There was no notice to visitors asking them to speak with a member of staff prior to visiting. The deputy manager told us that they had not established if there was an infection control issue, but it was possibly a communication issue between staff. The manager told us that she was aware of a communication problem and is trying to address this issue. One person who completed a survey told Care Homes for Older People Page 18 of 26 Evidence: us better communication is needed there is no direction or leadership from management. Another member of staff told us we work well as a team we support one another. A requirement will be made at the end of the report regarding infection control procedures within the home. The dishwashers in the servery in each unit have been removed leaving a gap in the servery. It was noted that staff had hand washed the breakfast crockery and cutlery and had left these items to drain and some had used tea towels to dry them. We discussed this with the manager and the chef who told us that staff should take the used items to the main servery for them to be put in that dishwasher. 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. Staff numbers at the home on the day of inspection were sufficient to meet the assessed needs of the people using the service and regular staff training takes place. Evidence: Staff rotas were observed which demonstrated that for the five units the manger ensures in the morning ten carers are on duty supported by two team leaders. The manager and deputy are also on duty and are supernumerary. The deputy told us that she would help and support staff where needed if they had a shortage of staff due to sickness. During the afternoon there are nine carers supported by two team leaders and at night one team leader and six carers. During the day staff are supported by three domestics, two laundry assistants, the chef and two activity organisers. On the day of inspection the home appeared calm with staff working efficiently. The manager told us that they do not use agency staff. Some staff completed surveys and told us We have good customer care skills and are always welcoming to all residents and relatives to the home. The residents well being and care comes first for us. The manager said that over 60 of the care staff have NVQ certificate at level two and that the training at the home is on going. Some members of staff have achieved the level three qualification also. The manager told us that all new staff have an Care Homes for Older People Page 20 of 26 Evidence: induction which lasts at least two weeks and then a further induction period when they join their home. Three staff employment folders were sampled and were found to have the necessary paper work to enable the home to employ those people safely. This ensures that the people who use the service are protected by the homes recruitment procedures. All of the staff folders are kept in a secure cabinet in the administrators office. The manager told us that training for the staff takes place regularly. Some of the topics covered in the last twelve months include moving and handling, care planning and person centred planning, medication, safeguarding adults and palliative care. A staff member that completed our survey told us The home trains staff to a high standard and follows policies and procedures. 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. Management arrangements at the home ensures the staff team is adequately supported and there are clear lines of managerial accountability. Quality assurance systems are in place which should improve the quality of care offered to the people who use the service. Evidence: The person in charge on the day of inspection is the person who is proposed to be the registered manager. She has worked for Care UK for a number of years having managed other care homes and also held the position of operations manager. She has many years experience and has begun to make changes at Kingsleigh to improve the way staff care for the people who use the service. She told us that she is pleased to be back in a managers role as she had missed the daily contact with the people who use the service. She is supported by a deputy manager who will cover for the manager during any absence. The manager and the deputy share an office at the front of the building and the manager told us that this enables them to see visitors to the home as they arrive and leave. The manager operates an open door policy and told us Care Homes for Older People Page 22 of 26 Evidence: that visitors are welcome to visit at any time. The manager told us that surveys are sent to the people who use the service and their relatives/representatives to seek their views on the quality of the service and care provided. These surveys are sent out twice a year. An action plan is then written so that any shortfalls identified can be addressed. The manager said that the surveys allow them to implement changes quickly when a problem is identified. Care UK have issued revised policies and best practice guildelines for all aspects of care and the service that is provided. Monthly quality assurance audits are carried out by the manager and she showed us some evidence of these audits. Staff meetings are held monthly to alow them to air their views and regular one to one sessions are held with staff for their supervision. Regulation 26 visits are carried out at the home unannounced every month and copies of these reports are avaialble to us during the inspection. All necessary health and safety certificates are in place and we also observed a range of policies and procedures relating to health and safety. The housekeeper has responsibility for the health and safety of the staff and people using the service. All staff receive training in health and safety. 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 1 26 13 To ensure suitable 25/07/2010 arrangements are in place to prevent and control infections within the home. This ensures that all people who use the service are protected from the spread of disease and infection. 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 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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!