Care Home: Marifa Lodge

Similar services:

• Claremont House
• Oak Ridge
• Sun Court Nursing Home
• Ashville House
• Bilney Hall
• Hill Barn
• Mabbs Hall Nursing Home
• Henrietta House

What the care home does well The service is set in an attractive older style of property with large grounds which are accessible to people living in the home, and the care and support they provide is done in a very caring manner, offering the residents a very homely atmosphere. A range of activities and events are available, and people are encouraged to go out from the home whenever possible, either in the garden, walks locally or trips out in the service owned minibus, which during the summer are arranged on a regular basis. The care and support is well managed, and the people we spoke with were very happy that their needs were being well met by the care staff in the home, and that they enjoyed a good variety of food. Marifa Lodge DS0000061476.V376837.R01.S.doc Version 5.2 What has improved since the last inspection? Since our last visit, a number of improvements have been made, especially around the recording of information and the training received by staff. All staff have now received training in safeguarding matters, and know the importance of accurate recording in the daily records. New care plans provide a lot more detail about the person, and continue to be developed further, providing information about the individuals’ life history. One of the owners has now taken day to day management responsibility for the service, and has himself undertaken training in the provision of care to people with dementia, which is an area that may develop further. The changes made were reflected in the comments made within the surveys received and from representatives of the commissioning authorities, and reflected in the homes Quality assurance survey, which gave an increased satisfaction rating of 91.7% for the last year, up from 87% previously. What the care home could do better: The service needs to ensure that continued refurbishment takes place, and that the improvements that have been noted above are maintained. They also need to improve their occupancy levels to ensure that the service remains financially viable. Risk assessments must be in place to ensure that anyone looking after their own medication can do safely, and that they continue to improve the care plans and the detail they contain, and to ensure that they are reviewed to reflect any changing needs.Marifa LodgeDS0000061476.V376837.R01.S.docVersion 5.2 Key inspection report CARE HOMES FOR OLDER PEOPLE Marifa Lodge Delph House Wisbech Road Welney Wisbech Norfolk PE14 9RQ Lead Inspector Alan Buttery Key Unannounced Inspection 21st July 2009 09:00 DS0000061476.V376837.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. Marifa Lodge DS0000061476.V376837.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 Marifa Lodge DS0000061476.V376837.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Marifa Lodge Address Delph House Wisbech Road Welney Wisbech Norfolk PE14 9RQ 01354 610300 01354 610241 enquiries@delph-house.co.uk www.delph-house.co.uk Mr Graham Rainbird Mrs Teresa Rainbird Manager post vacant Care Home 22 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) Category(ies) of Old age, not falling within any other category registration, with number (22) of places Marifa Lodge DS0000061476.V376837.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to twenty-two (22) Older People, of either sex, not falling within any other category may be accommodated. 11th August 2008 Date of last inspection Brief Description of the Service: Marifa Lodge is a care home providing personal care and accommodation for twenty-two older people. Marifa Lodge is a converted 19th century rectory in the village of Welney, on the Norfolk/Cambridgeshire border. It is close to the local amenities and a public house with accommodation. The home was opened in 1988 and consists of a two-storey building with a more recently built extension. The home provides sixteen single bedrooms and three shared on the ground and first floors. Access to the first floor is by a staircase at each end of the building, or a passenger lift. The home has well-maintained, accessible grounds, providing an attractive view over the fenland, close by the well-known bird observatory. The fee range was confirmed as between £347:00 to £410:00 per week. Additional charges include hairdressing, private chiropody and newspapers. A copy of the last inspection report is available in the main hall, and copies on request. Marifa Lodge DS0000061476.V376837.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 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced visit carried out over a period of four hours, during which time we examined records held by the service including resident and staff files. We looked around the premises and spoke with three of the residents currently living in the home and the two staff members on duty, as well as the manager (who is one of the owners of the service). Prior to the inspection, the service submitted the required Annual Quality Assurance Assessment (AQAA), and we also looked at surveys received from residents, staff and families. This inspection report takes into account our findings on the day of the inspection, information from within the AQAA and evidence gathered since our last inspection visit in august 2008. In addition, we spoke to representatives of the two local authorities who commission care from the home What the service does well: The service is set in an attractive older style of property with large grounds which are accessible to people living in the home, and the care and support they provide is done in a very caring manner, offering the residents a very homely atmosphere. A range of activities and events are available, and people are encouraged to go out from the home whenever possible, either in the garden, walks locally or trips out in the service owned minibus, which during the summer are arranged on a regular basis. The care and support is well managed, and the people we spoke with were very happy that their needs were being well met by the care staff in the home, and that they enjoyed a good variety of food. Marifa Lodge DS0000061476.V376837.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The service needs to ensure that continued refurbishment takes place, and that the improvements that have been noted above are maintained. They also need to improve their occupancy levels to ensure that the service remains financially viable. Risk assessments must be in place to ensure that anyone looking after their own medication can do safely, and that they continue to improve the care plans and the detail they contain, and to ensure that they are reviewed to reflect any changing needs. Marifa Lodge DS0000061476.V376837.R01.S.doc Version 5.2 Page 7 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. Marifa Lodge DS0000061476.V376837.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 Marifa Lodge DS0000061476.V376837.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): Standards 3 and 6 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. Detailed assessments are made before anyone moves into the home to ensure that a prospective resident can be confident that their needs will be met by the home, in a way suited to them. EVIDENCE: At our last inspection, we noted the admissions procedures that were in place. The proprietor of the home told us that these procedures remained largely the same, and as part of the process people are invited to spend a day at the home, during which time their needs can be assessed, to ensure that the home is able to meet those needs. Marifa Lodge DS0000061476.V376837.R01.S.doc Version 5.2 Page 10 The trial visit normally involves staying for lunch and afternoon tea, and this also offers the prospective resident the opportunity to have a look around the home. Occasionally, it is not possible for the prospective resident to spend time at the home, in which case the proprietor would meet with them to carry out the required assessment, either in their own home or in hospital. Information is also gathered from professionals involved in the person’s care and from family members where possible. Once the assessment is complete, and the service is satisfied that the identified needs can be met, arrangements would be made for the person to move into the home, and initial care plans prepared. During our visit, we looked at the individual records for three people living in the home, and these records contained details of the assessments carried out. For a number of reasons, there have been few admissions to the home in the past year, and although these have mostly been short term admissions for respite care, the same process is followed. The information submitted in the AQAA indicated that there had been 4 short term admissions and 1 permanent one in the past year. The service does not offer intermediate care. Marifa Lodge DS0000061476.V376837.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): Standards 7, 8, 9 and 10 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. Individual plans show how support should be given to suit individual preferences when meeting identified needs. EVIDENCE: As already indicated, initial care plans are prepared based on the pre admission assessment. The format followed has been changed, since our last visit, with advice obtained from both local authorities that the service deal with, and the new plans being used were seen on the 3 files we examined during our visit. Marifa Lodge DS0000061476.V376837.R01.S.doc Version 5.2 Page 12 These plans do now in general provide the detail that was lacking when we last inspected the service, and include some life history, details of the person’s physical and mental health needs, nutritional and pressure care assessments, and moving and handling and falls assessments. Since our last inspection, the service has introduced accountability sheets which detail the actions taken by care staff on a daily basis. Staff complete details of the care and support that they have provided on that day, which ensures that a detailed record is available, and that the actions of staff can be checked ensuring that everyone is receiving the level of care and support that is required and detailed in their plan. The service does need to ensure that anyone able to administer their own medication does so safely, as we were told by the manager that one of the residents of the home does administer his own medication, but no risk assessment has been undertaken to ensure this is safe, or what additional steps the service need to take to enable this to continue. Care plans must show sufficient detail in all areas. For example the care plan we looked at fro one of the residents in the home indicated from the assessment that the resident hoped to regain the ability to walk, but the plan itself contained insufficient detail on how staff would support and enable her to achieve this. The proprietor advised us that they continue to have a positive working relationship with their local GP surgery, and the doctor visits the home once a week, although is of course available for emergency call outs. The local surgery has its own pharmacy, and provides medication for the residents of the home, which are stored in a purpose built medication trolley. During our visit we looked at the medication record sheets, which were seen to be in order, and being completed once the person concerned had taken the prescribed medication. Support is available from other health professionals as required including dieticians and continence advisers. Marifa Lodge DS0000061476.V376837.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): Standards 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. A range of activities are available to people living in the home, both within the home and outside, and people living in the home can be confident that they will be able to take part in things they enjoy doing. EVIDENCE: One of the home’s senior carers takes a lead in organising events and activities which include a variety of games, activities, entertainment and trips out. The service tries to arrange a weekly trip out for those able to go, and have visited local open gardens and Ely in the past few weeks. Activities and games within the home include Bingo, carpet bowls, snakes and ladders, exercise to music, manicures, old time music and walks around the garden and for those who prefer it, staff will spend time sitting and talking to the residents. Marifa Lodge DS0000061476.V376837.R01.S.doc Version 5.2 Page 14 This is of course made easier at the present time by the relatively low number of residents in the home, and it is important that the level of activity is maintained as occupancy levels increase. The service also arranges a summer fete and Christmas and Easter celebrations, although have scaled these down from those previously arranged which appears to suit the residents better. A variety of home cooked food is available to people living in the home, and generally residents prefer traditional meals, although the home are trying to introduce more variety. People we spoke to were happy with the meals they are served with and the choices available, and are able to have breakfast in their own room if they prefer. One person indicated in the quality assurance surveys that the ‘food, effort to entertain and general care is outstanding’ Marifa Lodge DS0000061476.V376837.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): Standards 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. Procedures are in place to ensure that any concerns complaints or safeguarding issues are dealt with quickly and appropriately, and people living in the home know who to make any concerns known to. EVIDENCE: A complaints procedure is displayed in the front hall, and included within the Service User Guide, and indicates that complaints will be investigated in a timely manner. Although no complaints were recorded in the Aqaa in the past year, the manager did tell us about one issue, which is currently being dealt with in accordance with their procedure Residents that we spoke to during our visit were aware of who they should talk to should they have any concerns. At the last inspection, concerns were expressed around the safeguarding procedures and training provided to staff, and 5 safeguarding issues have been recorded in the past year. Marifa Lodge DS0000061476.V376837.R01.S.doc Version 5.2 Page 16 These have now been resolved, the major problem in the past was the way in which information had been recorded, and all staff have now received satisfactory safeguarding training. As part of our inspection process, we also spoke to representatives from both Norfolk County Council and Cambridgeshire County Council, who confirmed that they were now satisfied with the improvements that have been made by the service, and happy to place new residents in the home. Marifa Lodge DS0000061476.V376837.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): Standards 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. The service provides a clean, safe and homely environment for the people living there. EVIDENCE: The service is set in an old rectory within its own landscaped grounds, which are accessible safely for people living in the home with shaded areas and seating around the garden. It is in reasonable decorative order, and has two communal lounges, a separate dining room and all rooms are within easy reach of toilet facilities. Marifa Lodge DS0000061476.V376837.R01.S.doc Version 5.2 Page 18 Since our last visit, the office has been relocated, and is now in a much better position for the proprietor/manager to monitor what is happening within the home. On the day of our visit, the home was clean, and there were no unpleasant odours. Individual rooms are well furnished, and during our visit we looked at some of the rooms, and these clearly showed how residents are encouraged to personalise their rooms with items of their own. An ongoing process of redecoration continues, and vacant rooms will be decorated as and when new residents move into the home. Marifa Lodge DS0000061476.V376837.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): Standards 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. Recruitment procedures and staff training ensure that residents have competent staff to help meet their everyday needs. EVIDENCE: Staffing levels are dependant on the number of residents living in the home, and over the last year this has been well under the number the home are registered for. Consequently, staffing has been at a lower level than may have previously been noted, but sufficient to enable them to meet the needs of those residents living in the home at the current time. At the present time there are two care staff working during the day together with a one person on domestic duties and one cooking. At night the service has one waking night staff and a second person sleeping on the premises as back up. Concerns that were addressed last year around the training of staff and the recording of training received have been addressed, and a plan of the coming years training was also provided. Marifa Lodge DS0000061476.V376837.R01.S.doc Version 5.2 Page 20 We looked at three staff records, which showed that all the required training had been provided, and spoke to two staff members who told us that they had received far more training in the past year than they had received in previous years. This training included Health and safety, safeguarding, moving and handling, dementia care, fire safety and infection control, all of which has been given since our last visit. This has ensured that the staff team are better equipped to meet the range of needs of the residents currently living in the home. The files also showed that all the other required checks were being made including application forms, references, CRB checks and medical declarations. This ensures that people living in the home can be confident hat the staff that are supporting them have undergone a rigorous recruitment process. Marifa Lodge DS0000061476.V376837.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): Standards 31, 32, 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. The service is well run and the views of the residents taken into account in all areas. Health and safety procedures ensure that resident and staff in the home are not placed at risk. EVIDENCE: Since we last visited the home, one of the owners has also officially taken on the role of manager, and has worked on the areas identified previously by both the regulators and the two local authorities who commission care from the home. Marifa Lodge DS0000061476.V376837.R01.S.doc Version 5.2 Page 22 There have been significant improvements in the way the service is now run, the training and support to staff and the recording of information in the home, and this was similarly conformed by people we spoke with from the two local authorities involved. A quality assurance survey has recently been done, which involved residents, families, staff and visiting professionals, and this was seen during our visit. Comments were generally very positive throughout, and showed how satisfied the residents and families in particular are with the care and support they receive. Comments included ‘Grandmother is very lucky to live here’ ‘I am very content and happy here’ ‘They make me feel at home rather than in a home’ In addition we spoke with three residents and two staff members and they told us about the choice and involvement they have, and the staff about the improved training. Health and safety procedures have been reviewed and the AQAA detailed the maintenance checks that have been made in the last year. The only area of concern is the current low occupancy levels, which if maintained may put financial strain on the service. This was discussed with the manager, who is keen to move more people into the home in the coming few weeks, which would then improve the position. Marifa Lodge DS0000061476.V376837.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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 X 3 3 Marifa Lodge DS0000061476.V376837.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? 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. 1. 2. Refer to Standard OP7 OP9 Good Practice Recommendations Care plans should offer more detail where specific aims are sought A risk assessment should be in place to ensure that where anyone manages their own medication, this does not place them at risk. Marifa Lodge DS0000061476.V376837.R01.S.doc Version 5.2 Page 25 Care Quality Commission Care Quality Commission Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. 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. Marifa Lodge DS0000061476.V376837.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!