Care Home: Oakwood Hall

What the care home does well This is a well established service in a specialised area of support, that is very clear about the work it can do with people, and has the resources to provide a high standard of care and support. People feel they have choice and control over their daily lives. The level of involvement that people have in developing and reviewing their own support plans makes sure that their preferences and wishes are valued and staff know what outcomes each person wants to achieve. The service regularly consults the people living there about how Oakwood Hall runs, which gives people a real sense of being able to influence key decisions. The levels of information about things to do, places to go, etc., is of a high standard and of particular note is the information file that contains reviews of various activities that people have tried. This is an excellent practice, providing first hand knowledge that other residents may find helpful, and shows the service`s commitment to improving social inclusion. People enjoy the food and are encouraged to stay well by eating a healthy diet. The service takes complaints seriously and encourages residents to use this process to resolve conflicts between themselves, so helping to empower people. The training that staff have had has raised their awareness of capacity and safeguarding issues, and any incidents are properly reported and managed. The service`s policy on safeguarding is fully accessible to residents and explains their right to be protected from abuse. The service is managed well and has developed some excellent practice in making sure that residents are kept informed and included in the decision-making and development of the service. What has improved since the last inspection? Requirements from the previous inspection have been addressed. The staff team continue to involve the residents in how the building is utilised and have continued to develop better facilities. The changes to the communal dining and kitchen area have contributed to more of an inclusive atmosphere. Staff have received more training in Safeguarding and the Mental Capacity Act. What the care home could do better: Disability access could become an issue if a wheelchair user was to be admitted, as some of the internal design elements would make it difficult for someone to achieve full independence when moving around the building. Advice should be sought from an Occupational Therapist before people with disabilities are offered a service. Napkins could be provided on the table at mealtimes.Only the current information about how to contact an Inspector or return a comment card should be contained within the residents` information file. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Oakwood Hall Oakwood Grange Lane Oakwood Leeds Yorkshire LS8 2PF     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Stevie Allerton     Date: 0 5 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Oakwood Hall Oakwood Grange Lane Oakwood Leeds Yorkshire LS8 2PF 01132359079 01132350845 team@oakwoodhall.orangehome.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Community Links Name of registered manager (if applicable) Maureen Lyndsey Perry Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home The service provides nursing care and support for up to twelve people aged 18 - 65, who have enduring mental health problems. Qualified mental health nurses, supported by a team of mental health support workers, provide nursing care within the home. In addition, the home is supported by general and specialist local health care services. Respite care services are also provided. Accommodation is domestic in style, the home being situated in a quiet street of large and mainly detached family style houses. There are three floors to the house and bedrooms are situated on the ground and first floors. Accommodation is provided in all single rooms, comfortable and well decorated in the occupants own style. Several have en-suite facilities and one of the ground floor rooms has enhanced access for wheelchair users. To the rear of the house there are large, attractive and enclosed Care Homes for Adults (18-65 years) Page 4 of 28 12 Over 65 0 care home 12 Brief description of the care home gardens. Local amenities, including shops, pubs, banks and post offices are a short walk away, and there are regular buses into Leeds. Care Homes for Adults (18-65 years) Page 5 of 28 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This service last had a key inspection on 06/03/07 and had an Annual Service Review in June 2008. We visited the service without prior announcement and were there for a full day, into early evening. An Expert by Experience was also at the service for 4 hours (someone who has experience as a service user but is not employed by the inspecting authority). This gave plenty of time to meet people using the service (who prefer to be called residents), talk with the staff team, look round the building and look at written documents and records. We sent out surveys to residents and to health care professionals. The service had just undergone an in-depth review from Joint Care Commissioning (who fund places at the service), which included surveying the Care Homes for Adults (18-65 years) Page 6 of 28 residents, so we had a low rate of return, just one from the residents and three from community-based nurses and care co-ordinators. Three people were case tracked, and other files were looked at. Case tracking is how we decide if people receive good quality care that meets their individual needs. Where appropriate, issues relating to the cultural and diverse needs of residents and staff were considered. Using this method, all twenty-one key standards from the Care Homes for Younger Adults National Minimum Standards, plus other standards relevant to the visit, were able to be assessed. What the care home does well: What has improved since the last inspection? What they could do better: Disability access could become an issue if a wheelchair user was to be admitted, as some of the internal design elements would make it difficult for someone to achieve full independence when moving around the building. Advice should be sought from an Occupational Therapist before people with disabilities are offered a service. Napkins could be provided on the table at mealtimes. Care Homes for Adults (18-65 years) Page 8 of 28 Only the current information about how to contact an Inspector or return a comment card should be contained within the residents information file. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This is a well established service in a specialised area of support, that is very clear about the work it can do with people. The process of assessment prior to admission means that everyone involved is clear about the service that can be offered. The service has the resources to provide a high standard of care and support. Evidence: Case files showed that people undergo a thorough assessment of their mental health needs, personal support needs and potential risk, before they are offered a service. There is a good level of written information about the specialist services provided, which informs people about the philosophy of the service and helps them to decide whether to accept a place. The staff team have a range of skills and qualifications to achieve the aims of the service. Diversity is embodied throughout all written information about the service. One quote from a returned survey was Oakwood Hall provides a service which is Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: matched by no other in Leeds. When asked how could the care service improve, they replied: By having more respite and residential beds. Another said: A very useful and important part to play in mental health residential services for people who are difficult to place. Care Homes for Adults (18-65 years) Page 12 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People feel they have choice and control over their daily lives. The use of risk assessment strategies and written agreements help the individual to make positive choices, supported by the staff team. The level of involvement that people have in developing and reviewing their own support plans makes sure that their preferences and wishes are valued and staff know what outcomes each person wants to achieve. The service regularly consults the people living there about how Oakwood Hall runs, which gives people a real sense of being able to influence key decisions. Partnership working with other services ensures that peoples support needs are met and goals are addressed. Evidence: Three people with a wide range of support needs were case-tracked, their support plans looked at in depth and the findings verified by discussion with those people, where possible, and the staff who support them. All of the files contained evidence that the service works in partnership with other statutory agencies and voluntary Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: groups in order to achieve the best outcome for each person. People are involved in planning their own care and support and there is a mechanism in place to give people the opportunity to challenge things that staff members record in their daily notes. Key workers actively provide one to one support and keep the care plans up to date. Therapeutic agreements (a type of contract) are drawn up between the service and the individual where appropriate, for example, to set boundaries regarding displaying aggressive behaviour, or using illicit substances on the premises. If these contracts are breached, then the service can be withdrawn and the person given notice to leave. Where people have restrictions on freedom and choice, perhaps because they are subject to mental health legislation, these are clearly recorded. Some residents exercised their choice not to speak to members of the inspection team, as they had had another service review only one month previously and did not welcome another intrusion by strangers into their home. Care Homes for Adults (18-65 years) Page 14 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The philosophy of the service includes supporting people to access social, education and leisure activities in the community. The levels of information about things to do, places to go, etc., is of a high standard and of particular note is the information file that contains reviews of various activities that people have tried. This is a very good practice, providing first hand knowledge that other residents may find helpful, and shows the services commitment to improving social inclusion. People enjoy the food and are encouraged to stay well by eating a healthy diet. Evidence: Care plans were looked at for evidence of how people are supported to live fulfilling lives. We also spoke to the residents, if they were happy to do so. They confirmed a wide range of community based activities, groups and classes that they take part in, supported by staff where needed. There was lots of information available to read in the Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: newly created Information Station in the hall. One new development is the Activity and Leisure file, which includes information from people who have sampled various activities and reviewed them, eg, what they did, whether they would recommend it, marks out of 10, price, location, transport and a photograph of the reviewer at the venue. There is also information about how to apply for discount cards, eg, the Leeds card, which gives reduced entry fees to the councils sports & leisure facilities, visitor attractions, etc. There was also a very useful file containing contact details for Citizens Advice Bureaux, MIND, Womens Aid, Mental Health Day Centres and Drop-ins, and agencies providing advice on sexual health. However, there were numerous out of date survey cards and contact details for predecessor organisations that had responsibility for inspecting the service in the past, which needed to be removed. Residents are encouraged to eat healthily and the menus showed a good choice of foods, with opportunities for people to request alternatives. One person said he preferred to eat at a local hot food outlet most lunchtimes, which the staff were aware of. Improvements to the dining experience have taken place, but could be improved further by the availablity of napkins. Care Homes for Adults (18-65 years) Page 16 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is good at promoting health and supporting each individual to take responsibility for their own health and well-being. Joint working with other agencies makes sure that people have access to a wide range of skills and expertise in health matters, including mental health. The harm reduction strategies in place provide positive and realistic support to help people reduce self-harming behaviour. Evidence: Support plans were looked at, with evidence that they provide guidance for staff in how to help people manage their health, including managing their own medication, where appropriate. The service uses a Harm Reduction strategy for people who behave in ways that injure their health. Written agreements that were seen were clear and outlined the shared responsibilities of the individual and the staff. People said that they felt well-supported by the staff. The service works with other agencies in order to improve health and well being, for Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: example the Leeds Addiction Unit. Feedback from health care professionals surveyed indicated that the service communicates well with mental health and primary care services. The service continues to notify us of untoward events and have demonstrated that they consult with other professionals in order to act in a persons best interests. Care Homes for Adults (18-65 years) Page 18 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service takes complaints seriously and encourages residents to use this process to resolve conflicts between themselves, so helping to empower people. The training that staff have had has raised their awareness of capacity and safeguarding issues, and any incidents are properly reported and managed. The services policy on safeguarding is fully accessible to residents and explains their right to be protected from abuse. Evidence: Written information about peoples right to be protected from abuse is on display at the Information Station. This is also discussed at community meetings. The complaints policy is regularly used by people to resolve differences, as could be seen by the records. The staff positively encourage people to use this method of resolving disputes with others. During the inspection, some residents expressed their concern at the intrusion they felt, by having two strangers in their home asking questions. There is an open approach from the staff that encourages people to voice their concerns. Staff have a good understanding of capacity and safeguarding issues. Action has been taken by the service to protect residents from staff behaving unprofessionally. Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team continue to involve the residents in how the building is utilised and have continued to develop better facilities. The changes to the communal dining and kitchen area have contributed to more of an inclusive atmosphere. Disability access could become an issue if a wheelchair user was to be admitted, as some of the internal design elements would make it difficult for someone to achieve full independence when moving around the building. Advice should be sought from an Occupational Therapist before people with disabilities are offered a service. Evidence: We looked round the ground floor of the building. No residents invited us to see their rooms at this visit. Records relating to the maintenance and safety of the building and mechanical and electrical systems were seen, with no issues noted. There is a good level of fire safety awareness, with relevant signs in place, written risk assessments and records of the routine checks on fire alarm systems. The risk assessment for the building had been done in December 2008. The kitchen was looked at briefly, mainly to follow up on the food hygiene records that had been a previous requirement. These were found to be much improved. The Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: Environmental Health Officer did an inspection in March 2009 and made some recommendations in their report - improve records by recording the 4 weekly review within the Food Hygiene pack, renew sealant around the sink and paint some bare plaster. The Manager said that action was in place to remedy those deficiencies. The Expert by Experience looked at accessibility issues, from the point of view of a person with disabilities that might be referred. She highlighted a number of improvements that should be considered if the service was to be offered to a disabled person, particularly a wheelchair user. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a staff team that is committed to good practice. Recruitment practices are sound, which protects people from those deemed unsuitable to work in this setting. Although there are staff shortages, training is still given high importance and the team has a range of skills and qualifications that benefits their work with the residents. Evidence: Records were looked at, the findings supported by observation of staff and resident interaction and speaking to people throughout the day. Although there are some current staff shortages, gaps on the rota are filled by regular locum or agency staff wherever possible, so that residents are supported by staff who understand their needs. Staff have access to a wide range of training and many are studying for higher qualifications in health and social care and specific mental health skills. There has been a focus on making sure that all staff have had training in Safeguarding and the Mental Capacity Act over the past year. Staff understand the need for good communication between themselves, both written and verbal, and the shift handover during the afternoon was an example of this. Care Homes for Adults (18-65 years) Page 22 of 28 Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is managed well and has developed some excellent practice in making sure that residents are kept informed and included in the decision-making and development of the service. The policies, procedures and written records in place make sure that peoples rights and best interests are safeguarded. Evidence: Written policies, procedures and records show the involvement of the residents in all aspects of the running of their home. The sharing of written policies with the residents, together with an explanation of why they have to be in place, is done through the information station in the hallway, through community meetings and individually with key workers. Residents spoken to during the day may not have agreed with some of the policies, but understood what they were and that some policies (such as smoking) are required by law. The service has used the National Minimum Standards and Key Lines of Regulatory Assessment (KLORAs) within their development plan and staff are aware of these Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: measures of quality. The service involves other stakeholders in their quality assessments as well as the residents. Records were well-kept and information was easy to locate. The addition of an administrator for part of the week has helped with this. The position of the manager (although now registered) is still officially an acting post, which the provider needs to resolve without delay. This is having a knock-on effect with other staff in the service acting up in various roles and is making it more difficult for forward planning. Safe working practices are observed, as verified by staff and looking at the records. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 17 22 The staff should make napkins available at mealtimes. The service should make sure that only the details of the current registration body (CQC) are kept in the residents information file, so that they have up to date information should they wish to contact us. Disability access could become an issue if a wheelchair user was to be admitted, as some of the internal design elements would make it difficult for someone to achieve full independence when moving around the building. Advice should be sought from an Occupational Therapist before people with disabilities are offered a service. 3 29 Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 28 of 28 - 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!