Latest Inspection
This is the latest available inspection report for this service, carried out on 30th October 2009. CQC found this care home to be providing an Good service.
The inspector found no outstanding requirements from the previous inspection report,
but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.
For extracts, read the latest CQC inspection for Steven Lodge.
What the care home does well Steven Lodge is a small, 3-bedded service for people with learning disabilities. The home is set in a residential area of Chatham within a short distance from the town centre and local amenities. There are good public transport links serving the town. Parking is available on the street outside the home. The home is a terraced house and is arranged over three floors. The premises have been newly refurbished and redecorated to a good standard. All of the bedrooms are single occupancy, one of which has en-suite facilities. There are domestic style kitchen and laundry facilities and sufficient communal space. The service has developed a pre-admission assessment process that ensures that the needs of service users are fully assessed and that the home will be able to meet their needs. Service users are supported in choosing how they spend their time and are encouraged to take an involvement in the day-to-day running of the home. Leisure activities are provided based on the interests and preferences of service users. Visitors are welcomed into the home and residents are able to choose what they wish to eat and are supported to become involved in the preparation of meals. There is a clear complaints process and adult protection protocols are in place. There are currently sufficient staff on duty at all times to meet the needs of the service users and staff have received training to enable them to carry out their duties safely. The manager has over 8 years of experience of working with people with learning disabilities and is a Registered Mental Nurse. What has improved since the last inspection? This is the first key inspection for the service. What the care home could do better: 1 requirement and 5 recommendations were made as a result of this inspection process. It is required that the service ensures that medication processes, recording and storage facilities are developed in accordance with the guidance developed by the Royal Pharmaceutical Society of Great Britain relating to care homes. The service user guide has been developed providing clear and accessible information, but some minor amendments are required. A further recommendation was made to ensure that some specific issues relating to one service user are clearly identified within the service users plan and detailed guidance provided to staff. Minor amendments should be made to the application for employment form ensuring that a full employment history is gained. Some improvements regarding staff training were also identified, specifically providing staff with courses relating to learning disabilities and other service specific topics as and when they arise. The service should also develop a fire risk assessment and keep this document under at least annual review. Key inspection report
Care homes for adults (18-65 years)
Name: Address: Steven Lodge 22 Steven Close Chatham Kent ME4 5NG 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: Joseph Harris
Date: 3 0 1 0 2 0 0 9 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 Adults (18-65 years)
Page 2 of 28 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 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 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) 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 Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home
Name of care home: Address: Steven Lodge 22 Steven Close Chatham Kent ME4 5NG 01634830489 01634830489 info@stevenlodge.co.uk,sifiso@stevenlodge.co. uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: TKSD Care Homes and Training LTD care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 3. The registered person may provide the following category/ies 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: Learning disability (LD) Date of last inspection Brief description of the care home Steven Lodge is a small, three-bedded home supporting people with learning disabilities situated in a residential area of Chatham within a reasonably close distance to the town centre and local amenities. The home is arranged over three floors and has been newly refurbished and decorated throughout. All bedrooms are single occupancy and one bedroom has en-suite facilities. There is a domestic style kitchen with laundry facilities and toilets are located on each floor of the building. There is a garden to the rear of the home that has been well Care Homes for Adults (18-65 years)
Page 4 of 28 Over 65 0 3 Brief description of the care home tended and street parking available at the front of the service. There is a small lounge on the lower ground floor and a seating area in the kitchen for meals and activities. The registered provider and the registered manager are both qualified nurses with extensive experience working in the field mental health and learning disabilities. The current scale of fees relating to the home are available on request from the service and a summary is included in the service user guide. The website address for the service is www.stevenlodge.co.uk The email address is info@stevenlodge.co.uk The service can also be contacted by telephone or fax on 01634 830489. 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: two star good 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 key unannounced inspection process culminated in a site visit to the Steven Lodge on 30th October 2009. This was the first inspection carried out in relation to the service under the Care Home Regulations 2001 and Care Standards Act 2000. Prior to the site visit a range of information was examined and reviewed as part of the pre-inspection planning process. This information included the Annual Quality Assurance Assessment (AQAA) completed by the service providing details of areas identified for improvement, things that the service does well and barriers to improvement. The AQAA focuses on the outcomes for service users. It also provides some numerical and statistical information about the service. We also looked at all information received in relation to the home including notifications about untoward occurrences, information received from others including health and social care professionals and any complaints, concerns or allegations made in relation to the home. Care Homes for Adults (18-65 years)
Page 6 of 28 The site visit commenced at 10:00 hours and last for approximately 5 hours. During the course of the visit a tour of the premises was conducted. Discussions were held with service users, staff and the manager. A range of documentation was examined including information relating to service users, staff, health and safety and the day-today running of the service. Care Homes for Adults (18-65 years) Page 7 of 28 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. Care Homes for Adults (18-65 years) Page 8 of 28 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users and their representatives are able to make an informed choice about the home. Service users needs are assessed prior to admission. Evidence: The home has a statement of purpose and service user guide in place. The guide is provided to all prospective service users and their representatives. The guide has been written in an easily accessible and informative manner. It contains all required information and was recently updated in September 2009. Information relating to the Care Quality Commission needs to be updated. Documentation relating to the admission process for one service user was examined. This demonstrated that sufficient information was gathered prior to the individual moving in to ensure that the service would be able to meet all needs. Information had been received from the care manager and records from the persons previous placement, which formed the basis of the intial care plan. The individual was spoken to and confirmed that they had been able to visit the home before choosing to move in. The person added, I like it more than my last home. The manager confirmed that a multi-disciplinary review will be held after 3 months to ensure satisfaction of the
Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: placement. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The individual needs and choices of service users are planned for and met. Evidence: One individual service users file was examined demonstrating a person-centred approach to planning. The plan of care was based ostensibly upon the information received from the service users previous placement, but had been updated to reflect current issues. The information is set out in a clear and logical manner containing sufficient information to enable staff to consistently meet assessed needs. A discussion was held with the manager identifying some areas for further development including a more detailed family history and pen portrait and more guidance for staff regarding issues such as epilepsy. One service user was spoken to who stated that they are able to choose how they spend their time and that the staff respect their choices. Evidence was available showing the involvement of an Independent Mental Capacity Advocate (IMCA) in one service users placement options prior to moving into the service. Risk assessments have been developed as part of the person-centred planning
Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: process. These address all aspects of perceived risk promoting positive risk taking, they are based on information received from other sources and are kept under review. 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. Service users have a lifestyle that suits their needs. Evidence: The home provides a range of activities for service users based on their individual needs and choices. One service user told us that they enjoy their time in the home and that they can choose what activities they want to do. The individual plan clearly identifies preferences, interests and hobbies. A record of activities is maintained demonstrating the opportunity for residents to engage in a variety of pastimes and interests. These include activities such as bowling, badminton, shopping and other trips out. Activities are also available in the home such as games, music and television. The manager stated that the home is still in the process of identifying suitable resources in the community and are continually striving to improve the range of activities on offer. Residents are encouraged to take pride in their environment and are supported in
Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: household tasks as appropriate such as cleaning and cooking. Visitors, it was reported, are welcome to visit at all reasonable times. No visitors were present at the time of the site visit, therefore feedback in this regard could not be sought. The home has a domestic-style kitchen and the cooking duties are carried out by staff with service users input where possible. Menu records and food stocks demonstrated that a healthy, balanced diet is provided tailored to individual requirements and choices. One resident said, I like the food, i can have what i like to eat. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of service users are met. Evidence: The personal care needs of service users are clearly identified in the person-centred planning process. Staff have been able to develop good interpersonal relationships with residents in a relatively short space of time. One resident was observed to be able to clearly identify her choices and needs and staff responded to these. The current needs are minimal in respect of personal care issues for service users and staff provide encouragement where required. The home retains records relating to healthcare issues and can demonstrate that service users healthcare needs are monitored and referred appropriately to relevant professionals. The outcomes of any appointments are recorded and plans are updated to reflect any changes. Service users are registered with a local GP surgery and complimentary healthcare needs are also addressed. Medication records and processes were examined. Areas of improvement were identified and discussed with the manager, who has subsequently submitted an action plan addressing all of the issues raised during the course of the site visit. One service user, who has recently moved into the home, is currently on prescribed medication.
Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: The service has registered with Boots to provide their monitored dosage system, however, interim measures are in place. Administration records required updating, which was completed at the time of the site visit. Storage facilities are currently adequate, but it was recommended that dedicated medication facilities should now be provided. Evidence has been submitted to us to show that these issues have been addressed by the service. Refer to requirement 1. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users views are listened to and acted upon and they are protected from abuse. Evidence: The home has a complaints process in place that is summarised in the service user guide and displayed within the home. No complaints have been received regarding the service since it opened. the manager stated that staff attempt to address any concerns on an informal basis in the first instance, but should this prove unsatisfactory recourse is available to the formal complaints procedure. Policies and procedures relating to adult protection and abuse awareness are in place and staff demonstrated a good working knowledge of these topics. The manager is a trained trainer in adult protection and has ensured all staff have received training in this regard. No safeguarding vulnerable adults have been raised in connection with the service. 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 premises are suitable for the needs of the service users. Evidence: The home is located in a residential area relatively close to the town centre of Chatham. The home is a modern terraced building with parking space available in front of the service and public transport links nearby. The premises are arranged over three floors and have been newly refurbished and redecorated to a very good standard. All bedrooms are single occupancy one with ensuite facilities. The lower ground floor consists of communal space including a small lounge and a domestic kitchen with access to the garden. The ground floor houses the office and one bedroom, with the top floor having two bedrooms. There are toilet facilities on each floor and two bathrooms. Service users are encouraged to personalise their bedrooms according to taste. The home was clean and hygienic offering a bright and airy environment. Due to the domestic nature of the home the laundry facilities are sited in the kitchen area and procedures are in place to ensure dirty laundry is not transported through the kitchen at times of food preparation. It was reported that the home meets the requirements of the environmental health and fire safety departments. Care Homes for Adults (18-65 years) Page 20 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. There are sufficient staff who have received the required training. Recruitment practices are followed to ensure the protection of service users. Evidence: At the time of the site visit one service user had moved into the home. The service operates within a minimum of 1 staff member on duty at all times, but the manager stated that as and when further residents move in the number of staff on duty will be increased commensurately. All new staff work through an induction process based on the Common Induction Standards and the home provides suitable training covering mandatory topics. Additional training courses have also been provided to staff, but it was advised that all care staff should complete a course covering issues relating to learning disabilities. The manager agreed to source training courses of this nature. There is currently a staff team of three including the manager, future recruitment is planned for additional staff. One staff member is currently studying for a foundation course in health and social care that is equivalent to NVQ level 3, another member of staff has been enrolled on her NVQ level 2 and the manager is a qualified Registered Mental Nurse. 2 staff personnel files were examined both of which contained all required information including two written references, CRB and POVA checks and proof of identity among
Care Homes for Adults (18-65 years) Page 21 of 28 Evidence: other information. The manager was advised to update the organisations application form to ensure a full employment history. Care Homes for Adults (18-65 years) Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run and the health and safety of service users maintained. Evidence: The registered manager has been involved with the inception of the service prior to registration in August 2008. She is a qualified Registered Mental Nurse and has extensive experience working with people with learning difficulties and mental health problems. She has completed all additional elements of the Registered Managers Award, which, at the time of the site visit, was awaiting verification by an assessor. One staff member on duty stated that the manager is supportive and provides good leadership. The home is a small, privately run service. The responsible individual and registered manager are a husband and wife team and both are in day-to-day contact with the home. Sufficient measures are in place to ensure the on-going quality monitoring of the service. However, due to the fact that the home has been fully operational for a matter of months, it was not possible to fully evaluate the efficacy of these systems at the present time. All records relating to health and safety issues were in place and up to date. This
Care Homes for Adults (18-65 years) Page 23 of 28 Evidence: included fire safety logs, service certificates such as gas and electrical wiring and all other records examined. The home has not yet developed a fire risk assessment however in accordance with fire safety regulations and this was discussed with manager who agreed to complete this. Policies and procedures are in place relating to safe working practices and all other aspects of the day-to-day management of the service. Care Homes for Adults (18-65 years) Page 24 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 25 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 1 20 13 2) The registered person 09/12/2009 shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. To ensure that medication practices are updated in accordance with Royal Pharmaceutical Society of Great Britain guidance and the service action plan is implemented. 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 1 To update the service user guide and statement of purpose including current information relating to the Care Quality Commission. To ensure clear guidance relating to the management of epilepsy is in place. 2 6 Care Homes for Adults (18-65 years) Page 26 of 28 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 3 4 5 34 35 42 To update the organisation employment application form. To ensure that staff receive all required training including topics such as learning disability awareness. To develop a fire risk assessment in accordance with fire safety regulations. Care Homes for Adults (18-65 years) Page 27 of 28 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. 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. 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!