Care Home: Windward Nursing Home

Similar services:

• The Vicarage
• Fairfields Country Rest Home
• 7 Hyde Road
• 5 Seafield Road
• Poldhu
• Queensmount
• Trevaylor Manor
• Didsbury Court Rest Home

What the care home does well Windward is a well managed home. It is comfortable, homely and welcoming. People said they were cared for by kind and caring staff. Staff were knowledgeable and confident. They receive the necessary training to be safe in their work and to understand the needs of older people with significant health care needs. Care plans and risk assessments are detailed and regularly reviewed to ensure all staff have access to the most current information about someone`s needs. The Recreational Officer organises and facilitates leisure and social activities for people, including those who are being nursed in their rooms and who may be at risk from isolation. The home is commended for recognising the need to offer meaningful activity during the day for people despite their poor health. People said the meals were very good and confirmed there was always a choice at mealtimes. Drinks and snacks are available throughout the day and cakes are baked daily. What has improved since the last inspection? No requirements for improvement were made at the previous inspection. The Registered Manager and her staff team have continued to review the services provided to ensure people`s needs are met. Refurbishment of the home continues to ensure it is maintained in good order. What the care home could do better: No requirements for improvement or good practice recommendations have been made at this inspection. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Windward Nursing Home Dartmouth Road Stoke Fleming Dartmouth Devon TQ6 0QS     The quality rating for this care home is:   two star good 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: Jane Gurnell     Date: 0 2 0 2 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 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 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 Older People Page 2 of 26 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Windward Nursing Home Dartmouth Road Stoke Fleming Dartmouth Devon TQ6 0QS 01803770789 01803770827 windwardnh@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Robert Henry Gunn care home 25 Number of places (if applicable): Under 65 Over 65 3 0 old age, not falling within any other category physical disability Additional conditions: 0 25 The maximum number of service users who can be accommodated is 25. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Physical disability (Code PD) maximum number 25 Old age, not falling witrhin any other category (Code OP) maximum number 3 Date of last inspection Brief description of the care home Windward Nursing Home is located on the outskirts of the village of Stoke Fleming 2 miles from Dartmouth. There are several country lanes leading from the home, which can provide wheel chair walks for Service Users and their relatives. The home has a driveway leading to parking for several cars. The home is registered to provide accommodation and care for up to 25 older people of either gender who require nursing or personal care due to frailty and ill health. Accommodation is provided over two floors with a passenger lift providing access to the first floor. Some bedrooms have Care Homes for Older People Page 4 of 26 Brief description of the care home wheel chair accessible en-suite facilities. All rooms have a nurse call bell and television point. There are two lounge room on the ground floor one of which has access to the patio and benefits from countryside and sea views: some of the bedrooms also benefit from these views. There is a variety of equipment to support physically disabled people and specialist equipment is available following an assessment of need. The bathroom and shower room on the ground floor are suitable to be used by people with reduced or poor mobility. The shower room on the first flooor is suitable for more able people. A registered nurse is on duty at all times supported by a team of care assistants, an administrator, catering and domestic staff, a recreatinal officer responsible for providing leisure and social activites, and maintenance staff. The fees charged range from 509 to 650 pounds a week depending on each persons needs. People requiring continuing care have their fees negotiated by the placing authority on an individual basis. The latest inspection report is displayed in the entrance foyer and information about the service provided at Windward Nursing Home can be obtained directly from the home. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Windward Nursing Home was last inspected on 26th February 2007 when it was assessed as providing good outcomes to the people living at the home. This unannounced inspection took place on 2nd February 2009 from 10.30 am until 2.00 pm . The Registered Manager was present throughout the inspection and she and her staff team were helpful and co-operative. The Nursing Director, a nurse employed by the owner to oversee the quality of the service provided at the home, was also present. Many of the people living in the home were spoken with, not all of whom were able to express their views about the care and support they received. Three visitors were Care Homes for Older People Page 6 of 26 spoken with as were the staff on duty. A tour of the home was carried out and documents relating to the care of three people, the recruitment of three members of staff as well as health and safety issues were looked at. Prior to the inspection, the Registered Manager completed an Annual Quality Assurance Assessment, this is a document which provides the Commission with information about how the home supports people and what has improved over the past 12 months as well as future development plans. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service or who are considering moving to Windward have good information about the home in order to make an informed decision about whether the home is right for them. The personalised needs assessment means that peoples diverse needs are identified and planned for before they move to the home. Evidence: Three care plans were looked at and each contained a pre-admission assessment identifying peoples care needs, any equipment or aids necessary to meet these needs, their medications and general information about the person. This ensured that peoples needs were known prior to their admission and the Registered Manager could give assurances about the homes ability to meet peoples needs. A brochure that includes the up to date Statement of Purpose is given or sent to every person wishing to move into the home. The information is easy to read and includes all Care Homes for Older People Page 10 of 26 Evidence: of the information that is useful to somebody when they move into the home. The Registered Manager said that if someone is local to the area she or one of the other senior trained nurses visits them in their current setting to make the assessment and discuss life at the home. People are welcome to visit the home prior to moving in, as are relatives should the person be unable to visit themselves. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Registered Manager promotes and maintains peoples health and ensures access to health care services to meet assessed needs. The homes medication systems are safe and people are treated with respect and their right to privacy is upheld. Evidence: Those people spoken with who were able to comment said they were very well cared for by kind and caring staff. Those people who were uanble to comment due to their poor health, were seen to be well groomed, in clean clothes and were warm and comfortable in bed. Many of the bedrooms had beautiful views over the countryside to the sea and where possible beds had been positioned to allow people to see this. Three care plans were examined in detail. All contained clear information about the persons needs as well as risk assessments relating to specific needs such as skin care, nutrition, moving and handling and safety issues - including risk of falls and the use of bed rails. Each care plan had been regularly reviewed, providing a description of the persons current care needs to ensure consistency in care giving. It was evident that Care Homes for Older People Page 12 of 26 Evidence: where possible the plans had been created and reviewed with input from the person the care plan was about and/or their representatives. The plans are kept in the persons bedroom so that they are easily accessible and can be completed at the same time as the staff provided assistance. The home admits people with continuing care needs and terminal illnesses. The care plans reflected the persons wishes with regard to their end of life care and involved the family, where appropriate, and the GP and specialist health care professionals with decision making. The nurses and staff use the Liverpool Care Pathway which is a plan that provides guidance on different aspects of palliative care, irrespective of diagnosis, including comfort measures, psychological, spiritual and family support. (Further information can be found on www.mariecurie.org.uk). Records are well maintained and detail all visits to the home by social or health care professionals, including the GP. The medication system is well managed and only Registered Nurses administer medicines. A sample of the controlled drug stock was checked against the records and found to be correct. The Registered Manager said stock is checked weekly and ordered monthly or as and when needed. Disposal of unused/ out of date medication is safe, well recorded and removed by a licensed contractor. Staff were overheard knocking on doors prior to entering peoples bedrooms and their interaction with people was polite and respectful. A Recreational Officer is employed to plan and facilitate leisure and social activities with the home and she was seen interacting with people in a dignified and appropriate manner. On the day of the visit to the home, the activities included a group quiz in the morning and 1:1 activities and conversation with people in the lounge rooms as well as those being nursed in bed. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Effort is made by the home to provide an activities programme and social interaction/stimulation for all those living in the home. People are able to maintain contact with family and friends and exercise choice and control over their lives. People receive a wholesome appealing diet with plenty of choice. Mealtimes are not rushed and are seen as a social event. Evidence: The home employs a Recreational Officer responsible for consulting with people about their preferred leisure and social activities and organising and facilitating these. The home is commended for recognising the importance of providing meaningful occupation and stimulation for people, particularly for those who are frail due to ill health. On the day of the visit to the home she was conducting a quiz with a group of people in one of the lounge rooms and was seen to offer individual activities to people in the other lounge room as well as those people being nursed in bed. The Registered Manager was advised to record all of these interactions, regardless of how much someone was able to participate, to demonstrate the homes good practice. A tour of the home showed people in their rooms watching appropriate TV programmes, Care Homes for Older People Page 14 of 26 Evidence: listening to music, reading newspapers and magazines and chatting with visitors. People said the meals were very nice and there was always a choice. The menus are on a rolling 4-week plan and are changed to reflect the season and peoples preferences. On the day of the visit to the home the lunch-time meal was sausages in a tomato and basil sauce with potatoes and vegetables. People were offered a choice of sandwiches, soups or eggs should they not want the main meal. The teatime meal was also a cooked meal and drinks and snacks are provided throughout the day. Cakes are baked fresh every day and fresh fruit and vegetables were seen to be available. Specialist diets are catered for and the cook and the catering assistants had a good understanding of peoples likes and dislikes as well as their special needs: several people required a diabetic diet or a pureed diet. The cook explained that each part of the meal was pureed separately so the person could taste the individual vegetables and meat. People can eat in their rooms or in the lounge rooms as there is no separate dining room. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People and their relatives/friends know how to make a formal complaint and can be assured their concerns will be taken seriously and dealt with promptly. Evidence: The people living in the home who were able to comment said they felt comfortable in making any concerns known to the staff and Registered Manager. The visitors spoken with confirmed this. The complaint procedure was seen displayed within the home and is in the Statement of Purpose, given to people and/or their representatives prior to admission. The Registered Manager said she works as the nurse on duty several days a week and carries out a daily round at different times of the day and people will often talk to her about any concerns at this time enabling her to resolve these issues promptly. Mr Gunn, the owner, employs a Nursing Director to support the Registered Manager and nurses within Windward, as well as two other homes he owns. The Nursing Director works 2 evenings a week at the home, enabling her to talk to people, visitors and staff and to monitor the quality of the care and support provided. Neither the home nor the Commission had received any complaints prior to this inspection. The home maintains a complaints register to enable the Registered Manager to make a record of the action she has taken to resolve an issue should a complaint be made. Concerns and suggestions made by people living in the home or their relatives are recorded in their daily care notes. Staff had received training in Care Homes for Older People Page 16 of 26 Evidence: adult protection and the Registered Manager and Nursing Director were aware of the local authoritys policy should they suspect someone is at risk of abuse. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Windward Nursing Home provides a comfortable, warm and safe home for people. There are sufficient facilities to meet peoples needs. Evidence: People said they were very comfortable in their rooms and found the home warm and clean. A tour of the home showed that peoples rooms were well decorated and furnished with personal items including furniture, ornaments and pictures. As the home is not connected to mains gas, the heating in the bedrooms and communal areas is provided by electric storage heaters. The surface of these heaters becomes very hot and signs were displayed next to these warning people of this. The risk assessments in peoples care plans indicated that people were not to sit next to the heaters to reduce the risk of burns should they come into contact with them. The home appeared well equipped to meet peoples needs: lifting and bath hoists, wheelchairs and other aids for mobility were available. Specialist mattresses and adjustable beds were seen in use for people with risk of developing pressure sores due to their ill health and immobility. There is call bell system throughout the home, and those people were seen in their rooms had the bell placed within their reach. Some of the bedrooms provide en suite toilet facilities and there was a variety of Care Homes for Older People Page 18 of 26 Evidence: toilets and shower/bath rooms for people to use. The home employs a housekeeping team to manage the domestic activities and the home was seen to be very clean and tidy with no odours. The housekeeping staff demonstrated a good understanding of peoples needs and it was evident they had a good relationship with people. There are two lounge rooms on the ground floor; one with a television and the other designated as a quiet room. Both lounges were tastefully decorated, with comfortable seating positioned in a way that encouraged conversation between people. Visitors were seen with their relatives in the lounge and in the privacy of their own rooms. A passenger lift provides access to the first floor. The doors leading to the stairwells on the first floor were fitted with keypad locks to ensure people could move freely around the upper floor with out the risk of accessing the stairs which they may be unsafe to use unsupervised. Outdoor space consists of a patio leading from the lounge room. The area has good views of the local countryside and the sea. Hand washing facilities were seen throughout the home, as were protective gloves and aprons. There are two sluice rooms, one on each floor for the cleaning of commodes and disposing of soiled items, thus reducing the risk of cross infection. The laundry has one industrial washing machine, with a disinfecting sluice cycle and a large tumble dryer. The staff and the Registered Manager said that this was sufficient for the washing the home produces. The kitchen appeared well equipped and was very clean indicating regular cleaning takes place. Although the kitchen is small, the cook said she manages to provide meals for the number of people living in the home without difficulty. There was sufficient storage space for dried goods as well as three large fridges and freezers. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient numbers of staff with appropriate skills and knowledge to meet the needs of the people living in the home. Recruitment procedures ensure, as far as possible, only suitable people are employed, thus protecting people from the risk of abuse. Evidence: People said the staff were very kind and caring, and they were attended to promptly, indicating there are sufficient numbers of staff available during the day and night. At the time of the visit to the home there were 21 people living at Windward. The duty rota, observation and discussion with the Registered Manager confirmed there were usually 4 or 5 care staff on duty in the mornings, 4 care staff in the evenings and 2 care staff at night. In addition there is a trained nurse on duty 24 hours a day. Nursing and care staff are supported by housekeeping and catering staff, an administrator, maintenance staff and the Recreational Officer. As noted in a previous outcome group the Nursing Director attends the home during the week and offers training and supervision for care staff. Training records indicated staff receive training in the mandatory training of fire safety, moving and handling and infection control, as well as issues relating to care needs such as nutrition, dementia, skin care and the Mental Capacity Act. All care staff Care Homes for Older People Page 20 of 26 Evidence: either have an National Vocational Qualification in care, a recognised care qualification, or are in training. Three staff files were looked at and all contained the necessary preemployment checks including two written references and proof of a Criminal Records Bureaux checks, ensuring as far as possible only suitable staff are employed at the home. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed by an experienced Registered Nurse. She and her staff team strive to provide a caring, safe and stimulating home for people who are frail and have complex care needs due to illness and poor health. Evidence: The home has had a change in management since the previous inspection. The current Manager registered with the Commission in October 2007 and is a registered nurse. She has obtained the Registered Manager Award, a nationally recognised qualification regarding management skills and she has worked at the home for several years. The deputy manager has also achieved the Registered Managers Award. The former manager now holds the position of Nursing Director and supports the nurses and care staff in this home as well as two others owned by Mr Gunn. The Registered Manager and her team show a responsible attitude toward promoting and protecting the health, safety and welfare of the people living in the home and the staff. Care Homes for Older People Page 22 of 26 Evidence: A formal quality assurance system is in use in the home and involves the people living in the home, their relatives and friends and as well as other people involved in the persons care such as the GP and other health care professionals. The results of the most recent consultation from October 2008 showed a high level of satisfaction with the care and services provided. A summary of the results and an action plan was displayed in the entrance foyer. The manager has an open door policy for staff and visitors to bring any issues or concerns to her and this was evident on the day of the visit to the home. Evidence was available that equipment such as the fire alarm system and lifting hoists, is regularly maintained and tested ensuring it is maintained in good working order. The home holds money for some people for safekeeping. A sample of the records were looked at and found to be accurate. Records were clear and receipts were obtained for all expenditure. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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 Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!