Care Home: Winthorpe Residential Home

Similar services:

• Hillside
• Applegarth
• 122 Scorer Street
• Jubilee Villa Care Home
• Thornham Grove
• Beech Lodge
• 8 Thorndale Road (Homefield College)
• Hunter`s Lodge

What the care home does well People said that staff were friendly and attentive in general and welcomed visitors. People thought that their health care needs were well met. People thought there were no unnecessary restrictions and they could choose how they lived their lives. The home`s food was praised by people. Records of monies held were kept in clear detail. Staff feel supported by management in the job they do. What has improved since the last inspection? There have been more risk assessment done to assess risk and keep people safe. Care planning has improved to identify peoples needs and meet them. What the care home could do better: Peoples welfare could be more effectively met by ensuring that: There is easy read document for all information - brochure, complaints procedure, menu etc to help people understand the services that the home supplies. All aspects of care e.g. full information as to moving and handling practice (and this practice is always safe), religious needs etc are detailed in Care Plans to assist staff to meet all peoples needs. Care practice to be reviewed to ensure some peoples wishes are not carried out to the detriment of other people. More outings are needed to interest people and so improve their quality of life. Facilities need to continue to improve to make them more homely for people. The staff training programme becomes more comprehensive (vocational training, more detailed challenging behavior training etc) through ensuring all staff receive thorough training to increase their skills in delivering good quality care for residents. That there are Risk Assessments for all safe working practices in place to eliminate risks for people who live in the service. Key inspection report Care homes for adults (18-65 years) Name: Address: Winthorpe Residential Home 84 Westcotes Drive Leicester LE3 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 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: Keith Charlton     Date: 1 3 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Winthorpe Residential Home 84 Westcotes Drive Leicester LE3 0QS 01162332107 01162339170 winthorperch@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Patricia Smith care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: That the home is able to admit the person of category LD(E) named in variation application number V10279 Date of last inspection Brief description of the care home The last key inspection of this service was in February 2009. Winthorpe Residential Home is registered to provide care to up to seventeen adults with learning disabilities. The home is a three-story Victorian house situated close to the centre of Leicester. Residents are accommodated in one single and eight shared rooms. In addition to their rooms, residents have access to two lounge / dining rooms and a kitchen. There is a garden to the side of the property. Fees typically range from 351 to 590 pounds per week - this information was provided on the day of the inspection. There are costs for extras - hairdressing, toiletries, holidays, transport etc. The Deputy Manager has stated that residents and representatives can be provided with the homes Statement of Purpose, describing the homes services, and reference to the last Inspection Report, upon request. 2 1 0 1 2 0 0 9 17 Over 65 0 Care Homes for Adults (18-65 years) Page 4 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: The quality rating for this service is Two Stars. This means the people who use this service experience good quality outcomes. We as it appears throughout the Inspection Report refers to The Care Quality Commission. The inspection process consisted of pre-planning the inspection which included reviewing the Annual Quality Assurance Assessment (AQAA), which is self-assessment tool completed by a representative of the service. We have sent surveys to people who use the service along with staff which we will include in this Report if we get them back. The unannounced site visit commenced on the 13th January 2010 and was carried out by Keith Charlton. Care Homes for Adults (18-65 years) Page 5 of 28 The focus of the inspection is based upon the outcomes for people who use the service. The method of inspection was case tracking. This involved identifying people with varying levels of care needs and looking at how these are being met by the staff at Winthorpe. Three people were selected and discussions were held with four people by the expert by experience (who is a volunteer person who has learning disabilities, with experience of care services), and with four people by the Inspector, the Deputy Manager and two members of staff. We have sent surveys to staff and people who live in the service and we received back one survey from a person who lives in the home, who was fully satisfied with the service and said there was good food. We also received surveys back from two staff who thought the service ran well: We provide a warm, clean, homely environment, where staff care for residents in a non judgemental way. Care Homes for Adults (18-65 years) Page 6 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. 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 Care Homes for Adults (18-65 years) Page 7 of 28 order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 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 9 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. People living at Winthorpe have had their needs assessed before moving into the home so that staff can meet these needs. Evidence: The Deputy Manager stated in the AQAA that she is following up the issue of people having user friendly information so people have enough information about the service that they can understand to deceide whether they want to live at the home. Though all people have lived in the home for many years and there have been no recent new people moving in, we saw that people have had their needs assessed prior to moving in, to ensure that the staff at the home could meet their needs and we found that the assessment system had detail of these needs. Care Homes for Adults (18-65 years) Page 10 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 people living at Winthorpe are promoted but this needs to be tightened. Evidence: We looked at the care records of three people living at Winthorpe. We found care plans to support the care given to people who live at the home. There was a variety of useful information available to staff including Health Action Plans. Plans also detailed the mental health conditions of people who live in the home and supplied detail to staff as to how to approach any challenging behavior they may meet though the Deputy Manager agreed that further more detailed training would benefit staff to be able to cope with people with very challenging behavior. There was a comment that one person gets his own way due to his challenging behavior in that staff ask other people to e.g. move from their seats if he wants to sit there. This needs to be followed up, seeking other relevant professional advice, if needed. There are risk assessments so that everyone can be protected from all identified risks, Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: though some were not specific in regards to Moving and Handling practice as we saw that one person had been transferred by staff lifting her by the arm, which is a safety risk to the person. The Deputy Manager was asked to update this risk assessment and contact an Occupational Therapist to draw up an up to date plan. Care Plans also contain detail as to how to encourage peoples independence - the ability to wash and dress themselves etc. Staff said that they read Plans to ensure they can meet peoples needs, and keeping up to date with Plans is encouraged by management. We saw that care plans were reviewed on a six monthly basis to ensure they properly reflected the changing care needs of people living in the homes. Though people told the Expert by Experience that they did not have many meetings we found that there was evidence of regular Residents Meetings, which people can attend if they wish and make suggestions about how the home is run. During our visit we observed staff being friendly to people and there was evidence that people are able to live their own lives, e.g. going out to places in the community, choice of meal, choice of activity, clothes, bath or shower etc. Care Homes for Adults (18-65 years) Page 12 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Winthorpe have some opportunities to have a varied lifestyle though this needs to be extended. Evidence: There were a number of comments that there were not enough activities and outings, particularly at the weekend: It would be nice to have trips like going to the park and having picnics, go to pubs more, go bowling swimming and things like that, was one comment. The Expert by Experience also noted that people were happy in the home but wanted more outside activities and that the TV was too small and they would like a bigger one. The Deputy said these issues would be followed up. We looked at the care plans of people who live at Winthorpe. These contain details of what people like to do and where they attend day centre, church, voluntary work, go into town etc. These showed us that people are able to experience a varied social life Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: if they can go out. A person said he was able to use the kitchen to make cups of tea for himself and others and liked to wash up and set the table. People have annual holidays and staff said that people had been to Skegness. We saw that staff are sensitive to the needs of people living at the homes as we saw staff talk to and interact well with people who live at the home. Staff said there were no rules that people had to follow and could choose what they wanted to do. We saw that there were choices for meals and people said that they enjoyed the food. The Deputy Manager said that people choose what they want to eat. Menus were in place and had sufficient variety. Care Homes for Adults (18-65 years) Page 14 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. People who live at Winthorpe receive good support to meet their personal and healthcare needs. Evidence: Yes, I go to the doctors if I am not feeling well, one person said. We looked at the personal and healthcare records of people who live at Winthorpe. We saw that they have access to healthcare services to meet their personal and healthcare needs as described in Care Plans. On talking to staff as well as looking at the records, we found that staff act on concerns they have about peoples needs. People told the Expert by Experience that staff called the Doctor if they were not well and they had health appointments such as the dentist. We looked at medication management and found that staff are administering medication appropriately to people who live at Winthorpe with no instances seen where medication was not signed as given though the coding system was not always adhered to to show why medication was not taken. The Deputy Manager said this would be followed up. Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: We also looked at how medication is stored and this was stored safely. We saw staff records and these showed us that staff have undertaken training in the administration of medication. Care Homes for Adults (18-65 years) Page 16 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. People who live at Winthorpe can be confident that their concerns will be acted upon and they are protected from abuse. Evidence: People said that they the Deputy Manager would follow up if they had concerns. Yes, I think Joy would put things right if we had any worries, one person said. The AQAA stated there have been no complaints in the past 12 months which we saw to be the case in records. We looked at the complaints procedure and saw that this was written in a format which is not helpful for people living at Winthorpe to understand. The Deputy Manager said that this issue is still on the agenda to be put in place. The procedure in the Terms and Conditions did not give the complainant the choice to go directly to the Lead Agency if they wish, instead of the home, though it did in the policies documents. The Deputy Manager said this would be quickly rectified. We saw by looking at staff training records, and by talking to staff that they have an awareness of safeguarding policies and procedures and know what to do if they suspect that a person who lives in the home is being abused in any way. The Deputy Manager said that she now fully understands the need to make a safeguarding referral to the Lead Agency once the need arises, and had done so in the Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: past week, which we saw evidence of. Care Homes for Adults (18-65 years) Page 18 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. People living at Winthorpe have a comfortable environment, which needs to continue to be upgraded. Evidence: Yes, I my bedroom is nice and I had it done in the colour I wanted, one person said. Other people agreed this was the case. We looked at the communal areas of the homes and some of the bedrooms of people who live there. We found the communal areas to be satisfactorily decorated and furnished and new furniture has been installed. The Deputy Manager said that the home continues to be refurbished as more bedrooms will be done in line with peoples preferences. The bedrooms were decorated to reflect the personalities and preferences of the people using them. The only aspects that needed attention was the bathrooms are to have the baths replaced/refurbished as they still have enamel stains and there was a tear in the lounge carpet. The Deputy Manager said these issues were being followed up. We found that the central heating was not working properly but this had been Care Homes for Adults (18-65 years) Page 19 of 28 Evidence: replaced by electric heaters which was of a warm temperature and people confirmed that it was warm enough for them. We found that some radiators had covers on them and more were to be fitted, to ensure that people are protected from burning injuries. 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. People who live in Winthorpe have satisfactory staffing levels and support from a motivated staff team. Evidence: Staff are friendly. They help me if I ask them about anything, one person said. The Expert by Experience also confirmed that staff were praised for their friendliness towards people who live in the home. We saw that there has been an increase in staffing levels, which means that there are now three staff during the day and evening to meet peoples needs. The Deputy Manager said there was no need at present to have a waking staff member. At present there is a sleeping in staff with a call system. We talked to staff and saw them supporting people who live in the home. We saw good interaction between staff and people who live in the home, and staff demonstrated good general understanding of the needs of people living there. Staff said they were supported well to do their job by management. Care Homes for Adults (18-65 years) Page 21 of 28 Evidence: We looked at training records and this confirmed that staff have undertaken relevant training to help them in their roles. Training included health and safety, medication management,working with challenging behavior (though not all staff had relevant training). The Manager stated in the AQAA that more staff is to be arranged and that three quarters of staff will have NVQ vocational training by this year. There was evidence of detailed induction training and on going training relating to the job they do, which we found to be the case in staff records. We looked at a sample of staff records, and saw that all the necessary checks were made to safeguard people who live at the home as there were references and criminal checks in place for staff before they commenced employment, which protects people from unsuitable staff. 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. Health and safety systems are in place to protect peoples welfare. Evidence: There is a Manager for the home, though Joy Hood is in effect the joint Manager as she deals with the management tasks, and Joy said she would be applying to us to be formally registered as such. There are quality assurance and monitoring systems in place, and we saw the questionnaires that go out to people (though not to all relevant parties - GPs, Social Workers etc) to ascertain peoples views of the service, so that improvements can be made if needed. However an Action Plan was not in place to progress suggestions made. The Deputy Manager said this is being followed up in January 2010. Monies were checked for two people and found to be correct with a good system for recording monies. The AQAA informed us of the policies and procedures the service works to, to ensure Care Homes for Adults (18-65 years) Page 23 of 28 Evidence: good health and safety practice in the home. Risk assessments are in place for safe working practices though not for all issues - tripping hazards, use of ladders etc. As regards to Moving and Handling practice as we saw that one person had been transferred by staff lifting her by the arm, which is a safety risk to the person. Fire risks were seen to be covered by regular fire drills and a fire risk assessment is in place with emergency lighting and fire bells having regular testing etc. Staff were aware of the fire procedure. Care Homes for Adults (18-65 years) Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 42 12 Risk assessments need to be 28/03/2009 carried out for all identified risks, e.g. COSHH products, communal radiators and window restrictors. To protect the health and safety of residents. 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 18 13 Moving and handling practice must be safe and follow statutory requirements. To keep people and staff safe and protect them from injury. 13/02/2010 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 3 4 6 14 22 24 Care plans need to be fully detailed with all peoples needs so they can be met. Frequent trips out need to be organised so that people have activities they want to do. All copies of the Complaints Procedure need to show the correct version. Facilities in terms of carpeting and decor, and the replacement of enamel baths, need to continue to be improved to ensure that they are homely. More staff need to have vocational qualifications to ensure they are fully skilled to meet peoples needs. 5 32 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 6 35 More training is needed so that staff are fully competent in all areas of peoples needs. 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!