Inspection on 04/07/05 for 523 - 525 Marfleet Lane

This inspection was carried out on 4th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

523 - 525 Marfleet Lane 02/10/08

523 - 525 Marfleet Lane 05/10/06

523 - 525 Marfleet Lane 13/12/05

523 - 525 Marfleet Lane 17/03/05

523 - 525 Marfleet Lane 17/11/04

523 - 525 Marfleet Lane 04/03/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Muston Road (70)

Grayling

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 523 525 Marfleet Lane 523 & 525 Marfleet Lane Hull HU9 4EP Lead Inspector Tina Bettison Unannounced 4 July 2005 9:30 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 523 525 Marfleet Lane J54 915 Marfleet Lane V235951 4 July 05 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service 523 & 525 Marfleet Lane Address 523 & 525 Marfleet Lane, Hull, HU9 4EP Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01482 796093 office@avocettrust.co.uk Avocet Trust vacant CRH 7 Category(ies) of LD 7 registration, with number of places 523 525 Marfleet Lane J54 915 Marfleet Lane V235951 4 July 05 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17/11/05 Brief Description of the Service: The service at 523-525 Marfleet Lane is managed by Avocet Trust who rent the premises from Sanctuary Housing. It is one of a small number of similar services that Avocet provides. Avocet Trust is a registered charity. 523-525 Marfleet Lane consists of two units registered to provide personal care and accommodation for up to 7 adults of either gender with a learning disability. The home is purpose built, designed to meet the needs of the service users who live there and is situated to the east of the city centre. The accommodation consists of seven single rooms (four in one unit and three in the other) and each unit has its own kitchen, laundry, and bathing facilities. All accommodation is on the ground floor with wheelchair access. There are gardens to the rear of each unit and some parking space to the front of the home. The home is on a main bus route into the city centre and close by are shops, pubs, GP surgeries and leisure / recreational facilities. 523 525 Marfleet Lane J54 915 Marfleet Lane V235951 4 July 05 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 6 hours and was an unannounced inspection. A tour of the premises took place, staff files, care records, rotas, policies and procedures, quality assurance files, staff lists and training records were all examined. 3 of the staff, the service manager and the service users that were at home were spoken to. Care practices and interactions were observed during the inspection. What the service does well: What has improved since the last inspection? The home has a new way of getting the opinions of service users and their families about the way the home is run. They hope that this will mean service users have say in how the home achieves its goals in the future. This new way of working is only at the beginning and needs to grow. 523 525 Marfleet Lane J54 915 Marfleet Lane V235951 4 July 05 Stage 4.doc Version 1.40 Page 6 All service users are provided with a statement of terms and conditions, this ensures an understanding of what service users could expect from the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 523 525 Marfleet Lane J54 915 Marfleet Lane V235951 4 July 05 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR 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) Scoring of Standards Statutory Requirements Identified During the Inspection 523 525 Marfleet Lane J54 915 Marfleet Lane V235951 4 July 05 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: There had been no new service users (who would have had their needs assessed) come to stay at Marfleet Lane since the previous inspection; therefore none of these standards were assessed. 523 525 Marfleet Lane J54 915 Marfleet Lane V235951 4 July 05 Stage 4.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,9,10 Service users have detailed individual plans/IPP that ensure their specific needs and goals are met and enables them make decisions as much as they can. Measured risk taking is seen as an essential part of life in order for service users to try out new things and stretch themselves to meet their identified needs and goals. EVIDENCE: Samples of Individual plans were examined as part of the inspection process and had been developed to cover all aspects of assessed needs. Staff were able to confirm that the plans were kept under review and that they were formally reviewed every 6 months. Copies of the notes from reviews were seen to support this. Risk assessments were in place for any areas that posed a risk to service users and measures put in place to minimise the risks, e.g. personal safety, access to the kitchen and leisure activities. All service users had a key worker. 523 525 Marfleet Lane J54 915 Marfleet Lane V235951 4 July 05 Stage 4.doc Version 1.40 Page 10 All service users were enabled to be as independent as possible within their capabilities this was confirmed by talking to staff and families. Information was observed to be securely kept and handled in accordance with the Data Protection Act. Lockable facilities were used. Staff were observed to knock on doors and to ask service users permissions to enter their bedrooms. 523 525 Marfleet Lane J54 915 Marfleet Lane V235951 4 July 05 Stage 4.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13,14,15,16 Service users are enabled to be part of the local community by the provision of an ordinary housing located in a residential area and access to a wide range of community activities. Staff focus on the individual person and ensure that they are listened to and have a say in their daily lives by the use of their individual plan/IPP that details the way in which they like to be supported and their likes and dislikes thereby promoting their rights and responsibilities. EVIDENCE: Service users social, emotional, communication and independence skills are developed and maintained by the use of detailed care plans and risk management guidelines and risk assessment. Specialist staff from the community team learning disability offers specialist intervention and support. 523 525 Marfleet Lane J54 915 Marfleet Lane V235951 4 July 05 Stage 4.doc Version 1.40 Page 12 Service users participated in leisure activities in the community e.g. swimming, shopping and attendance at day services. Contact with families is encouraged and maintained. Families are welcomed to visit and all families spoken to say that staff kept them well informed of progress, problems and/or illness. On the whole service users had unrestricted access to the houses and gardens, where access was restricted due to safety reasons this was documented in the service users care file. 523 525 Marfleet Lane J54 915 Marfleet Lane V235951 4 July 05 Stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20 The service users physical and emotional needs are met, by the provision of a wide range of healthcare professionals and outside agencies, however the inadequate medication training provided to staff compromises this. EVIDENCE: Three service users care files were examined as part of the inspection process. There was evidence that contact with GP, dentist, optician, audiologist, chiropody, community nurses and therapists was being facilitated on a routine basis for service users. The home has policies and procedures for the administration of medication however staff have not yet received training for the administration of medication that includes a competency check or a workbook to complete at the end to ensure staff understand their responsibilities. This remains an outstanding requirement from the previous inspection. From observations and discussion with relatives it is apparent that staff promoted service users dignity, privacy and respect. Staff were observed to behave in an appropriate manner towards service users. 523 525 Marfleet Lane J54 915 Marfleet Lane V235951 4 July 05 Stage 4.doc Version 1.40 Page 14 Times for going to bed and getting up were flexible. Individual likes and dislikes were recorded on the individual plan and the communication passport. One of the service users is fed by the use of a Percutaneous Endoscopic Gastrostomy; this had been agreed by the GP, family members and district nurse who retains overall responsibility. The staff had all received training, however Avocet must ensure that their Policies and Procedures support this practice and staff have clear unambiguous guidance. 523 525 Marfleet Lane J54 915 Marfleet Lane V235951 4 July 05 Stage 4.doc Version 1.40 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 Service users and/or their representatives are listened to and their views acted on by a wide range of methods. Avocet has a complaints procedure. The staff team are not fully aware of the Protection of Vulnerable Adults policies and procedures and their responsibility within these therefore strategies are not in place to ensure that service users are protected from abuse, neglect and harm EVIDENCE: Avocet had a complaints policy/procedure that included timescales. Minor issues were dealt with in the houses. There are regular parents meetings were issues can be raised and serious issues were taken up by the QA coordinator who responds to these areas of concern and/or complaint. There had been two complaints regarding the service at Marfleet Lane, which were in the process of being investigated. From discussion with staff it was apparent that they were not fully informed about the Protection Of Vulnerable Adults Policies and Procedures and their responsibilities within this. There was no evidence to support that all staff had received any training or briefings. 523 525 Marfleet Lane J54 915 Marfleet Lane V235951 4 July 05 Stage 4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,29,30 Some decorating had been undertaken in the houses; however despite these improvements some service users continue to live in a home whose appearance is tired and dated and in need of redecoration. EVIDENCE: 525 Marfleet Lane The lounge and one bedroom had been decorated on this house, however the rest of the house requires redecoration. The sensory environment/room has been used a store room this needs to be returned to its former use as the inspector was informed that some of the service users like to use it. 523 Marfleet Lane The hallway had been decorated in this house, however the rest of the house requires redecoration. 523 525 Marfleet Lane J54 915 Marfleet Lane V235951 4 July 05 Stage 4.doc Version 1.40 Page 17 The bathrooms in both houses appear clinical and institutional and require updating. The gardens require some attention to provide a pleasant environment outside in which service users can enjoy. The inspector was informed that staff or family members/volunteers have to undertake the decorating, this must be addressed as it takes time away from meeting service users needs. Avocet should consider the use of contractors or appoint a handy man/gardener to undertake decorating and gardening. Avocet should also consider the purchase of a dishwasher for each kitchen to ensure good hygiene practices/infection control and assist the staff team in prioritising service users over domestic chores. 523 525 Marfleet Lane J54 915 Marfleet Lane V235951 4 July 05 Stage 4.doc Version 1.40 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35 Service users are cared for by a staff group, which is sufficient in numbers to meet their needs, however staff recruitment procedures are inadequate and do not ensure that service users are protected from people who are unsuitable. There is no definitive register of staff, lack of training both mandatory and service specific leading to the staff team not being adequately supported and thereby there is potential for service users needs not to be met. EVIDENCE: From examination of records, discussion with staff and observation it was evident that staff work to support the written aims and objectives of the home. It was also evident from discussion with staff that they knew how to meet the needs of service users and there was good evidence in case records of the involvement of other agencies with specific expertise. It was evident that the manager and staff had well-developed relationships with service users. 523 525 Marfleet Lane J54 915 Marfleet Lane V235951 4 July 05 Stage 4.doc Version 1.40 Page 19 Each house has different staffing levels but there is usually a minimum of 1 staff to two service users during the day and there are sleeping-in staff or waking night staff depending on the needs of service users. Throughout the inspection it was evident that staff respected service users and were seen to be accessible, approachable, and comfortable with them. It was difficult to ascertain the numbers of staff that have achieved NVQ level 2 due to poor records; therefore a requirement has been made in respect of this. A sample of staff recruitment records were examined, including staff appointed since the previous inspection. Not all staff had an up to date CRB disclosure and one staff member had only one written reference obtained. Some staff files did not contain all of the ID required by schedule 2. This did not support a thorough recruitment process. The manager reported that within Avocet Trust there is a Human Resources section responsible for organising training. From examination of records and discussion with the manager and staff there was some evidence of training and this was linked to the needs of service users, e.g. moving and handling, epilepsy, use of stesolid, basic food hygiene and first aid, however not all staff were up to date with their mandatory training and had not received appropriate medication training. New staff are supposed to complete Learning Disability Award Framework – accredited training to meet the Sector Skills Council targets for staff induction. New staff were not doing so and some staff spoken to were not clear about their responsibilities with regard to the Protection of Vulnerable adults, therefore all staff must receive updated training. 523 525 Marfleet Lane J54 915 Marfleet Lane V235951 4 July 05 Stage 4.doc Version 1.40 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39,40,41,42,43 Marfleet lane is without a registered manager thereby not providing the service users with a stable and consistent staff group and lead person to develop the service. Service users live in a safe environment however there are some areas of redecoration that must be addressed and all staff need to be up to date with mandatory training to ensure that the health, safety and welfare of service users is promoted. EVIDENCE: The Service Manager and senior programme worker presented themselves as helpful,friendly and approachable throughout the inspection, they had a clear sense of direction and aims for the home, however an appointment of a registered manager is crucial for the ongoing stabilty and development of the 523 525 Marfleet Lane J54 915 Marfleet Lane V235951 4 July 05 Stage 4.doc Version 1.40 Page 21 home. The Service Manager reported that budgets are set by the provider and she has responsibility for managing a range of budgets e.g. staffing, food, petty cash,and training. There was suitable insurance cover in place. As previously stated the houses appear tired and dated and must be redecorated and the gardens attended to. Staff reported that they are responsible alongside of friends/familiy and volunteers for the decorating of the houses and the upkeep of the garden and given the needs of the service users and staffing numbers they find this very difficult. Avocet should give consideration to the appointmnet of a handyman/gardener to undertake these tasks and free up the staff for caring/household duties only. Avocet have developed a quality assurance system however this has not yet been fully implemented within the home, this means that service users and their families views are not yet utilised to help shape the way the service is provided in the future. As part of the inspection the maintenance records were examined and those seen were in order, however the inspector was concerned that some of the records could not be located and must be made available for the next inspection, this incuded the electrical wiring certificate. It was evident throughout the inspection that the service is centred around the service users. The Service Manager supported staff to ensure this was the case. Policies and procedures were examined as part of the inspection process, although some have been updated the majority date back to 1995/98 with no evidence of update or review. The registered person must ensure that Avocet,s policies and procedures are reviewed and amended in line with changes in legislation and best practice guidance. 523 525 Marfleet Lane J54 915 Marfleet Lane V235951 4 July 05 Stage 4.doc Version 1.40 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 3 2 Standard No 11 12 13 14 15 16 17 x x 3 3 3 3 x Standard No 31 32 33 34 35 36 Score 3 2 3 2 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 523 525 Marfleet Lane Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 1 x 3 2 3 2 3 J54 915 Marfleet Lane V235951 4 July 05 Stage 4.doc Version 1.40 Page 23 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 19 Regulation 13(6) Requirement The registered person must ensure that the policies and procedures give clear guidance in relation to consent,staff involvement role,training and record keeping when service users have a Percutaneous Endoscopic Gastrostomy in situ The registered person must ensure that all staff receive training in the administration of medication and this must include a competency check The registered person must ensure that all staff recieve training in the protection of vulnerable adults The registered person must ensure that the houses are redecorated The registered person must ensure that the garden is attended to The registered person must ensure that at least 50 of staff are qualified to NVQ level 2 The registered person must ensure that all new staff have a satisfactory CRB clearance, 2 written references before commencement and all ID as Timescale for action 30/9/05 2. 20 13 30/9/05 3. 23 13 (6) 30/10/05 4. 5. 6. 7. 24 24 32 34 23 23 18 7,9,19 schedule 2 30/10/05 30/10/05 1/12/05 from the date of inspection 523 525 Marfleet Lane J54 915 Marfleet Lane V235951 4 July 05 Stage 4.doc Version 1.40 Page 24 required by schedule 2 8. 35 18 The registered person must ensure that all staff are up to date with mandatory training and this must include Infection control The registered person must ensure that a training audit is undertaken a training plan developed for the staff team The registered person must ensure that all new staff receive induction training that meets LDAF standards The registered person must ensure that documentary evidence of qualification is retained on staff files The registered person must ensure that all staff have an individual training profile The registered person must ensure that a manager is appointed and registered with the CSCI The registered person must ensure that Avocets policies and procdeures are updated and amended in line with legislation and best practice guidance. The registered person must ensure that the policy and procedure for the use of restrictive physical interventions is reviewed and amended 30/9/05 9. 35 18 30/9/05 10. 35 18 30/9/05 11. 34 7,9,19 schedule 2 18 8 30/9/05 12. 13. 35 37 31/10/05 30/11/05 14. 40 24 30/1/06 15. 40 24 30/9/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 24 Good Practice Recommendations The registered person should give consideration to the appointment of a gardener/handyman J54 915 Marfleet Lane V235951 4 July 05 Stage 4.doc Version 1.40 Page 25 523 525 Marfleet Lane 2. 30 The registered person should give consideration to the provision of dishwashers in the houses 523 525 Marfleet Lane J54 915 Marfleet Lane V235951 4 July 05 Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 523 525 Marfleet Lane J54 915 Marfleet Lane V235951 4 July 05 Stage 4.doc Version 1.40 Page 27 - 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!