CARE HOMES FOR OLDER PEOPLE
Agincourt 116 Dorchester Road Weymouth Dorset DT4 7LG Lead Inspector
Amanda Porter Key Unannounced Inspection 10:00 16th & 23rd August 2007 X10015.doc Version 1.40 Page 1 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 Agincourt DS0000026757.V344131.R01.S.doc Version 5.2 Page 2 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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery 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. Agincourt DS0000026757.V344131.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Agincourt Address 116 Dorchester Road Weymouth Dorset DT4 7LG Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01305 777999 F/P01305 777999 office@agincourt.plus.com Mr Derek Edwin Luckhurst Mrs Meryl Susan Hodder Mrs Roslynn Ann Camp Care Home 31 Category(ies) of Dementia - over 65 years of age (26), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (26), Old age, not falling within any other category (5) Agincourt DS0000026757.V344131.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Only room 7 to be used as a double. Date of last inspection 14th February 2007 Brief Description of the Service: Agincourt care home is registered to provide residential care for a maximum of 31 people, this includes 26 service users over the age of sixty five with a Mental Disorder or dementia and five service users in the category of old age and not falling within any other category. The home is situated on one of the main roads into Weymouth, approximately one mile from the town centre and half a mile from the sea front. It is close to a range of amenities including a post office, shops, pubs and churches. A ‘bus stop’ is on the road outside the home, for buses to and from Weymouth. Agincourt has been owned and managed by the current registered providers, Mr Luckhurst and Mrs Hodder, for approximately 16 years. Mrs Ros Camp became the registered manager in April 2003 and is responsible for the day-today running of the home with the assistance of a deputy manager. The home specialises in the care of elderly people who are mentally frail and most of the service users currently accommodated experience dementia or a related mental disorder. Service users bedrooms are on the ground and first floor of the home; many of the ground floor rooms have patio doors providing direct access into the back garden. There is a communal lounge on each of the two floors floor and a separate dining room on the ground floor. Assisted bathrooms are available on the ground and first floors of the home and many rooms have en-suite WC’s. A passenger lift links the ground and first floor. There is level access to most rooms; some first floor bedrooms are separated from the lift by steps. At the rear of the premises is an attractive garden pond with a water feature and flower borders, lawns and garden furniture and gazebo. The garden is fenced and secured and is well used by the current service users in the warmer weather. Agincourt DS0000026757.V344131.R01.S.doc Version 5.2 Page 5 Laundering of clothing and household linen is carried out at the home and arrangements can be made for chiropodists, opticians and other health and social care professionals to visit individual residents. The weekly fees at the home at the time of inspection range between £461.65 and £550 per week, extra amounts are charged for chiropody services, hairdressing, daily papers /magazines. See the following website for further guidance on fees and contracts www.oft.gov.uk (Value for Money and Fair Terms in Contracts). Agincourt DS0000026757.V344131.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 16th and 23rd August 2007 over a period of approximately eight hours. The purpose of the inspection was to review the requirements and recommendations made at the last inspection and assess all of the key standards. The Registered Manager, Mrs Camp, was on hand throughout to aid the inspection process. Information gathered for this report came from several sources including: • Reports made to the Commission for Social Care Inspection by the home. • The annual quality assurance assessment completed by the home. • 5 written surveys from relatives and visitors and 1 by a health care professional. • Tour of the premises. • Review of a variety of documentation including care records, staff records, maintenance records, policies and procedures. • Discussion with residents and staff. • Two hours were spent observing the care being given to a small group of residents. The care of two people was looked at in depth when comparisons with the observations were made with the homes records and the knowledge of the care staff. During the course of the inspection three residents, four visitors and four members of staff were spoken with and asked their views on the service provided at the home. Comments received in surveys and through discussion included: “I feel that the home caters for a client group with very challenging needs, and has demonstrated a sensitivity to individuals’ personalities and preferences, often in difficult circumstances.” “The staff are lovely. The place is spotlessly clean. The food smells good!” “The home does a commendable job in very difficult circumstances.” “The home provides a caring, loving and supportive environment for its residents. Practical matters are always dealt with well (cleanliness, quality of food etc). Family members are made to feel welcome and cared for also.” “There could be more activities.” “There is a friendly, welcoming and cheerful atmosphere.” Agincourt DS0000026757.V344131.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection?
The programme of routine maintenance has been ongoing and some of the areas within the home have been repainted and refurbished. Thermostatic controls have now been installed on all hot water outlets to minimise the risk of scalds or burns. Agincourt DS0000026757.V344131.R01.S.doc Version 5.2 Page 8 Following a requirement and recommendations made at the last inspection improvements have been made to the recording of medication and medicines are managed well in the home in the best interests of residents. 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. The summary of this inspection report can be made available in other formats on request. Agincourt DS0000026757.V344131.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Agincourt DS0000026757.V344131.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A good admissions procedure enables prospective residents, and/or those acting on their behalf, to make informed decisions about admission to the home and ensures that only residents whose needs can be met by the home are offered places there. EVIDENCE: The home’s service user guide was reviewed and it contained sufficient information for prospective residents and their family to be able to make an informed decision about whether they wish to stay at Agincourt. In response to the question in the relatives’ survey “Do you and/or your friend or relative get enough information about the care home or agency to help you make decisions?” 3 people said “Always”, 1 said “Usually” and 1 said “Getting
Agincourt DS0000026757.V344131.R01.S.doc Version 5.2 Page 11 information in order to choose a care home was a nightmare. I was told to go out and find a level 3 care home and be quick because they needed the bed in the ward. Quite by luck I picked Agincourt, which is lovely.” The files for three residents who had recently moved into the home were inspected. These showed that the home has a good procedure in place. Prior to anyone moving to the home the Registered Manager assesses his/her needs. Sufficient information was obtained so that a care plan could be drawn up and made available to staff. The Registered Manager confirmed in writing to the resident and/or chosen representative that needs could be met by the home. Agincourt DS0000026757.V344131.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of care was seen to be good although the care documentation does not always support this by ensuring that staff have sufficient information upon which to base their care practice. The principles of respect, dignity and privacy were put into practise. Medicines prescribed by doctors are safely stored and correctly administered. EVIDENCE: The care files for five residents were reviewed over the two days of inspection. Files contained a variety of general risk assessments. By the second day of inspection work had begun in identifying the level of risks to the resident within the assessments that had taken place. However there was no nutritional assessments or full mental health assessments seen.
Agincourt DS0000026757.V344131.R01.S.doc Version 5.2 Page 13 Each file contained care plans and relatives spoken with during the inspection said they were involved, by the staff, in making decisions about care and were always involved in any changes. The goals for care that were set were not always measurable, for example, one diabetic care plan did not give the expected outcomes or clear instructions as to what care needed to be given. Generally the daily written statements in the care files lacked detail about what sort of day the resident has had, how they have been occupied and whether they were in a state of wellbeing. Through discussion with staff it was evident that there were good links with GPs, district nurses, social services and Community Psychiatric Nurses. One health care professional commented, “I feel that the manager and staff show a high degree of attention and concern about the clients’ health care needs, and are prompt in asking for help and advice.” Records and stocks of medication in the home evidence good practice and medication is managed in accordance with legal requirements. A health care professional said, ”The manager and staff show a very good awareness of the principles of safe and appropriate administration of medication, and a good working knowledge of commonly used medicines. I am frequently asked for information about medication, and have been impressed at the prevailing culture of keeping sedative medications to a minimum.” Residents and visitors spoken with were happy with the care they or their relative received and confirmed that staff treated them with respect and were supportive and kind. The time spent observing residents daily life and staff care practices found staff were very patient, always took time to ask residents questions rather that deciding for them and some people were encouraged to be active, but could also sit quietly if that was their wish. Comments received included, “When I have visited clients, their privacy and dignity has always been respected; staff always escort the patient to their own room. Apart from a few occasions when they have been called al ways to another client, a member of staff has always remained with the client. This is a great help to me, as it provides the client with the support of a familiar person while they are being examined, and staff members are often skilled in encouraging the client in giving a history of a problem.” “I like the staff.” “I am happy with the care and attention my relative receives.” Agincourt DS0000026757.V344131.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are able to have contact with family, friends and the local community if they wish and are able. However there is a lack of provision for recreational facilities for some residents on a regular basis. EVIDENCE: Care staff are responsible for organising activities, which usually take place in the afternoon. This can be limited depending on what other tasks the care staff have to undertake, such as the laundry and preparing supper. The activities organised are not always based on the assessed needs of residents. The Registered Manager has identified the need to employ more staff so that activities can always take place. Visitors to the home confirmed that they were always made welcome in the home.
Agincourt DS0000026757.V344131.R01.S.doc Version 5.2 Page 15 Observation took place over one lunchtime and residents appeared to enjoy the food provided. Visitors confirmed that residents ate well and the food was good. The home offers a choice of food at any meal and staff are aware of residents dietary preferences. Agincourt DS0000026757.V344131.R01.S.doc Version 5.2 Page 16 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure. Protection from abuse is promoted. EVIDENCE: The home has a clear complaints procedure available to everyone. Relatives spoken with during the inspection said that if they feel confident about talking to the Registered Manager, knowing that she would listen to them. The home has a policy and procedure to respond to suspicion or evidence of abuse or neglect. Staff confirmed that they receive training on the protection of vulnerable adults. Through discussion it was apparent that they had a clear understanding of local procedures. Agincourt DS0000026757.V344131.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The poor condition of some of the fixtures and fittings means that some residents live in an inadequate environment. EVIDENCE: Over the two days of inspection there were some unpleasant odours present on the first day. However the routine programme of carpet cleaning had been completed by the second day of inspection and the home smelled fresh and appeared clean. Some furniture, particularly the lounge chairs upstairs, were heavily stained. Since the inspection the Registered Manager has confirmed that new chairs are being ordered for this area.
Agincourt DS0000026757.V344131.R01.S.doc Version 5.2 Page 18 The home has an ongoing programme of routine maintenance and it was evident that when a room becomes vacant it is repainted and refurbished as necessary. The Registered Manager said that she and the Registered Provider are still considering the issue around wheelchair access at the front of the building. There is a very steep ramp in place, which places anyone using it at some risk, either of back injury when pushing the wheelchair or falling if sitting in the wheelchair. The laundry was well managed and adequate supplies of clean linen were seen to be available. Agincourt DS0000026757.V344131.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient staff are employed to meet the care needs of residents. Robust recruitment procedures are in place to protect residents from the risk of unsuitable staff working at the home. Staff are given the training and support so that they can give a good standard of care to the residents living at Agincourt. EVIDENCE: At the time of inspection staff rosters demonstrated that there are sufficient staff on duty at that time. During the inspection staff were on hand to meet the needs of the residents. However they had many care tasks to perform including laundry duties and preparing suppers therefore they had little time to organise activities with residents. The Registered Manager has recognised this as a shortfall and wishes to employ a member of staff specifically for activities. In response to the question in the survey to relative, “Do the care staff have the right skills and experience to look after people properly?” 1 said, “Always” and 4 said, “Usually”. Agincourt DS0000026757.V344131.R01.S.doc Version 5.2 Page 20 The home has an ongoing training programme, which includes NVQ level 2 in care. The Registered Manager confirmed that at the time of inspection more than 50 of care staff held this award. Two staff recruitment files were reviewed and they contained: • Application forms • Two written references • Enhanced CRB and POVA first checks • Terms and conditions of employments • Documentary evidence of any relevant qualifications • Proof of identity, including a photograph. A complete work history for prospective employees with an explanation of any gaps had not been sought. Training files demonstrated that staff were receiving induction training and this was confirmed with staff spoken with during the inspection. Staff also confirmed that the Registered Manager had encouraged them to take up a number of training opportunities provided including: • Protection of vulnerable adults • Emergency aid • Team leader course • Dementia care • Moving and handling In discussion with some of the newer recruits it was evident that they were still waiting to start the dementia care training. To ensure safe working practices the Registered Manager needs to see that these members of staff are working with the more experienced members of staff at all times and that the dementia care training is delivered promptly. Further information on available training can be accessed through the following websites: www.picbdp.co.uk www.skillsforcare.org.uk Agincourt DS0000026757.V344131.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well organised and the daily management and running of the home centres round the care of residents. Good management practice, systems in place, and records kept, confirm the health and safety of all in the home. EVIDENCE: The Registered Manager is experienced in caring for elderly people and is suitably qualified. As well as achieving the Registered Managers Award and the Level 2 BTEC in Caring for the Older Person with Mental Health Problems she
Agincourt DS0000026757.V344131.R01.S.doc Version 5.2 Page 22 has recently completed the NVQ level 2 in Customer Care. Relatives and staff confirmed they found the management style at the home open and supportive. Staff spoken with said that regular staff meetings are held and everyone’s views are listened to. The home has a quality assurance monitoring system, which seeks feedback from relatives and GP surgeries. The Registered Manager confirmed that action is taken as a result of their findings. The home needs a robust system of internal audits, which would highlight any shortcomings in the services provided at the home. This would enable the Registered Manager to rectify any shortfalls or weaknesses in a timely fashion. The home does hold some “pocket money” for any residents who request this. Clear records are kept of any monies held and how this is spent on behalf of the resident concerned. Records showed that staff had received recent training in fire safety and all had manual handling updates. Substances hazardous to health were seen to be stored securely. Records showed that equipment had been serviced regularly. Accidents were recorded and analysed and appropriate action was taken as necessary. Since the last inspection thermostatic controls have been put on hot water outlets to minimise the risk of scalding. Agincourt DS0000026757.V344131.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Agincourt DS0000026757.V344131.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO 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 OP7 Regulation 15 Requirement The registered person must, after consultation with the service user, or a representative of his, prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. (The plan must be based on a full assessment of needs. Goals for care must be measurable and achievable. Records should also show whether goals set for the care are being met.) Timescale for action 23/11/07 2. OP12 16(2)(n) 3. OP27 18(1)(a) The Registered Person must 23/11/07 consult residents about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including, having regard to the needs of residents, activities in relation to recreation, fitness and training. The registered person must 23/11/07 ensure that at all time suitably competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. (This
DS0000026757.V344131.R01.S.doc Version 5.2 Page 25 Agincourt must include sufficient staffing hours for activities with residents). 4. OP30 18(1)(c) (i) The Registered Person must ensure that the persons employed by the Registered Person to work at the care home receive training appropriate to the work they are to perform including structured induction training. (New staff must receive training in dementia care and until they have must work with an experienced and appropriately trained member of staff). The Registered Person must establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home. (This must include a system of internal audits.) 23/11/07 5. OP33 24(1) 23/11/07 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. 2. 3. 4. Refer to Standard OP7 OP8 OP19 OP19 Good Practice Recommendations The evaluations of care plans should indicate how effective care given has been. Nutritional screening with residents should be undertaken on admission and subsequently on a periodic basis. Badly stained furniture should be replaced. The home should ensure that there is easy access in and out of the home for those people using wheelchairs. Agincourt DS0000026757.V344131.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 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
© 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 Agincourt DS0000026757.V344131.R01.S.doc Version 5.2 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!
