Inspection on 13/05/09 for Attlee Court

This inspection was carried out on 13th May 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Attlee Court 14/05/08

Extracts from inspection reports are licensed from CQC, this page was updated on 06/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Attlee Court Attlee Street Normanton Wakefield West Yorks WF6 1DL     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: User doesnt belongs to any group     Date: 1 3 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Attlee Court Attlee Street Normanton Wakefield West Yorks WF6 1DL 01924891144 01924897755 attleecourt@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Minster Care Management Limited care home 66 Number of places (if applicable): Under 65 Over 65 0 0 66 0 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: 66 66 0 66 The maximum number of service users who can be accommodated is: 66 The registered person may provide the following category of service only: Care home with nursing - Code N; to service users of the following gender: Either; whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP; Dementia - Code DE; Mental Disorder, excluding learning disability or dementia - Code MD; Physical Disability - Code PD. Date of last inspection Brief description of the care home Attlee Court is a purpose built 66-bedded care home on two levels, which opened in July 2000. Minster Care Management took over the ownership of the home in October 2007. The ground floor is designed to accommodate older people who require either Care Homes for Older People Page 4 of 29 Brief description of the care home residential or nursing care. The upper floor is designed to accommodate older people who have a diagnosed dementia type illness and who require residential or nursing care. Private accommodation comprises of single en-suite bedrooms throughout. The home provides appropriate communal accommodation with each floor having separate communal facilities. Occupants of both floors share the garden area although access for those living on the top floor is difficult. The premises are situated in Normanton within walking distance of the local shops. The town centre is a short distance by car or local transport. The home has a statement of purpose that explains the aims, objectives and philosophies of the home. The most recent inspection report is made available to anyone who wishes to see it upon request from the home?s manager and can also be found on our website www.csci.org.uk. The current residential care fees at the time of the visit on 11 May were £396 to £450 per week, and nursing fees are individually assessed. Care Homes for Older People Page 5 of 29 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We went to the home without telling them we were going to visit. This report follows the visit that took place on 11 May 2009. The visit lasted from 10.30 until 17.30. The purpose of the visit was to make sure that the home is operating and being managed in the best interests of people living there. Information has been used from various sources for this report. These sources include reviewing information that has been received about the home since the last inspection visit and information provided to us by the manager of the home in their Annual Quality Assurance Assessment (AQAA) We sent out surveys to people living at the home and to others with an involvement in Care Homes for Older People Page 6 of 29 the home but at the time of writing this report only one survey had been returned. During the visit time was spent talking to people who live at the home, relatives and staff. We also had a look around the home. The manager was available throughout the visit and the findings were discussed with her and the operational manager during and at the end of the inspection. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not move into the home without being given assurance that they will be provided with the care and environment they need. Attlee Court does not provide intermediate care. Evidence: The manager said that a senior member of staff goes to visit any person who wishes to move into the home to make an assessment of their needs. These assessments assist the staff at the home in making a decision about whether they can provide the care and the environment the person needs. The manager said that they look at all of the persons activity of daily living daily living needs as well as their care needs during this assessment. Care Homes for Older People Page 10 of 29 Evidence: Copies of these assessments were seen in the care files looked at. Care Homes for Older People Page 11 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal and healthcare needs are mostly met. However some shortfalls in care planning and medication procedures could put people at risk. Evidence: All of the care files seen contained care plans which are to developed to to detail peoples individual needs and to inform staff of what actions they need to take to support the person in meeting their needs. The files also included a number of assessments which staff have made in order to assess the level of care the person needs and any risks that may need to be managed in order to make sure the person remains safe and comfortable. These assessments include looking at the likelihood of the person developing pressure sores, how they need to be supported to move and mobilise safely and how best to manage any problems with incontinence. Care Homes for Older People Page 12 of 29 Evidence: Other assessments had been completed to assess the individuals preferences within their care, this included information such as how many pillows a person prefers on their bed or how they like their room to be lit at night. This is good practice and shows a consideration of peoples individuality and comfort. The results of these assessments should then be used to develop the care plan. Generally the care plans did give good detail of how staff should support people and how the person liked to receive that support but some were found not to include important details which staff need to know in order to maintain the persons health and wellbeing. In two files the pressure sore assessment concluded that the person was at moderate risk of developing pressure sores and needed to have a care plan developed to inform staff of how they should manage this risk. Care plans had not been developed for this area of need and daily records and body maps showed that both people had developed skin breaks. A wound assessment chart had been developed for one of these people detailing what treatment was being given and which dressing was being used, however the chart did not say where the wound was on the persons body. Another care plan which had been developed in relation to managing diabetes was lacking in any specific detail and could have resulted in the person becoming ill as a result of their condition not being managed properly. Another file included specific written details from the persons relative about the most important thing staff could do to assist this person in their well being. No care had been developed for this and it was observed that staff had not given the support detailed in the information from the relative. Positively another of the files contained care plans which gave very good detail about how to manage a specific risk and included information and guidance from specialist health professionals involved in the persons care. Records showed that the advice and assistance from health care professionals is sought when needed. This includes GPs, district nurses, mental health nurses and dietitians. Although care plans talked about the need to maintain peoples dignity, some instances of where this had not been followed were observed during the visit. Care Homes for Older People Page 13 of 29 Evidence: Some ladies, particularly on the unit for people with enduring mental health problems, did not look as though staff had spent time in making sure their hair looked nice. Several ladies did not have any stockings or tights on and for some who did the stockings had holes and ladders in them. One person on the general nursing unit was seen to have food stuck on their jewelery and another person had been been seated on a very dirty sheepskin chair cover. On the unit for people with mental health problems staff had failed to clean food and stains from dining chairs before seating people on them. Such lack of attention suggests that staff do not always consider peoples dignity. People said that staff did make sure that their privacy needs were met. Systems for the management of medication were checked on both units. On the unit for people with mental health problems, systems appeared to be safe although staff should make sure that when handwriting prescriptions on MAR (Medication Administration Record) sheets, that the handwriting is legible and that the instruction has been double checked by another member of staff. On the general nursing unit most medications could be audited to show that systems were being followed. However the MAR sheet for one person did not contain any record of administration for a medication they were prescribed to take each morning. This suggested that the person had not received this important medication for thirteen days. Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged and supported to make choices and to follow their own routines but not all people are supported with social and recreational activities. People with particular nutritional needs are not always getting their needs met. Evidence: The manager said that three activities organisers are employed at the home to engage the people who live there activities on a daily basis. An activities programme is on display detailing both group and one to one activities. The manager said that they are currently doing audits on which activities people enjoy and would like to see continue on the programme and which they do not enjoy. On the day of the visit people were engaging with dogs from the local pets are therapy group and appeared to be enjoying the interaction. One person was being supported to go out to visit a relative and one person was seen enjoying time alone in their room. Staff said that one person who lives on the general Care Homes for Older People Page 15 of 29 Evidence: nursing unit is able to come and go from the home during the day as they choose. None of the people on the unit for people with mental health problems were seen to be engaged in any activity either during the morning or the afternoon. Some people were sitting in a room with a television on but the picture was very fuzzy and the sound had been turned down very low. Such poor audio visual stimulus could be confusing and distressing for people, particularly those who have dementia and are unable to resolve the situation themselves. The manager said that there had been some problems with T.V reception but staff should be aware of issue and make sure people are not left in such a situation. Some people visiting relatives said that they found staff to be welcoming when they visit and that they could visit at various times. Both units have dining rooms where people can take their meals if they wish. Both rooms are pleasant but on the downstairs unit some tables had been laid for lunch with dirty table cloths and the and upstairs food spillages from previous meals had not been cleaned up before people were taken to the table for lunch. Salt and pepper were available on tables in the downstairs dining room but not upstairs. Staff said that people upstairs may spill the salt and pepper if it were on tables but could have it if they asked for it. People with dementia may not ask for condiments but may use them if they are made available. The likelihood of people misusing or spilling them should be managed by staff. The lunchtime meal on the unit for people with mental health problems was observed. Staff were seen to be offering people choices and people were responding well to this. Some people were wandering in and out of the room and staff said they would have their meal after the people already eating had finished. Although the initial serving of the meal in the dining room appeared to go well there did not seem to be much organisation in how the meals would be served to those not in the dining the room. It also appeared that, as all the soup had been served, they may not have the same choices as those served first. Staff were observed to serve a person with diabetes a meal which would not usually fit in with a diabetic diet. People said that they enjoyed the meals at the home and the meal looked nutritious and appetising. Care Homes for Older People Page 16 of 29 Evidence: People were seen being offered a choice of tea and coffee and biscuits mid morning. Several people on the unit for people with mental health problems told the inspector that they were thirsty. The nurse in charge made them all a drink of their choice. Diet and fluid intake charts are maintained for every person at the home, whether or not their nutritional assessment indicates that they need to have their intake monitored. However for people who need to have their intake monitored, these charts did not give sufficient detail of the amounts of diet and fluid they were taking, nor were the charts being audited to make sure that people were getting the food and drink they need to maintain their health. The manager said that she would address this issue. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their concerns are listened to and that systems are in place to keep them safe. Evidence: The home has a complaints procedure on display in the foyer of the home and information about how to make a complaint is also given to people within the service user guide which each person is provided with when they go to live at the home. Complaints records showed that complaints are taken seriously, are investigated and the outcomes are recorded and fed back to the complainant. people spoken with said that they would speak to the staff if they had any concerns or complaints. The manager said that she continues to refer any actual of potential abuse under local multi agency safeguarding procedures. This includes any instances where people who live at the home have had altercations. The home is working closely with with mental health nurses from the community in looking at peoples behaviour in particular factors which may precipitate aggressive behaviour toward other people who live at the home. Staff continue to receive training in safeguarding. Care Homes for Older People Page 18 of 29 Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is safe although improvements in cleaning practices would provide people with a more pleasant, comfortable and hygienic environment. Evidence: The home employs a full time handy man to attend to smaller maintenance jobs around the building. Generally the home appeared safe and well maintained. One of the bathrooms has had screws but through the flooring and into the floorboards below. This is unsightly but more importantly some of the screw heads are raised and could be uncomfortable for anybody walking in the room with bare feet. The majority of bedrooms on both floors were clean and pleasantly furnished and decorated although some are ready for some redecoration which is being planned. The majority of bedrooms had been personalised by the occupant with soft furnishings and personal ornaments, pictures and photographs. It was apparent that staff take time to make sure that these items are looked after. Some communal areas were in need of better cleaning. Chairs and tables in dining rooms were in need of thorough cleaning, this was particularly the case in the mental health unit where chairs were badly stained and still had food spillages on them from previous meals. There was also a large tub of waste food and drink from the previous Care Homes for Older People Page 20 of 29 Evidence: meal in the small kitchen off this dining room. Staff said that this tub would be used for waste from the lunchtime meal before being disposed of. This should be disposed of immediately following each meal. Some of the furniture in the dining rooms was in need of repair and again of a good clean. The carpet in the downstairs dining room was heavily stained and in need of replacement. The flooring in one of the downstairs shower rooms was damaged with a small area peeled away from the floor. This is a potential trip hazard and an area where bacteria would grow. Some of the hoist slings and sheepskin throws used for people to sit on were dirty. Staff also need to be aware and take action to prevent cross infection issues posed by having communal bars of soap and dirty nail brushes in bathrooms. The manager said that plans were in place to improve the gardens. This includes a fish pond, raised flower beds and a vegetable patch which people who live at the home could be involved in maintaining. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at the home are supported by well trained staff who are available in sufficient numbers to meet their needs. Evidence: People who live at the home said that they think there are enough staff available to meet their needs and that they respond quickly when called. Observations, particularly on the unit for people with mental health problems, suggested that some reorganisation of staff deployment in the unit would be useful. This is particularly the case at mealtimes when all of the staff are working in the dining room but some people who live at the home are in need of support in other areas of the unit. Observations during the visit were that staff have an easy but respectful relationship with the people who live at the home. Staff were observed supporting people with their needs in a kind and friendly manner. A training matrix showed that learning and development is ongoing for all of the staff at the home and that this training is updated on a regular basis. The manager said that all new staff follow the common induction standards along with an induction to the home. The manager has developed a useful booklet to support staff during their induction. Care Homes for Older People Page 22 of 29 Evidence: Four staff files were looked at during the visit. information was available in all of the files to show that appropriate checks and clearances had been taken prior to the person starting work at the home. One of the files did not contain a full employment history of the person concerned. The manager said that she had discussed this with them but note should be made within the file of the discussion. Care staff are supported to follow the national vocational qualification (NVQ) training in care. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and peoples views are taken into account. Health and safety matters would be improved with better standards in cleaning. Evidence: The registered manager is well experienced having been in the post for many years. She holds a management qualification. The manager conducts annual quality assurance surveys where she seeks feedback and opinions of people who live at the home and their relatives, staff, and other people associated with the home such as healthcare professionals. She was in the middle of this process at the time of the visit. In addition to this the manger had completed and returned to the Commission an annual quality assurance assessment known as an AQAA. This document is for the home to provide the Commission with information about how they think they are doing Care Homes for Older People Page 24 of 29 Evidence: and any improvements they are thinking of making to improve outcomes for people who live at the home. People can, if they wish, have small amounts of money kept on their behalf in the homes safe. Records are maintained of all transactions. The AQAA completed by the manager indicated that servicing and maintenance of equipment used in the home are up to date. In order to make sure that peoples health and safety is better protected, the manager should make sure that the risk of cross infection within the home is minimised and should therefore put in place arrangements for better standards of cleaning and infection control. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 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 7 15 Wherever an assessment suggests that a person may be at risk, a care plan must be developed to instruct staff on how to minimise and manage the risk. To keep people well and safe. 31/07/2009 2 9 13 Medications must be administered as prescribed. To maintain peoples wellbeing. 31/07/2009 3 26 16 The home must be clean and 31/07/2009 hygienic and as far as possible the risk of cross infection eliminated. To keep people safe and to provide a more pleasant place for people to live. 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. Care Homes for Older People Page 27 of 29 No. Refer to Standard Good Practice Recommendations 1 2 10 12 Staff should make sure that they take action to meet peoples dignity needs. All of the people living in the home should have access, on a daily basis, to social and leisure activities appropriate to their choice and ability. This will make sure that people have their needs met in this area. Systems should be put in place to inform staff of people with particular dietary requirements. This will make sure people receive the diet they need. The manager should put in place and audit systems to maintain good hygiene standards within the home. This is to keep people safe. 3 15 4 38 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - 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!