Inspection on 27/09/05 for Avenue Road

This inspection was carried out on 27th September 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 23 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Avenue Road 11/04/05

Avenue Road 27/10/04

Avenue Road 01/06/04

Avenue Road 15/03/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Avenue Road 35 Avenue Road Darlaston Walsall West Midlands WS10 8AR Lead Inspector Lesley Webb Unannounced Inspection 27th September 2005 12:30 Avenue Road DS0000020834.V252160.R01.S.doc Version 5.0 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 Avenue Road DS0000020834.V252160.R01.S.doc Version 5.0 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 Adults 18-65. 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. Avenue Road DS0000020834.V252160.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Avenue Road Address 35 Avenue Road Darlaston Walsall West Midlands WS10 8AR 0121 526 3313 01902 421941 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) Swan Village Care Services Limited Sarah Jane Ann Perry Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Avenue Road DS0000020834.V252160.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th April 2005 Brief Description of the Service: Avenue Road is a detached two-storey premise that is connected to all main services. The home offers five single bedrooms (without en-suite facilities), a large lounge and separate dining room. There are bathing, shower and toilet facilities on each floor. The home is owned by Swan Village Care Services Limited, who also own several other care homes in the West Midlands and a Day Centre. The home is situated in a quiet area of Darlaston and is close to all the local amenities such as shops, pubs, library, parks and public transport. The home is registered for the care of five adults with a learning disability. All of the present service users also demonstrate challenging behaviour. Staff at the home uses a client-focused approach, with the aim being to encourage and develop maximum potential and independence for each service user. All packages incorporate choice, privacy, dignity and respect. Avenue Road DS0000020834.V252160.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector arrived unannounced at 12.30pm and stayed until 6.30pm. On arrival there was one service user at home, one at college, one at work, one visiting their family and one on holiday in Spain. During the visit the inspector spoke to three service users (one by telephone), interviewed three members of staff, looked at records and toured the building before giving feedback to the manager. In addition to this documentation supplied by the manager prior to the inspector was also used to assess how the home is meeting National Minimum Standards. Four relative comment cards were received by the inspector, all of which praised the home and the service it provided. For example one stated, “The staff have good values and treat service users with dignity and respect”. Also five service user comment cards were also received that had been completed with help from staff at the home, again all of these stated that service users are happy with the staff and the care they receive. This was the second unannounced inspection to take place this year and therefore the previous inspection report should be read in conjunction with this one in order to obtain a comprehensive assessment of all National Minimum Standards assessed this year. By the end of the visit the inspector was satisfied that the home offers a good service and would like to thank everyone at the home for his or her cooperation and assistance during the inspection process. What the service does well: Staff should be congratulated for their efforts to build relationships with service users. All staff interviewed demonstrated knowledge and understanding of the individual needs of service users and gave example of how this is implemented. For example one person stated, “One person needs additional support with personal care. We encourage that person to do as much for themselves but don’t offer help unless they need it as this reduces their independence”. All service users that were spoken to also praised the staff, making comments such as, “the staff are very kind, they help me with things I cannot do by myself” and “the staff are great, we have a laugh with them”. Avenue Road DS0000020834.V252160.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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. Avenue Road DS0000020834.V252160.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Avenue Road DS0000020834.V252160.R01.S.doc Version 5.0 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 the following standard(s): Standards not assessed at this inspection. EVIDENCE: It was noted by the inspector that a previous inspection Requirement to include service users views in the Service User Guide has now been met. Avenue Road DS0000020834.V252160.R01.S.doc Version 5.0 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 the following standard(s): Standards not assessed at this inspection. EVIDENCE: A previous Requirement instructing the home to ensure care plans are reviewed on a monthly basis was found to be partly met. The inspector sampled two care plans and found evidence that one had been reviewed on a monthly basis but that neither contained evidence of service user involvement. Avenue Road DS0000020834.V252160.R01.S.doc Version 5.0 Page 10 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 the following standard(s): Standards not assessed at this inspection. EVIDENCE: Avenue Road DS0000020834.V252160.R01.S.doc Version 5.0 Page 11 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 the following standard(s): 18, 19 and 20. Personal support in this home is offered in such a way as to promote and protect service users privacy, dignity and independence. Generally the health needs of service users are well met, with evidence of good multi disciplinary working taking place on a regular basis. Medication practices within the home do not promote independence within a risk-managed framework. EVIDENCE: The inspector found an abundance of evidence through looking at records, observing care practices and talking to staff and service users that personal support is provided in a sensitive and flexible manner. The inspector observed staff knocking on doors before entering, offering choices and talking to service users in a friendly yet respectful way. These practices were confirmed as the norm by staff when interviewed. For example on person stated, “we always try to give choices for example with meals, activities, what people wear and promote their dignity by giving them space and privacy when personal care takes place”. Service users confirmed these observations when asked how they are treated by staff. For example one service user said, “the staff are great, they help me with things and talk to me nicely”. Avenue Road DS0000020834.V252160.R01.S.doc Version 5.0 Page 12 Three of the four Requirements identified in the previous inspection have been met by the home, ensuring referrals to relevant medical professionals are now made in a timely manner and that comprehensive health records are maintained. Records indicated that service users are still not being weighed monthly. Two of the three previous Requirements relating to medication have now been addressed by the home. No progress has been made to ensure comprehensive assessments are completed to determine if service users can self-administer medication. It was noted that during the inspection that the manager produced a format for documenting this process which she agreed to implement. Avenue Road DS0000020834.V252160.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 23. Presently the home is not fulfilling its obligations in full to protect service users from abuse through its monitoring systems. EVIDENCE: Two Requirements identified in previous inspections relating to the protection of vulnerable adults remain outstanding. The inspector found evidence that the manager is fulfilling her obligations in relation to one of these but that senior management within the organisation have not been completing audits of service user finances despite an adult protection incident relating to service user finances occurring previously at the home. The manager stated that staff have undertaken physical intervention training (previous Requirement) however certificates were still not maintained within the home to validate this comment. All service users confirmed that they feel safe living at the home with one adding, “I was lonely living by myself and used to feel scared. Its nice here because I know the staff will help me and will watch out for me”. Avenue Road DS0000020834.V252160.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 24, 25, 26, 27, 28 and 30. Limited improvements to the décor have been made. The outstanding matters do not provide the people living in the home with safe, comfortable surroundings. EVIDENCE: After touring the building the inspector found that generally the home is maintained to a satisfactorily standard however four areas were found to require urgent attention. 1. The lounge suite must be replaced as when sitting on it the springs can be felt and some of the legs are unsteady. It was also noted that service users have to sit on sheets to ensure infection control measures are maintained due to continence issues and therefore the inspector strongly recommended that when a new suite is purchased this be made of a material that is washable. It was also noted that one particular service user requires a chair that will meet their individual needs as they were witnessed having to place cushions in order to be comfortable. Also due to this person’s height and weight the chair that is currently used appeared inappropriate, with the legs to the chair being unsteady and posing a potential health and safety risk. 2. The shower room requires urgent attention, as high levels of water are located under the flooring posing risk to anyone entering this room. Avenue Road DS0000020834.V252160.R01.S.doc Version 5.0 Page 15 Mildew was found to be over the walls and imbedded in the grouting and a dining chair is being used for service users when sitting under the shower. 3. The oven must be replaced as this is potentially dangerous to users as the grill is unsteady and the oven door faulty. The inspector instructed that an assessment of risk be completed for this until a new one is purchased. 4. The damaged ceiling in a service users bedroom must be investigated and made safe. The Fire Department visited the home in January 2005 with all but one Requirement implemented. Avenue Road DS0000020834.V252160.R01.S.doc Version 5.0 Page 16 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 36. The staff have a very good understanding of the service users rights and responsibilities and their roles within this area, resulting in an inclusive atmosphere within the home. There is a good skill mixture of staff within the home; ensuring consistent care is given to the people who live there. Inconsistencies in staffing levels have the potential to impact on service provision. EVIDENCE: All staff that were interviewed demonstrated in-depth knowledge and understanding of their roles and responsibilities in relation to the needs of service users. For example one person stated, “we try to get service users to do as much for themselves, the strengths they have let them use and encourage them to do things they might not have done before. A lot of the time its about having confidence, they think they are going to fail, we must praise and encourage”. Throughout the day the inspector observed staff treating service users with respect whilst supporting them in areas of care they required. Since the last inspection all staff have undertaken equal opportunities training, but the home is still to implement a training needs assessment for the staff team as a whole in order to identify benefits to service users and to inform future planning. Records confirmed that three staff have completed LDAF accredited training with all other staff in the process of Avenue Road DS0000020834.V252160.R01.S.doc Version 5.0 Page 17 completing training in this area. All staff that work at the home undertake induction training, however the inspector recommended that the manager ensure its systems and structures for induction comply with recent changes in legislation. Previous Requirements to implement a policy regarding supervision and to ensure staff receive an annual appraisal have been met, with all staff files sampled containing evidence of this occurring. There are three care staff on duty morning and afternoon and one person at night with a sleep-in person in case of emergencies. Records and discussions with the manager confirmed that the agreed staffing ratios have not always been maintained and that staff meetings have not been occurring as regularly as they should. The manager stated that wherever possible they have implemented the agreed ratios but due to annual leave or sickness this has not always been possible. Avenue Road DS0000020834.V252160.R01.S.doc Version 5.0 Page 18 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 42 and 43. The home does not regularly review aspects of its performance through a good programme of self-review and consultations and therefore cannot monitor that it is meeting its aims and objectives. Further work is required to ensure that all practices within the home promote and safeguard the health, safety and welfare of the people using the service. EVIDENCE: When asking staff if there is a quality assurance system in the home and if so what does it contain all staff that were interviewed confirmed why quality should be monitored but no one could give details of how the home monitors quality. For example one person stated, “it is there to make sure service users have a quality life, there is a quality assurance folder but I do not know what is in it. The manager deals with that”. The inspector and manager discussed quality assurance in detail as presently the system in place does not allow for effective monitoring, is very time consuming and is not felt to be of value by anyone. Since the last inspection the home has sent out questionnaires to Avenue Road DS0000020834.V252160.R01.S.doc Version 5.0 Page 19 service users and their representatives and analysed the findings from these but as there is no development plan for the home the findings are not being acted upon. When asking staff how their health and safety at work is promoted everyone demonstrated knowledge of systems and responsibilities in this area including training, policies and procedures, monitoring of the building and reporting to appropriate persons. When looking at records relating to health and safety the inspector found that the majority of the staff working at the home have undertaken moving and handling, first aid and food hygiene training, with only infection control remaining outstanding. Also there has been one recorded accident at the home since the last inspection involving a service user. When looking at the records for this the inspector found that CSCI had not been notified in line with Regulation 37 of the Care Homes Regulations. When looking at fire equipment and training records the inspector found that fire drills occur every three months but recommended that the times that these occur vary as presently drills only occur in the daytime. Fire alarms are tested monthly. The inspector instructed that this must be increased to weekly with outcomes recorded. The home provides its own transport however no records relating to its maintenance could be found. The inspector instructed that safety procedures must be introduced for this facility as in other parts of the home. All other records associated with maintenance and the monitoring of health and safety were found to be in order. For the last five months the Commission for Social Care Inspection has not received copies of Regulation 26 reports completed by the service co-ordinator. During the inspection the service co-ordinator visited the home and acknowledge this, agreeing to reinstate this audit. A previous Requirement to implement a financial plan for the home could not be assessed as this information was stored in a cabinet that was locked and the manager did not have access on the day of inspection. Avenue Road DS0000020834.V252160.R01.S.doc Version 5.0 Page 20 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 Score X 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X X X X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 2 3 2 3 X 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score 3 3 2 X 2 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Avenue Road Score 4 2 2 X Standard No 37 38 39 40 41 42 43 Score X X 2 X X 2 2 DS0000020834.V252160.R01.S.doc Version 5.0 Page 21 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 YA6 Regulation 15 Timescale for action Careplans must be reviewed with 31/12/05 the service user on a monthly basis (part met) – REQUIREMENT ORIGINALLY MADE APRIL 2005 Service users must be weighed 31/12/05 every month and the findings recorded – REQUIREMENT ORIGINALLY MADE APRIL 2005 Comprehensive assessments 31/12/05 must be completed to determine if service users can self medicate – REQUIREMENT ORIGINALLY MADE APRIL 2005 All service user records 31/10/05 pertaining to finances must be regularly audited and monitored by a person other than the manager – REQUIREMENT ORIGINALLY MADE JUNE 2004 The home must be able to 31/12/05 validate that staff have undertaken physical intervention training – REQUIREMENT ORIGINALLY MADE APRIL 2005 The lounge suite must be 31/12/05 replaced A lounge chair must be provided 31/12/05 suitable to the needs of ‘G’ The oven must be replaced and a 31/10/05 DS0000020834.V252160.R01.S.doc Version 5.0 Page 22 Requirement 2 YA19 12(1) 3 YA20 13(2) 4 YA23 10(1) 5 YA23 10(1) 6 7 8 YA24 YA24 YA24 16(1) 16(1) 16(1) Avenue Road 9 10 11 12 YA24 YA25 YA27 YA33 16(1) 16(1) 16(1) 18(1) 13 14 15 YA33 YA33 YA35 18(1) 18(1) 18(1) 16 YA39 24 17 YA39 24 18 YA42 13(3) 19 20 21 YA42 YA42 YA42 13(3) 13(3) 13(3) 22 YA43 25 risk assessment completed whilst still in use All requirements made by the Fire Department must be acted upon The damaged ceiling in a service users bedroom must be investigated and made safe The shower room must be renovated The home must maintain staffing levels to agreed levels (3 plus 1 when a named service user attends dayservice) Staff rotas must be expanded to include details of when service users are not in the building A minimum of six staff meetings must take place every year, with records maintained The home must ensure a training needs assessment is completed for the staff team as a whole – REQUIREMENT ORIGINALLY MADE MARCH 2004 The home must implement an annual development plan – REQUIREMENT ORIGINALLY MADE MARCH 2004 An annual audit of the quality assurance system must take place – REQUIREMENT ORIGINALLY MADE APRIL 2005 All staff must undertake infection control training – REQUIREMENT ORIGINALLY MADE OCTOBER 2004 All accidents must be reported to CSCI in line with Regulation 37 Fire alarms must be tested weekly, with the outcomes recorded Monitoring and safety checks must be implemented for the homes transport, with records maintained at the home The home must implement a DS0000020834.V252160.R01.S.doc 31/10/05 31/12/05 31/12/05 27/09/05 31/12/05 31/12/05 31/12/05 31/12/05 31/12/05 31/12/05 27/09/05 27/09/05 31/12/05 31/10/05 Page 23 Avenue Road Version 5.0 23 YA43 26 financial plan that is open to CSCI for inspection – REQUIREMENT ORIGINALLY MADE MARCH 2004 Regulation 26 visits must be undertaken with copies of reports sent to CSCI 31/10/05 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 2 3 4 Refer to Standard YA24 YA35 YA39 YA43 Good Practice Recommendations That when a new suite is purchased it is constructed of a washable material That the manager obtains information regarding staff induction to ensure policies and practices comply with legislation That the home review its quality assurance systems That the registered proprietors attend a percentage of staff meetings Avenue Road DS0000020834.V252160.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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 Avenue Road DS0000020834.V252160.R01.S.doc Version 5.0 Page 25 - 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!