Inspection on 20/06/07 for Barnfield House

This inspection was carried out on 20th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Barnfield House 11/06/09

Barnfield House 08/11/06

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOME ADULTS 18-65 Barnfield House Barnfield House 9-10 Barnfield Terrace Station Road Liskeard Cornwall PL14 4DT Lead Inspector Alan Pitts Unannounced Inspection 20th June 2007 09:40 Barnfield House DS0000066649.V335405.R01.S.doc Version 5.2 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 Barnfield House DS0000066649.V335405.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 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. Barnfield House DS0000066649.V335405.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barnfield House Address 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) Barnfield House 9-10 Barnfield Terrace Station Road Liskeard Cornwall PL14 4DT 01579 347617 01579 347617 Rebecca Joy Miller Michael Stephen McGillicuddy Christine Martin Care Home 14 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (14) of places Barnfield House DS0000066649.V335405.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Room 12a may only be used by the service user who currently occupies the room. Service users to include one named person outside the category of the home. 8th November 2006 Date of last inspection Brief Description of the Service: Barnfield House is registered to provide accommodation and personal care for up to 14 service users with a mental health condition. The home charges £350 per week. It is situated close to the local train station, bus services, shops and facilities of Liskeard. The accommodation comprises what was originally two houses, adapted to become one. Accommodation is offered in predominantly single rooms with 2 shared rooms provided. Stairs provide access to the upper floors. Barnfield House is an established service, which came under new ownership in March 2006. The new owners are Mrs R. Miller and Mr S McGillicuddy. Barnfield House DS0000066649.V335405.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection of care standards at Barnfield House, which took place over a period of approximately 5.5 hours on 20th June 2007. The inspector met with residents, a number of staff including the manager elect and the registered provider, and toured the premises. The residents were complimentary about the home generally, and the kindness and consideration of the care staff. The owners have gradually made their own mark on this home since buying it in 2006, and have improved things in a number of areas. The owners are receptive and clearly focused on the welfare of the residents. The small number of requirements and recommendations made in this report should not detract from the overall high standard of care provided at this small, ‘homely’, care home. The fee charged is £350/week. What the service does well: What has improved since the last inspection? The registered provider and staff have ensured compliance with the requirement identified at the previous inspection, and have also met with all but two recommendations. The registered provider has ensured that there is ongoing training available and booked for staff. Policies and procedures have been revised, though more improvement is possible in this area. Barnfield House DS0000066649.V335405.R01.S.doc Version 5.2 Page 6 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. Barnfield House DS0000066649.V335405.R01.S.doc Version 5.2 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 Barnfield House DS0000066649.V335405.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 - Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The registered provider is thorough in ensuring that prospective residents will have their needs met at Barnfield House. EVIDENCE: There is a small admission/discharge turnover at Barnfield House, and as a result the residents have an established community at the home. Significant time and effort is spent making admission to the home personal and well managed. Prospective residents and their families are treated as individuals and with dignity and respect for the life changing decisions they need to make. There is a high value on responding to individual needs for information, reassurance and support. All potential residents receive a full comprehensive needs assessment before admission, and the registered provider will obtain a summary of any assessment undertaken through care management arrangements. Individuals are supported and encouraged to be involved in the assessment process. Information is gathered from a range of sources including other relevant professionals. Before agreeing admission the registered provider carefully considers the needs assessment for each individual prospective person and the capacity of Barnfield House DS0000066649.V335405.R01.S.doc Version 5.2 Page 9 the home to meet their needs. Prospective residents are given the opportunity to spend time in the home with the existing residents, helping them to feel comfortable in their surroundings, and enable them to ask any questions about life in the home. The home has a comprehensive Statement of Purpose and Service User Guide, which is specific to the resident group and considers the different styles of accommodation, support, treatment, philosophies and specialist services required to meet the needs of residents. The information is in a format suitable to the needs of the resident, and their families. Barnfield House DS0000066649.V335405.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans were seen to be informative and comprehensive, showing the resident’s health care needs being met as appropriate. Residents are involved in decisions about their lives, and a risk-assessment is in place for each resident. EVIDENCE: A selection of care plans were inspected, and the care needs of those residents discussed with the registered provider, manager elect, and staff. The care plans and daily entries show resident involvement in day-to-day decisions about their lives. The home has a strong belief that it is essential to involve residents in the planning of care that affects their lifestyle and quality of life. Management and staff understand the importance of residents being supported to take control of their own lives, and to encourage and enable them to exercise their rights and make their own decisions and choices. Barnfield House DS0000066649.V335405.R01.S.doc Version 5.2 Page 11 Each resident has a plan that has been agreed with him or her. It is presented in a format that ensures residents can access and understand the information it contains. It is written in plain language, is easy to understand and considers all areas of the individual’s life including health; specialist treatments, personal and social care needs. The plan is reviewed regularly, though more could be done to show the involvement of the resident or, where agreed, their families. The care plans are updated and action taken to respond to any changes. All members of staff regard the plan as a working tool and support residents to achieve their desired outcomes. There are regular house meetings, and the registered provider meets with residents individually. Residents are consulted on many areas including choice of décor for their rooms and menu planning. Residents are encouraged to make informed decisions, and are given the information they need in order to do so. The home also makes use of other professionals/agencies in order to ensure residents have the resources they need. There is a written risk-assessment for each resident, and agreed with the resident. The registered provider maintains good communication links with other relevant agencies. Barnfield House DS0000066649.V335405.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A flexible lifestyle that provides residents with opportunities is at the heart of the care provided. Residents are provided with as many options as possible to encourage independence, further education, and leisure opportunities. Residents are fully supported to enable them to get the maximum benefit from these, whilst being encouraged to be responsible and responsive in their daily lives. EVIDENCE: The registered provider and staff demonstrate a strong commitment to enabling residents to develop their skills, including social, emotional, communication, and independent living skills. The registered provider and staff recognise the individual’s right to live an ordinary and meaningful life, both in the home and in the community. This is supported by the discussions at the time of the inspection and the comprehensive care documentation. Barnfield House DS0000066649.V335405.R01.S.doc Version 5.2 Page 13 Residents have the opportunity to develop and maintain important personal and family relationships, and are able to determine whether or not they wish to see someone. The staff promote individual rights and choice, but also consider the protection of individuals, supporting people to make informed choices. There is a risk-assessment in place for each resident, which is agreed with the resident and reviewed regularly. Residents are involved in their own meaningful daytime activities, according to their individual interests and capability; they are involved in the planning of their lifestyle and quality of life, and this is included in the plan of care. Residents may, and do, access local community facilities. Staff were seen to knock before entering residents rooms. Residents may have a key to their room, and receive their own mail individually, though assistance is available if needed. The registered provider and staff recognise the residents’ rights as adults to determine their own lifestyle, and maintain close links with the residents and other relevant agencies in order promote this and facilitate informed decision-making. As important, the current residents recognise their rights and are able to voice any perceived restrictions on this. Residents are involved to varying degrees in the domestic routines of the home, and in menu planning making sure that they are able to enjoy the food they prefer and like. The menu is varied with choices available to residents, and is based on a 4-week rotating menu, with additional seasonal variations. A new menu is due to be implemented for the forthcoming summer month(s). The meals are balanced and nutritional and cater for the varying cultural and dietary needs of the residents. Residents have input into the menu. The main hot meal is provided in the evening, with a light lunch provided to those residents at home during the day. Barnfield House DS0000066649.V335405.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be confident that their health needs will be pursued actively, with their involvement and include specialist input as necessary. Medicines are administered safely. The care needs of the residents are handled with respect. EVIDENCE: Efficient systems are in place to ensure residents receive effective personal and healthcare support. There is a skilled and knowledgeable staff group. Staff are aware that the way in which support is given is a key issue for the residents. Resident’s individual plans clearly record their personal and healthcare needs and detail how they will be delivered. Personal support is flexible, consistent, and responsive to the changing needs of the residents. Residents have the opportunity to choose their own GP and have access to all NHS healthcare facilities in the local community. Regular appointments are seen as important and systems are in place to ensure they are not missed. The home arranges for health professionals to visit residents at home when necessary. Staff are alert to health care triggers and warnings and fully understand how they should respond and take action. Barnfield House DS0000066649.V335405.R01.S.doc Version 5.2 Page 15 There is a comprehensive medicines procedure. Medicines are stored securely, and administered safely. Medicine Administration Records were seen to be in order, though the registered provider should ensure that were medication instructions are hand written on Medicine Administration Records there are two staff initials confirming the accuracy of the entry. Records are kept of medicines received and returned. Staff training undertaken includes the safe handling of medicines. Barnfield House DS0000066649.V335405.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. No complaints have been received since the last inspection. Complaints are taken seriously and addressed quickly. Protecting residents from abuse or neglect forms part of the regular training that all staff have to undertake. EVIDENCE: The complaints procedure is on display at the home, and included in the service user guide and Statement of Purpose. The home and the residents have good and frequent links with other relevant agencies. No complaints have been received since the last inspection. There is a comprehensive adult protection policy and procedure in use and on display. The registered provider demonstrated a good understanding of the procedure to follow. Adult protection training is included in the home’s training programme. Barnfield House DS0000066649.V335405.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is suited to the needs of the residents, providing a safe, homely environment. The home is clean and hygienic. EVIDENCE: The home is a very pleasant, safe place to live. There are several communal areas allowing for residents to avoid or mix with people of their choosing. The shared areas provide a opportunities to meet relatives and friends in privacy. Residents are also free to use their own rooms. Residents are encouraged to personalise their bedrooms, and are asked to choose the colour scheme when rooms are decorated. The homes’ fixtures and fittings meet the current needs of the individuals. The bathrooms and toilets are fitted with appropriate aids and adaptations to meet the needs of the people who use the service, and are in sufficient numbers. The kitchen is domestic in nature, clean and organised. The laundry is small, but functional. Barnfield House DS0000066649.V335405.R01.S.doc Version 5.2 Page 18 The home is domestic in nature, well lit, clean and tidy. There is evidence of regular maintenance and safety checks. Barnfield House DS0000066649.V335405.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 - Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are knowledgeable and skilled in supporting the residents. The home adheres to a robust employment procedure. EVIDENCE: The registered provider, manager elect, and staff demonstrated a good understanding of residents care needs and capabilities. Staff were observed to be approachable and comfortable with the residents. Staff receive and inhouse induction when starting at the home, and a significant number are booked on a variety of training courses over the coming months, including: 1st Aid and food hygiene. The registered provider is actively seeking to develop a more specific training programme suited to caring for residents with mental health needs. Approximately 55 of the staff have achieved NVQ level 2 or above, and the registered provider advised the inspector that more staff would be undertaking this training later this year. It came to light at this inspection that historically the home has always operated with one carer asleep at night with additional support available from the registered provider who lives next door. Whilst this arrangement has met Barnfield House DS0000066649.V335405.R01.S.doc Version 5.2 Page 20 the nocturnal needs of the residents to date, the registered provider is receptive to the potential risks posed by this arrangement and the changing needs of the residents, and voluntarily agreed to having one carer awake at night with effect from 1st July 2007. It must be noted that whilst this situation has existed for some considerable time unbeknownst to the inspector this would have resulted in an immediate requirement if not for the confidence the inspector has in the registered provider to rectify the matter. There is a current and accurate duty rota in operation (surnames should be used). There is sufficient staff to meet the residents’ care needs (based on the following): • 3 carers between 07:30 – 15:00 (The third member of staff starts at 0830. The third person is not always on the premises, they might for example, be dropping service users at the GP Surgery or escorting them to the post office etc. There are always however a minimum of two persons actually on the premises, and the third person, even when temporarily absent, is in contact by mobile.) • 2 carers between 15:00 – 21:00 • 1 carer (awake) between 21:00 – 07:30, with on-call support from the registered provider. A sample of personnel files was inspected, which showed that the home is adhering to a robust employment procedure in order to protect residents. In addition to the in-house induction training, some staff have also undertaken an additional 1-day intensive course provided by external trainers. The registered provider must implement a National Training Organisation compliant induction programme for new staff (www.skillsforcare.org). Staff are regularly and frequently supervised, though as discussed the registered provider may want to consider simplifying the existing system. Barnfield House DS0000066649.V335405.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, 42 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has submitted an application to the Commission for Social Care Inspection for a registered manager. The home makes use of quality assurance questionnaires to ascertain the views of the residents. Residents health and welfare is protected. EVIDENCE: The home has recently submitted an application for a registered manager, and this is being processed by the Commission for Social Care Inspection. The registered provider lives next door and is in day-to-day control at the moment. There is a clear sense of hierarchy and leadership at the home. The home used quality assurance questionnaires in 2006 to ascertain the views of the residents, and the manager elect said that they were about to send out Barnfield House DS0000066649.V335405.R01.S.doc Version 5.2 Page 22 new ones. As discussed the home should extend the quality assurance to relatives and other visitors to the home, such as Community Psychiatric Nurses. The registered provider has summarised the findings of last years quality assurance returns and plans to publish this years findings in the service user guide. There is a generally comprehensive policies and procedures folder, but as discussed at the time of the inspection there is room for expansion and improvement, specifically discussed: infection control policies should be established to ensure the safety of residents and staff as the latter multi-task (i.e. carer/cook/cleaner). Documentation relating to the maintenance and safety of the premises was inspected and seen to be in order (e.g. gas safety certificate, insurance certificate, fire equipment and system maintenance). Barnfield House DS0000066649.V335405.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 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 Standard No Score 1 3 2 4 3 4 4 4 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X N/A X 3 3 X 3 X Barnfield House DS0000066649.V335405.R01.S.doc Version 5.2 Page 24 NO 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 YA35 Regulation 18 Requirement The registered provider must implement a National Training Organisation compliant induction programme for new staff (www.skillsforcare.org). Timescale for action 01/07/07 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. Refer to Standard YA6 YA20 Good Practice Recommendations More could be done to show the involvement of the resident or, where agreed, their families in care plan reviews. The registered providers should ensure that were instructions are transcribed onto Medicine Administration Records two initials are provided to check the accuracy of the entry. The breadth of areas covered by the home’s policies and procedures should be reviewed to ensure the safety of residents and staff as the former care needs change and the latter roles develop. 3. YA40 Barnfield House DS0000066649.V335405.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton Devon TQ13 7UP 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 Barnfield House DS0000066649.V335405.R01.S.doc Version 5.2 Page 26 - 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!