Inspection on 27/09/07 for Bethany

This inspection was carried out on 27th September 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bethany 07/06/06

Bethany 21/12/05

Bethany 02/06/05

Bethany 06/12/04

Bethany 11/05/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Bethany Pamber Heath Road Tadley Basingstoke Hampshire RG26 3TH Lead Inspector Ms Sue Kinch Unannounced Inspection 27th September 2007 10:40 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bethany DS0000011636.V344346.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bethany DS0000011636.V344346.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bethany Address Pamber Heath Road Tadley Basingstoke Hampshire RG26 3TH 0118 9701710 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) bethanyhome@tiscali.co.uk Bethany Care Trust Margaret Murray Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Bethany DS0000011636.V344346.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - (OP) The maximum number of service users to be accommodated is 37. Date of last inspection 7th June 2006 Brief Description of the Service: The home is registered to provide care and accommodation to 37 elderly Christians. Bethany is a large detached property set in spacious grounds in Pamber Heath, Tadley. The physical environment is of a high standard, with large attractive communal areas and the majority of bedrooms being single. The garden is large and well maintained, providing additional recreational space. Bethany Care Trust is the registered provider for Bethany and service users are encouraged to retain their own privacy. Fees range from £490 to £ 610 per person per week. Bethany DS0000011636.V344346.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A six hour visit to the home took place following an assessment of the information held in the homes file, and consideration of the Annual Quality Assurance Assessment (AQAA) submitted by the manager. 12 questionnaires received from residents, relatives and staff were also taken into account. During the visit conversations were held with eight residents, five staff and the manager. Records were sampled and some individual and shared areas of the home were seen. Care practices were also observed. What the service does well: 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. The summary of this inspection report can be made available in other formats on request. Bethany DS0000011636.V344346.R01.S.doc Version 5.2 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bethany DS0000011636.V344346.R01.S.doc Version 5.2 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have had their needs assessed before moving into the home and benefit from staff having written details and care plans to work from. EVIDENCE: The manager stated in the AQAA that admissions to the home take place after a full assessment of individuals with information from the resident, family, health and social services as appropriate. Records sampled during the inspection visit supported this. Opportunities are made for visits to view the facilities with families and to decide if the home will meet individuals’ needs. The home is specifically provided for Christians. Trial visits are offered including respite. Some people who have had respite have returned and others have written positively about the stays. An open day and BBQ was also held this year. The manager said that more are planned as is an update of the website. Bethany DS0000011636.V344346.R01.S.doc Version 5.2 Page 8 The four service users who responded to the written survey said that they received the right amount of information before admission. It was also noted that folders of information including the care plan, service users guide and contract are held in each room. Intermediate care is not provided at the home. Bethany DS0000011636.V344346.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents value the sensitive and respectful quality of the service they receive from staff. However, some residents would benefit further from more detailed risk assessments with more staff guidance. Medication is well organised and administered by trained staff. EVIDENCE: The manager’s view of care is that the home increasingly provides person centred care addressing equality and diversity influenced by the service users in assessments, discussion, residents meeting and questionnaires. She has plans to improve care by using a wellbeing assessment tool for people developing dementia and to improve records on wishes re death and dying and medical intervention and is aware of the need to include information relating to the Mental Capacity Act. The vast majority of written and verbal feedback from people using the service was very positive. Some examples are ‘I am so well provided for here in Bethany DS0000011636.V344346.R01.S.doc Version 5.2 Page 10 everyway’, ’ I have not had an unhappy moment here’, ‘they really care’, ‘very caring’, and ’there’s nothing to complain about’. A relative said that their relative living in the home ‘was always fresh with frequent changes of clothes as the need arises.’ In conversation with people living at the home during the inspection in answer to questions about the care at the home they gave many examples of how their individual needs are known to the staff and met by them. These included support with mobility, independence, personal care, activities and food. During the inspection staff demonstrated good knowledge of the individual needs of the residents and had caring and friendly attitudes. Consideration of choice, respect, dignity and privacy was evident throughout the day. Six personal files were sampled and care-plans were found to be up to date and in place in all instances and included health, personal care, emotional and social issues. In the rooms visited copies of care-plans included: personal routines, risk assessments and health needs were available and people using the service were aware of them to varying degrees. There are up to date risk assessments although some of these need further work to evidence that enough detail has been considered and appropriate people consulted such as when using bedsides. Some bathrooms are locked due to risks relating to a person living at the home but this is not documented. Neither has how more independent people remain independent in bathing. This was discussed with the manager who was aware that more work is needed and in discussion it was evident that more attention to risk had been given than evidenced in the paperwork. Staff, in written feedback and in conversation during the site visit, spoke positively about the service they provide and said that they feel that they can provide individualised care. They provided many examples of how they do this. Health needs are documented in the files held in the office and include evidence of monitoring by health professionals. In one sample these were more detailed due to higher support needs with details of moving and handling and monitoring of food and fluids. This was discussed with a member of staff who had a good understanding of the resident’s needs. A record of the monitoring was held in the resident’s room and was regularly completed. Four residents spoken with about staff knowledge of health needs said that the staff were aware. In the written feedback relatives said that they are informed of important issues affecting their relative. The home has a policy and procedure for dealing with medication, which enables service users to exercise choice over whether they wish to deal with their own medication. Risk assessments are place regarding this. Bethany DS0000011636.V344346.R01.S.doc Version 5.2 Page 11 Medication was discussed with a member of staff in control of medication in the home. The medication system is organised in a specific room and all drugs are held securely including controlled drugs. A sample of medication administration sheets was checked and drugs had been supplied to residents and recorded. Stock samples were accurate. Bethany DS0000011636.V344346.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are benefiting from the manager’s promotion of person-centred care and while those residents more independent are able to pursue their own interests, varied types of mental stimulation and activities are also provided. EVIDENCE: Varied lifestyles were discussed with four residents and from this it was evident that independence is supported as long as possible. The home provides opportunities for mental stimulation and supports residents to be involved in organising activities such as slide shows, speakers and art classes. Some social needs and support required is documented but following consultation recently completed by the activities co-ordinator the manager wants to increase the range of activities for all and further address meeting the needs of those difficult to motivate or with higher support needs. The manager said that staff are to be given training in this and staff hours are going to be provided to increase the focus on it. Bethany DS0000011636.V344346.R01.S.doc Version 5.2 Page 13 Discussion with staff, residents and the manager revealed that a range of activities is available regularly. One-off events also occur but work is taking place continually to find other things to provide residents with enough stimulation. Examples include: talks by missionaries; art classes; devotional meetings 5 days a week; reminiscence; videos; weekly trips in the minibus; using the local post office; sewing sessions; scrabble and films. One resident said that ‘there is enough to keep your interest going’. Another spoke of being provided with more individual care than in other homes. In written feedback residents said that they usually had activities provided. One relative said ‘This care home goes the extra mile and takes residents on a little drive each week if they wish, and will also take them to the shops on request, vehicles and staff permitting’. Another said ‘ abilities are not stifled and they are supported to be active mentally and spiritually.’ All four relative questionnaires agreed that the home supports people to lead the life that they choose. Residents are able to maintain links with friends and the community. A coffee shop has been opened in the grounds of the home and offer an additional place to see visitors as well as in lounges and private rooms. One resident said ‘Even my guests are made to feel very welcome’. Another said that facilities are available to make visitors drinks and that they can stay for meals. In three surveys relatives said that the home helps their relative to keep in touch. The vast majority of comments received about the food in surveys were positive. One person said that the food was presented well another said that it could be better. At the inspection all comments were good with evidence of choice and understanding among staff of the changing wishes of people with dementia. The dining room is an attractive place to eat and over the lunch period staff supported people gently to make choices. Buffet style breakfasts are served and residents can choose where they wish to eat. Some can serve themselves in one of the lounge areas. Two residents confirmed that the food had improved recently with it being ‘ more interesting and more variety’. Another said that it is good and ‘served nicely’. Bethany DS0000011636.V344346.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to raise issues on a day-to-day basis and are aware of the complaints procedure. They are also offered protection through an adult protection policy and procedure known to and understood by staff. EVIDENCE: The home has a complaints policy and procedure, a copy of which was included in the service users guide. A copy of this guide was kept in each bedroom at the home so that service users had ready access to it. Written and verbal feedback from residents confirmed that they knew what to do if they had complaints, although it was reported that the home had had no major complaints to deal with in the previous 12 months. One resident said that the care at the home was flexible and supportive; another said that things could be asked for; a third person said ‘I have nothing to complain about’. Survey information indicated that relatives are mostly aware of the complaints process but feel that they can raise issues if they occur. Staff are aware of what to do if a resident has concerns and said that generally communication between staff worked well. The home has an adult protection policy and procedures are in place but the manager said that no safeguarding referrals have been made in the last 12 months. She also said that all staff are trained in recognising signs of abuse. Bethany DS0000011636.V344346.R01.S.doc Version 5.2 Page 15 What to do if an allegation was made was discussed with a member of staff who was aware of what action to take should it occur and another confirmed to have received training during induction. Bethany DS0000011636.V344346.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoy in a spacious well-decorated, clean, comfortable and fully maintained environment offering plenty of shared space and pleasantly personalised rooms. EVIDENCE: There is evidence that work continues to take place to improve the environment for residents as stated by the manager in the AQAA and since the last inspection a coffee shop has opened in the grounds but attached to the main building with appropriate security considerations. Work on the grounds has also been completed offering a wider space for walking in the garden shared with a number of bungalows in the grounds. In addition one of the unused bathrooms is being converted into a wet room. Other work has taken place to maintain the environment and the new boiler referred to in the AQAA is now in use. Plans are in place to treat the external door and window frames Bethany DS0000011636.V344346.R01.S.doc Version 5.2 Page 17 but the manager said that this had been delayed by the wet weather in the summer. She said that there are regular house audits and at the inspection the maintenance book was viewed showing recently recorded problems to have been fixed. The home has it’s own maintenance person employed on a regular basis. The manager reported that some new carpets had been provided since the last inspection. Residents spoken with spoke favourably about the environment. Four bedrooms were viewed and all were clean, well decorated and contained personal items of furniture and other possessions. Adaptations were provided in these areas and in shared areas as needed. For example, the home has assisted bath and a call bell system. Some residents are provided with pendants to summons assistance as needed. The whole of the home is clean and in the residents surveys they all said the home is always fresh and clean. Some comments were ‘ Bethany is a lovely place’ and ‘ scrupulously clean with no unpleasant odours’. Ancillary staff are employed for cleaning. Others are employed in the laundry and one resident asked said that beds were changed regularly. The home has an infection control policy and the manager said in the AQAA that twenty-nine staff have been trained in it. Protective clothing was in use at the inspection. Bethany DS0000011636.V344346.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home are supported by staff properly recruited in adequate numbers, inducted, trained to increasingly work with residents in a person centred way with consideration to individuality and respect. EVIDENCE: Residents spoke highly of the support and care from staff. The manager reported that staff levels had increased since the last inspection and discussion with staff and observation of the rota supported this. Four staff were on duty in the morning, three in the afternoon and four in the evening. The member of staff said that there is always a team leader and that handovers take place. One took place mid afternoon of the inspection. The manager reported in the AQAA to be looking at the skill range of staff at weekends and plans to recruit staff on contracts that includes more weekend working. Some recruitment has taken place since the last inspection as staff numbers on shift have increased. In staff questionnaires they confirmed that preemployment checks are carried out. A sample of records for this was viewed and most of the relevant checks had been completed for them. However, one person recruited nine months ago commenced employment before the Bethany DS0000011636.V344346.R01.S.doc Version 5.2 Page 19 Protection of Vulnerable Adults (POVA) First check was completed although this had been subsequently carried out and a Criminal Record Bureau (CRB) check completed. The manager was aware that this was not the correct procedure and has subsequently ensured that the checks are completed before employment. Induction is provided and a new system is planned. A new member of staff inducted this year confirmed this and paper records are held. The induction involves shadowing, reading watching DVDs and written work, which is evaluated. The member of staff previously experienced in working with people with elderly people spoke of also receiving training in first aid, moving and handling and catheter care at the home. Written feedback from other staff confirmed that the induction had covered appropriate areas. Verbal and written feedback from staff confirmed that they are having training relevant to their job role, which helps understanding of needs of individuals and keeps them up to date with ways of working. One said that they worked well as a team and that morale was good. One resident said that ten or twelve staff had received training in moving and handling on the previous day and that the manager arranged constant staff training. There is evidence of training in the home on a range of issues and in staff files sampled each member of staff had received training. The manager said that they were involved in a pilot project with South East Care Advice Service (SECAS).All staff had been assessed with action plans for their development being ready for the manager to discuss with staff. There was also written and verbal evidence of day-to-day support for staff, supervision and staff meetings. Future courses were advertised on the notice board. Bethany DS0000011636.V344346.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well managed and organised home running in their interests with adequate attention to health and safety. EVIDENCE: The manager’s post was vacant at the last inspection but a new manager was registered in January 2007. In the AQAA the manager said that she had enrolled in an NVQ level 4 course and to be followed by the registered manager’s award but she has had training in recruitment, supervision, dementia care in the last year. Evidence of this was viewed at the inspection. She said the management team create an open and positive and inclusive atmosphere in the home. This was supported by positive comments received Bethany DS0000011636.V344346.R01.S.doc Version 5.2 Page 21 from staff and residents about her style of management including that the home is a more relaxed place to be in since she has been in post. Staff also said that they felt included and consulted. One said that the approach to residents is more holistic. One resident said that the manager was very good and thoughtful. There is evidence of management monitoring of the services provided with a well organised system of checks in place and a commitment to making improvements to the home. Residents spoke of being consulted by questionnaires and of their comments being listened to. One person felt that this could be better but observations and discussion during the inspection visit with management and staff an understanding of residents needs and that residents needs are a priority. Samples of completed questionnaires were viewed and many comments were noted to be positive including some from those having been in for respite care. Residents meetings are held regularly and all are provided with copies of the minutes. A resident had seen evidence of things being addressed. The home continues to provide a safekeeping facility for residents who wish to make use of this. Money being held in individual folders for two people was checked against the records and these records were accurate. Receipts are held but were not checked on this occasion. Health and safety is addressed in the home. Samples of checks required to be regularly made within the home included fire training, fire equipment checks and drills, fire risk assessment, and maintenance checks are in place. A member of staff confirmed that all staff have moving and handling training before they are involved in the relevant practices. The door to the tools and boiler were locked. Bethany DS0000011636.V344346.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Bethany DS0000011636.V344346.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bethany DS0000011636.V344346.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Bethany DS0000011636.V344346.R01.S.doc Version 5.2 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!