Inspection on 10/12/08 for Brambling House

This inspection was carried out on 10th December 2008.

CSCI found this care home to be providing an Good service.

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

Brambling House 12/12/06

Brambling House 17/10/05

Brambling House 21/04/05

Brambling House 02/11/04

Brambling House 17/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Brambling House 46 Eythorne Road Shepherdswell Dover Kent CT15 7PG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Penny McMullan     Date: 1 0 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Brambling House 46 Eythorne Road Shepherdswell Dover Kent CT15 7PG 01304830276 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Karen Warner Type of registration: Number of places registered: Mr Kanagaratnam Rajaseelan,Mr Kanagaratnam Rajamenon care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 20. 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: Old age, not falling within any other category (OP) Dementia (DE). Date of last inspection Brief description of the care home Brambling House is an extended detached property set back from the main road above a grassed bank and accessed by a steep drive. Car parking is available off road in a small car park at the rear of the premises. The Home is located off the main road through the quiet and rural village of Shepherdswell. There is a limited public bus Care Homes for Older People Page 4 of 28 Over 65 0 20 20 0 Brief description of the care home service, but the village has a train station with direct mainline access. The house provides residential care for up to 20 older people, some of which may be dementia service users. Accommodation comprises of 16 single rooms, seven being located downstairs, with a further 9 single rooms and 2 shared rooms situated on the first floor. The Home benefits from having three communal spaces for Service Users downstairs, in the form of one small lounge, a lounge/diner and a large conservatory area. All parts of the Home are accessible to residents via a shaft lift. Each bedroom has a private wash-hand basin and call bell, a telephone is available for Service Users to use. Service Users have access to a garden with a patio area which is located to the side and rear of the property. The current fees for the service at the time of the visit are 320 pounds to 500 pounds per week. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection carried out over a period of time and concluded with an unannounced visit to the home on 10 December 2008. The Registered Manager assisted throughout the visit. Surveys were sent to the home for the owners to distribute to people that use the service, staff and professionals who have contact with the service. All comments received are positive and have been included throughout this report. The care of three people was tracked to help gain evidence as to what its like to receive a service from the agency. Various records were viewed during the inspection. The agency returned the Annual Quality Assurance Assessment (AQAA) within the Care Homes for Older People Page 6 of 28 required timescale. Information within the AQAA was satisfactory but further detail would give a better indication of what the home has achieved and improved on since the last inspection. The last inspection on this service was completed on 12 December 2006. The home has recently been granted planning permission to build an extension. This includes plans to be linked to the residential home next door, which is also owned by the Registered Providers. There is no planned date to begin this work at the time of this inspection. What the care home does well: What has improved since the last inspection? What they could do better: When asked what the home could do better a staff member comments: Provide more otuings int he summer for more able resdients. The home needs to ensure that the assessment form includes details of religion and personal preferences to ensure equality and diversity. Care plans and risk assessments require further detail to provide staff with full details of how to meet residents needs. The medication refrigerator needs to be locked when not in use. Employment applicaton forms need to be fully completed to ensure the home is aware of full employment history. The quality assurance programme requires further development to ensure a formal Care Homes for Older People Page 8 of 28 programme of evidence and outcomes reflect the views of stakeholders, relatives and respresentaives. The home must ensure that weekly fire tests are carried out. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements are in place to ensure that residents receive a care needs assessment prior to moving into the home. Standard 6 is not applicable to this home.. Evidence: The Registered Manager or Deputy Manager assess prospective residents to ensure the home can meet their needs. The assessment form does not include religion and personal preferences to ensure equality and diversity is recorded. This information is recorded in the care plans but needs to be included on the assessment form to ensure the home can meet individual preferences before the resident agrees to move into the home. A recommendation will be made in this report. There is evidence that residents, relatives, or representatives are involved in the process. Care plans or joint assessments from the placing authority are also in place. Care Homes for Older People Page 11 of 28 Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are in place to ensure that residents needs are met, however, risk assessments require further development to ensure that a safe practice of work is in place to protect residents and staff. The management and administration of medication ensures that residents health care needs are met and privacy and dignity upheld. Evidence: The home is in the process of implementing new care plans, some have been completed, whilst others are in the process. Each plan has a life history of the person and details the persons preferences and wishes to meet their needs. In some care plans the word assistance is used to describe the care to be given, further detail is required to clarify just what this means to the individual. The moving and handling risk assessments detailed dependency but lack information of specific manoeuvres to provide staff with clear written guidelines of how to move the person. The home needs to ensure that this is recorded so that residents and staff are safe when carrying out Care Homes for Older People Page 13 of 28 Evidence: moving and handling tasks. The Registered Manager acknowledges the shortfalls in this area, therefore a requirement will not be made at this time, however a recommendation will be issued as a point of good practice. The plans are reviewed on a regular basis and there is evidence of relative and resident participation. There is clear evidence in the care plans that residents health care needs are monitored and recorded. Appropriate equipment to maintain skin integrity is in place and all health care appointments, visits from doctors and nurses are recorded. A resident comments: On several occasions I have had to have emergency treatment and have been dealt with swiftly and efficiently. All staff administering medication have received the appropriate training. Medication records are in good order and audited on a monthly basis. Carers are also shadowed by another member of staff to ensure they have the competency to accurately dispense the medication. Storage of the medication is satisfactory, however the home needs to ensure that the cold storage refrigerator is kept locked. A recommendation will be made in this report. Staff were observed knocking on doors before entering, and supporting residents to go to their bedroom in a reassuring manner. Two residents confirm that the staff treat them with respect and maintain their privacy, especially when they are bathing. One resident comments: The staff always knock on he door before entering and are very private when we have a bath. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a stimualting activity programme taking into account the residents preferences and wishes. Visitors are welcome in the home and residents rights and choices are promoted. The meals in the home are good, offering choice and variety. Evidence: The home now has a dedicated activity co-ordinator. Activities include a regular visit from a musician, church services, excersise, barbeques and themed parties, such as halloween. Bingo, board games and quizzes are aslo available. As the co-ordinator was on annual leave at the time of the inspection there was no full activity programme. The co-ordiantor is not replaced, therefore care staff try to provide some activity during the afternnoon. Two residents confirm that the activities are taking place and how much they enjoy them. Another said that he was not interested but would join in if there was something he wanted to do. Comment from a postal suvey is as follows: The activities arranged are varied but I would like a few more activities where more interaction is involved. There are a lot of one to one sessions which are nice for the person involved but not group orientated. Care Homes for Older People Page 15 of 28 Evidence: Residents confirm their relatives visit and they can see them in their room, dining room or conservatory. A resident comments: The staff are very kind and my visitors are made welcome. They always make them a cup of tea. The home does not take an appointee role with regard to any residents finance. Advocacy services are available and this information forms part of the assessment process and is agreed prior to admission to the home. The home support residents with their finances and has recording systems in place, together with the safe keeping of valuables. The menu for the day is displayed in the conservatory and the meal served on the day of the site visit looked appetising. There were a variety of drinks available. Nutrition is fully assessed and recorded in the care plan and records are kept of choices and meals eaten. There are four weekly menus in place. A questionnaire was sent to all residents with regard to the meals being provided and after consultation the menus have been reviewed and amended. Individual dietary needs and special diets are recorded in the care plan and reviewed monthly. Comment from a resident postal survey: Generally I am satisfied with the meals although I would like a more varied menu especially regarding the cakes maybe a yogurt could be given now and again. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can feel confident complaints will be listened to and dealt wtih appropriately. Arrangements are in place to ensure residents are protected from abuse. Evidence: The home has responded to four complaints since the previous inspections. These were responded to in a timely manner and appropriate action taken. The home needs to ensure that confidential records within the complaint folder are removed and placed in a secure storage. There is a suggestion box in the porch of the home and the complaints procedure is also on display. All residents spoken to on the day of the inspection say they have no complaints. Two said if they had concerns they would not hesitate to speak to the staff or manager. There has been one adult protection in the home since the previous inspection. The home raised the alert with social services, followed the correct protocols, took the appropriate action and the alert is now closed. All staff have received safeguarding of vulnerable adult training and demonstrated their awareness of the proceudres. Care Homes for Older People Page 17 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a comfortable and pleasant envrioment which is maintained to a good standard. Laundry facilites are satisfactory and policies and provedures are in palce to control the risk of infection. Evidence: There is a planned maintenance programme in place and since the last inspection the home continues with the ongoing redecoration. The new assisted bath installed in the upstairs bathroom gives residents more choice when bathing. Improvements have been made in the garden and new furniture purchased. Recommendations from the last environmental health office visit have been completed and there is an up to date fire risk assessment in place. A recommendation was made at the previous inspection to paint the outside of the home, but this was put on hold at that time due to the processing of the planning permission to extend the home. Now this planning permission has been granted this will be included in the new extension. A date to commence this work is not available at this time. The home has improved the lighting by cutting down the trees to provide more light in residents bedrooms. Care Homes for Older People Page 18 of 28 Evidence: At the time of the site visit the home was clean and tidy and there are sufficient laundry facilities in place. All staff have received or plan to have infection control training. Care Homes for Older People Page 19 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is adequate staff on duty to meet the residents needs and arrangements are in place for the safe recruitment of staff. A programme of training is in place to ensure service users receive care and support by trained staff. Evidence: The home has a vacancy for a maintenance person and apart from this is now fully staffed. There is usually three care staff on duty together with the Registered Manager or Deputy Manager. In addition to this there is one cook, one domestic and two waking night staff. Feedback from the five postal staff suverys received indicates that two members of staff feel there is never enough staff on duty to meet the needs of the residents, two say always and one says usually. A staff member also comments: Our clients needs change every day, most of the time we are spread very thinly on the floor. When asked if resdients receive the care and support they need, feedback from six postal resident surveys indicates that two say always, two usually and one sometimes. On residents comments: Mainly I receive good care and support but sometimes I am Care Homes for Older People Page 20 of 28 Evidence: asked to wait what feels to me to be an unreasonable amount of time to be taken to the toilet mostly during the night time hours. The dependency of the residents varies as some are dementia service users and some require more than one carer to support and meet their needs. There is also no kitchen assistant provided in the afternoons to serve tea and the carers are therefore required to do this as well as their care duties, leaving two members of staff providing direct care. Although the manager on duty may assist at this busy time, a review of staffing levels needs to be carried out to ensure that sufficient staff is on duty at busy times of the day. A recommendation will be made in this report. Three staff files were looked at and all had the appropriate documentation in place. However, in one case the application form was not completed fully and there was no evidence of previous employment. The home needs to ensure that application forms are completed with full employment history. A recommendation will be made in this report. Two written satisfactory references and proof of identify are on file. The Protection of Vulnerable Adult (POVA) and Criminal Record Bureau (CRB) checks have also been carried out. This ensures that residents are receiving care from staff that have been checked and are safe to provide care services. There are eight members of staff who have achieved National Vocational Qualified (NVQ) 2 or above, and this is over the required 50 . There is an ongoing NVQ programme for all staff to access. This ensures that residents are receiving care from trained qualified staff. The home has a training matrix, which indicates that all staff have received mandatory training. The training programme is ongoing and specialist training in dementia has also been provided to all staff. Senior staff have received more in depth dementia training. There is an ongoing training programme in place and copies of the training certificates are on individual staff files. Care Homes for Older People Page 21 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well run home, however there are shortfalls in the quality assurance system. The home has systems in place to ensure that residents financial interests are protected. Improvements are required to carry out weekly fire tests to ensure that the home is fully ptrotected and safe. Evidence: Karen Warner, is the Registered Manager of the home and has a sound knowledge of the home, having commenced employment in 2001. She became the Manager in August 2007 and is currently completing NVQ 4 and the Registered Manager Award. The Deputy Manager is also new in post, she has many years of experience and is currently completing NVQ 3. Care Homes for Older People Page 22 of 28 Evidence: A Quality Assurance questionnaire has been sent out to residents and in some cases relatives have assisted in completing the forms and made comments. This information has not been analysised and the results have not been made know to everyone. Questionnaires were also sent to residents with regard to the menus and meals being provided. This information was acted upon and the menus were changed to implement residents wishes. Further development of the quality assurance system is required to include the analysis and action taken. There are lots of informal quality assurance processes, which are not formalised in writing. For example, the Registered Manager visits residents daily, there is an open door policy and a weekly relative surgery for visitors to discuss any concerns. This however is not recorded or evidenced. Residents meetings are held and minutes were available at the time of the inspection and the home regularly sends out a newsletter. There is no written evidence however from other stakeholders, such as health care professionals. There was a requirement to improve the quality assurance programme in the previous inspection. Although the home has developed the programme, further recording of all discussions and any action taken to improve the home needs to be evidence. This will show that the home has made changes to the service as a result of listening to the residents, relatives and other stakeholders. As the final report and analysis was not available at the time of the site visit a recommendation will be made to ensure that this is completed and available for everyone concerned. The Area Manager states that the quality assurance programme will be reviewed and a formal procedure will be implemented. When residents move into the home it is agreed who will support them with their finances. Advocacy services are also available and information is on display in the home. The home has a robust financial accounting system in place, which is audited on a regular basis. Receipts for all transactions are on file and copies of the accounts are sent to relatives or representatives when required. Some relatives sign the records on behalf of the residents, and the home needs to encourage and support residents who are able to sign for their monies and be more involved with their finances. An ongoing programme of mandatory training is being provided, including induction training. The relevant safety checks in the home have been carried out. The fire book contains evidence of tests and drills taking place, however this is not being completed on a weekly basis and a requirement to do this will be made in this report. Environmental risk assessments are also in place and accidents were tracked though to service user plans, recorded and appropriate action taken. Care Homes for Older People Page 23 of 28 Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 38 13 The Responsible Individual 17/12/2008 must ensure that weekly fire tests are carried out. To make sure the fire alarm system and all points are periodically tested to protect the home from fire Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 To ensure the Assessment Form includes information on religion and personal preferences to ensure the home can meet individual needs To ensure that all care plans clarify what the word assistance means to the individual and risk assessments are completed to include clear guidelines of how to move each resident safely. To review staffing levels at core times to ensure that residents needs are met To ensure that all application forms are completed with full employment history. The home needs to ensure that the quality assurance programme is further developed to evidence that the residents, relatives, representatives and stakeholders are Page 26 of 28 2 7 3 4 5 27 29 33 Care Homes for Older People advised of the outcome of the programme and what changes have been made as a result of listening to the people. Care Homes for Older People Page 27 of 28 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - 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!