Inspection on 21/11/08 for Bridgemead

This inspection was carried out on 21st November 2008.

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

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

Bridgemead 05/12/06

Bridgemead 28/02/06

Bridgemead 07/11/05

Bridgemead 03/03/05

Bridgemead 02/11/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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: Bridgemead 81 St John`s Road Bathwick Bath Bath & N E Somerset BA2 6PZ     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: Andrew Pollard     Date: 2 1 1 1 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 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Bridgemead 81 St John`s Road Bathwick Bath Bath & N E Somerset BA2 6PZ 01225484904 01225466486 pam@bridgecare.plus.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Bridgecare Limited care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Manager must be a RN on parts 1 or 12 of the NMC register May accommodate up to 16 persons aged 65 years and over requiring personal care. May accommodate up to 24 Persons over 50 years of age requiring nursing care Staffing notice dated 03/03/2000 applies Date of last inspection Brief description of the care home Bridgemead is registered as a care home for a maximum of 32 service users, accommodating up to 24 service users requiring nursing care. It is operated by Bridge Care, a Christian trust and registered charity. The home also provides day care, Monday to Thursday, for up to 8 service users. The house is considered a home for life and all physical health care needs would be met, including end of life care. The cost per week to reside at Bridgemead ranges from five hundred and fifty six pounds to seven hundred and eighty six pounds. Fees are reviewed annually. This weekly fee does not include provision for items such as hairdressing, chiropody, dental, ophthalmic or aromatherapy services. Prospective residents can be provided with Care Homes for Older People Page 4 of 26 Over 65 32 0 Brief description of the care home information about the home by accessing the Service Users Guide, which will detail the services and facilities available at the home. Care Homes for Older People Page 5 of 26 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 an unannounced inspection visit conducted as part of the annual inspection process. Prior to the visit the inspector spent some time examining documentation accumulated since the previous inspection, including the Annual Quality Assurance Assessment, notified incidents and the reports conducted by the Registered Providers. The inspector sent surveys to all residents in the home prior to the inspection and 17 were completed and returned. Surveys were also given to staff and visiting health and social care professionals. Information from these has been collated and is detailed throughout the report. Care Homes for Older People Page 6 of 26 The inspector spent time throughout the visit in discussions with the registered manager, a number of residents and staff. Residents care plans and care files were examined. Records and files relating to the day to day running and management of the home were examined. The inspector toured the premises. Feedback was given as the visit progressed on the outcome of the inspection. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.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 8 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 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. Prospective clients and their families are given relevant information in written or verbal form about the home. Contracts and terms and conditions of services are provided to all clients.The assessment procedure is clearly written and a thorough assessment of prospective residents needs is carried out. Evidence: A brochure containing a service user guide and statement of purpose and other information is made available to prospective residents and their families. All residents stated in their surveys that they and their families had received information about the home prior to admission. The service user guide is to be revised to include more detailed admission criteria due to the Commissions intended removal of conditions. The pre-admission assessments were fully completed and informative. The manager or a senior nurse meets with prospective residents and their families Care Homes for Older People Page 10 of 26 Evidence: prior to admission. Familiarisation visits can be arranged if desired. The prospective resident, family and carers are involved in the assessment and all information is used to determine the suitability of the placement. Where possible the manager obtains assessments and care plans from other professionals for example, social workers and hospital staff. All residents are assessed to determine if health care funding is payable. All residents are given written terms and conditions on admission. Care Homes for Older People Page 11 of 26 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. Staff treat the residents in a warm and respectful manner.Care plans are detailed and relate to residents care needs. The staff provide appropriate personal and nursing care to maintains peoples health, well being and dignity. Good arrangements are in place for residents to access primary health care services.The staff properly store, administer and record medication on behalf of residents. Evidence: Several resident case files were examined during the inspection. The information supports peoples health and social needs including, psychological, emotional, and cultural needs, which demonstrates that the home takes a holistic approach to the provision of care. The documentation was detailed, clearly written and up to date. It is intended that more emphasis is to be put on developing a more person centred approach this year to include social and recreational aspects. It is intended that each resident has a brief biography written and a person centred assessment where their wishes, likes and dislikes are recorded as part of the care plan. Health Care needs were clearly detailed in the care files and included, wound care, nutritional, and Care Homes for Older People Page 12 of 26 Evidence: pressure area risk assessments. All care plans are evaluated regularly, Registered Nurses are involved with this process. It was suggested that a full reassessment of needs are carried out at least annually for each resident, with the involvement of the resident, family, the named nurse and key worker wherever possible. The reviews allow opportunity to discuss and evaluate residents care plans and any issues or concerns they may have. End of life Care Plans have been established in the home whereby residents are encouraged to think ahead about the care they would like to receive if their health deteriorates, using the Gold standard approach. Residents spoke positively about the staff and the care they receive. All were confident that if they had any problems they could talk to the staff or the manager who would sort them out. Residents confirmed that they were treated with respect. Each resident is registered with a General Practitioner. All residents stated in their surveys that they receive good medical support. Two GPs returned surveys giving positive outcomes, one saying, If only all nursing homes we deal with were as well run. District Nurses visit those residents not in receipt of nursing care. Daily notes are maintained for all residents. Records of the GP and Consultant visits and those from other professionals were evidenced in files including, chiropodists, opticians and dentists. Policies and procedures for receiving, storing, administering and disposing of medications were in place and all the records were up to date and in order. One person is self medicating. Care Homes for Older People Page 13 of 26 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. A range of social and recreational activities is arranged that seek to enhance the quality of life for the residents, which is both enjoyable and stimulating. Residents are able to maintain close contact with families and friends who are very involved with the home. The food is of a high standard and provides a balanced diet for residents. Evidence: The activity organiser works 20 hours per week and creates a monthly calendar of activities, such as theatre, outings, visiting entertainers, reminiscence and events in the garden. A copy of the calendars are circulated to residents and placed in communal areas to ensure that residents and visitors are aware of planned activities. Trips and outings are arranged throughout the year. Regular entertainment is provided in the afternoons including singers, musicians and guest speakers. It was suggested that relatives and staff are enlisted to develop more detailed residents biographies and social profile including interesting facts and life history information about each person. These documents will assist in creating social assessments in the care plan and developing more tailored activity plans for individuals. Residents meetings take place quite regularly to which relatives are also Care Homes for Older People Page 14 of 26 Evidence: invited. The surveys indicated that people said there were activities arranged that they could take part in. A photographic display of memorable days and events is on view in the corridor, which is updated and provides memories and topics of conversation for residents. In surveys residents said they had enjoyed attending various events at the home. Residents said that the social activities were varied and there were opportunities to do things if you wanted to. A full programme of activities is planned for Christmas including, local children singing carols and performing a nativity play, outings to see the Christmas lights are planned and visiting players are to preform a pantomime. The home provide presents for all residents and relatives are invited to Christmas parties and events. The grounds and gardens are well maintained and a volunteer gardiner works three days per week. The home also has a mobile shop and residents can buy a range of useful day-to-day items, including toiletries, sweets and a selection of greeting cards. The hairdresser visits weekly. Clergy of Christian denominations visit the home, there are two linked Chaplains. Weekly services take place. A monthly service and communion takes place. There are currently no residents with other faith backgrounds but the home would seek to meet any cultural or religious practise requirements of new residents. However, the staff team are multi cultural and a number recently conducted an event to explain aspects of their culture and provide examples of their food. The cook spends time with the residents to see if they are happy with the menus and this is discussed at residents meetings. Details of individual likes and dislikes are known and special diets including diabetic diets were catered for. The rotational menu offers traditional food and a meal of the day is set but choice is available at each meal. Surveys and discussion with residents confirmed that they enjoyed the meals provided and portions were tailored to their wishes. The kitchen had received an inspection by the Environmental Health Inspector and all was found to be in order. Care Homes for Older People Page 15 of 26 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. There are good arrangements in place for staff training and awareness related to safeguarding of adults.There are robust and comprehensive policies in place to protect residents, investigate complaints or manage any allegations of abuse. Evidence: A copy of the complaints procedure is on display in a well-frequented part of the home. There have been no complaints received by the home or the Commission. Residents who completed a survey indicated that they knew how to complain and who to talk to if they were not happy. Surveys and conversations with residents did not elicit any complaint. Comments included, I never need to complain. The healthcare professionals who responded indicated that they had never had any concerns about care. The home promotes staff training and education in adult protection during induction and by regular updates. Training has been booked for staff updates at alerter level, facilitated by the local Authority. Staff undertaking the National Vocational Qualification in care award complete a component of the award that addresses issues around the topic of safeguarding adults from abuse. Care Homes for Older People Page 16 of 26 Evidence: There are procedures as well as a range of guidance information on the topic of protection from abuse. The manager has attended investigators adult protection training run by the Local Authority. The home has a copy of the Bath and North East Somerset No Secrets or multi agency working policy. The General Social Care Council code of practice has been distributed to the care staff. Care Homes for Older People Page 17 of 26 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. The home is comfortable, well decorated and furnished. It provides a safe, peaceful environment for the residents. The standard of furnishing and decor is good to the benefit of residents. Bedrooms and communal rooms and facilities are suitable and well presented for their purpose and meet the residents needs. The standard of cleanliness is high. Evidence: The home is a purpose built home for older people. There are attractive grounds and views of the river that residents stated they enjoyed. The home is on three levels and a lift gives level access to all facilities. There are a variety of communal areas, lounges, dining rooms, a conservatory and quiet rooms. A number of residents have wireless Internet access and a new IT room is being created for residents to use. Bedrooms have en-suite bathrooms and there are communal bathrooms equipped with toilet and bathing aids. The home is well furnished, decorated, clean and maintained to ensure that all areas are homely. Residents are supported to personalise their bedrooms with pictures and ornaments and are able to bring items of furniture should they wish. Care Homes for Older People Page 18 of 26 Evidence: The home provides specialist equipment when necessary including pressure relieving equipment, profiling beds and electric reclining chairs for the residents in the home. The house was clean and free from unpleasant odours. The home employs domestic staff on a daily basis. Residents surveys confirmed that the home is always fresh and clean and one resident stated, There are good standards of cleaning here. Care Homes for Older People Page 19 of 26 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. The recruitment procedures and records are in good order to protect residents.The home is staffed with appropriately trained and experienced staff and review of numbers is being undertaken.There is good training of care staff for the benefit of residents. Evidence: At present there are six care assistants (CA) and a Registered Nurse(RN) on duty in the morning, five CAs and one RN in the afternoon and three plus one at night. The manager who is a RN is in addition to these staff. The nine staff surveys gave a mixed view of staffing levels, 3 people saying there were always enough staff on duty, 4 people that there were usually enough, 1 said sometimes and 1 said never. Two people wanted more staff in the mornings and there were three comments about the issue of managing dementia in the home which was time consuming. These views were supported by staff spoken to during the inspection. The manager is to convene a staff meeting to give all staff the opportunity to openly discuss the issue and will explore different ways of resolving the matter. In all other respects the staff survey outcomes were positive in particular around training and stating that they felt the standards of care were very good, this was supported by surveys and conversations with residents. The home is adequately staffed with house keeping and catering staff. in addition the Care Homes for Older People Page 20 of 26 Evidence: are admin and reception staff, an activity organiser and a number of volunteers. There is a warm cheerful atmosphere in the home The staff and resident interactions were respectful and caring. Staff have a committed attitude to their roles and responsibilities in ensuring they provide quality of care to the residents. All residents surveys agreed that staff were available when they needed them and listened to and acted upon what the residents had to say. The inspector viewed the personnel records for several staff members including new recruits. Staff files seen showed that employment records were in good order. Criminal Records Bureau disclosures are carried out prior to recruitment. All original disclosures were signed. A risk assessment had been conducted for one person but there was no written record of it, the manager was to write it up retrospectively. Registered Nurse PINs are validated annually. Staff turnover rates are low. The home has a small bank of staff and agency use is minimal. There is an induction programme, which includes all mandatory training, Fire, Manual Handling, Health and Safety, food hygiene and the Protection of Vulnerable Adults. The home has a mentor system where all new staff are linked with and shadow a senior staff member during each shift to enable continuity and continued training throughout the induction process. The home continues to support their staff with their NVQ training. In excess of 62 have completed at least level 2 three staff have level 3 and two more are on programmes for such. The nurse training records related to clinical updating were up to date and showed a range of clinical updating taking place. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and run in the best interests of residents taking into account their views and wishes. The Home protects the health and safety of residents and staff. The staff supervision and appraisal arrangements are in place to maintain quality of care for the residents. Evidence: Ms Bourton was appointed as manager seven years ago, she is able to demonstrate a clear understanding of regulations and management skills that are in line with the aims of the home and is fully supported by a senior RN and the trustees. The home has a stable staff team that has a commitment to providing quality care for the benefit of the residents. All staff receive supervision roughly every three months and an annual appraisal from which learning needs are identified. Some of the other senior staff have been trained to carry out supervisions so the manager can in part Care Homes for Older People Page 22 of 26 Evidence: delegate the role out. New documentation has been introduced for the new round of supervisions. One member of staff is pursuing a grievence which has somewhat stalled and the manager is going to facilitate it progressing to the next level. The home has appropriate policies and holds money and valuables in safe keeping for a number of residents. Records are kept which were found to be in good order at the last inspection. Regular staff meetings are held, enabling staff to have input and receive feedback concerning the running of the home. Regular resident and relative forums are held and play an active role in shaping the provision of care and services in the home. The results of the residents surveys and discussions with residents were overwhelmingly positive with all aspects of care, food, activities and the quality of staff being praised. Comments included,A very good home, with very caring staff and I only have complimentary comment. A relative rang the Commission to praise the quality of care and attitude of staff. Based on the comments made and through the inspectors observation it is evident that the home is run in the best interests of residents. The provider has recently carried out an annual quality assurance survey to assess the satisfaction with regards to the service that the home provides. The results are very positive. The results have enabled the home to identify strengths and weaknesses within the service and provide information to create an improvement plan The AQAA submitted to the Commisssion give good detail with regard to further planned improvements. The manager has responsibilities for aspects of Health and safety in the home and has had previous training but considers she may need to update her knowledge in the coming months. The home facilitates training of staff in Moving and Handling. Accident records and notifications to the Commission about incidents affecting residents are properly completed. The fire log book was up to date and in order. Health and safety records showed that relevant inspections and maintenance have been carried out for the fire alarm, fire fighting equipment, gas, hoists, lift and all other relevant equipment. Generic risk assessments have been reviewed for the resident and staff areas. Care Homes for Older People Page 23 of 26 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 24 of 26 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 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 2 7 12 Carry out at least annual reassessment of all residents needs and rewrite the care plan documentation. Encourage residents, families and care staff to develop more detailed biographies of residents which can be used as part of a detailed social assessment and tailored care plans. Ensure that when necessary risk assessments of disclosures are formally written up. 3 29 Care Homes for Older People Page 25 of 26 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 © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 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!