Inspection on 11/09/08 for Brooklands Nursing and Residential Home

This inspection was carried out on 11th September 2008.

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

Brooklands Nursing and... 21/01/10

Brooklands Nursing and... 19/10/06

Brooklands Nursing and... 28/02/06

Brooklands Nursing and... 20/10/05

Brooklands Nursing and... 04/01/05

Brooklands Nursing and... 09/07/04

Brooklands Nursing and... 24/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 26/11/2008.

CARE HOMES FOR OLDER PEOPLE Brooklands Nursing and Residential Home 44 Albany Road Old Swan Liverpool Merseyside L13 3BJ Lead Inspector Jeanette Fielding Key Unannounced Inspection 11th September 2008 09:30 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 Brooklands Nursing and Residential Home DS0000025092.V365172.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. Brooklands Nursing and Residential Home DS0000025092.V365172.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brooklands Nursing and Residential Home Address 44 Albany Road Old Swan Liverpool Merseyside L13 3BJ 0151 252 0080 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) Rosewood Care Services Limited Mrs Charlotte Sillitoe Care Home 49 Category(ies) of Old age, not falling within any other category registration, with number (49) of places Brooklands Nursing and Residential Home DS0000025092.V365172.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 with nursing - Code N 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 - Code OP The maximum number of service users who can be accommodated is: 49 Date of last inspection 19th October 2006 Brief Description of the Service: Brooklands is a large home providing both personal and nursing care to older people over the age of 65 years and is located in the Old Swan district of Liverpool. Local amenities such as shops and churches can be found within a short walking distance and good transport links are available to local communities, nearby towns and Liverpool City centre. The home is purpose built with accommodation on two floors. A passenger lift provides full access to the upper floors of the home. There is wheelchair access and parking at the front of the premises. A pleasant, private garden is located to the rear of the building. Fees range between £322.50 and £429 per week depending on the level of care required. Brooklands Nursing and Residential Home DS0000025092.V365172.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that people who use the service experience good quality outcomes. This unannounced key inspection was undertaken in one day over a period of seven hours. As part of the inspection process, all areas of the home were viewed including many of the service users bedrooms. Assessments and care plans were inspected together with staff records and certification to ensure that health and safety legislation was complied with. Observation of the interaction between staff and people who live at the home provided further evidence of the actual care given. Seven service users were case tracked to evaluate their care and obtain their views. Discussion took place with the manager, nurses, care staff, service users and visitors to the home. The manager completed an Annual Quality Assurance Assessment form prior to the inspection to give additional information regarding the home. What the service does well: What has improved since the last inspection? Improvements to the décor and furnishings within the home continue to ensure that service users are provided with a bright, pleasant and homely environment. The deployment of staff has been reviewed to ensure that each shift provides a mix of staff skills and experiences to meet the individual needs of the service users. Brooklands Nursing and Residential Home DS0000025092.V365172.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Brooklands Nursing and Residential Home DS0000025092.V365172.R01.S.doc Version 5.2 Page 7 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 Brooklands Nursing and Residential Home DS0000025092.V365172.R01.S.doc Version 5.2 Page 8 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): 1 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Full information regarding the services and facilities offered by the home enables prospective service users to make an informed decision regarding their care provider. EVIDENCE: The home has produced a detailed Service User Guide and Statement of Purpose. These documents are issued to all prospective service users and their relatives to provide them with full information regarding the services and facilities offered by the home to enable them to make an informed decision regarding their care provider. These documents are also on display in the foyer of the home together with sample menus, activities programme, the Annual Service Review and the last two Inspection Reports. Brooklands Nursing and Residential Home DS0000025092.V365172.R01.S.doc Version 5.2 Page 9 Prospective service users and their relatives are encouraged to visit the home, view the rooms available and to meet with staff and service users. Pre-admission assessments are undertaken by the manager or one of the nurses prior to the service users’ admission to the home. These assessments are undertaken to identify the service users medical, care and social needs and to enable any specialist equipment to be made available prior to admission. The manager has prepared a designated assessment form which identifies with all the information that is need to confirm that the home can meet the service users’ needs. The prospective service user, their family and any health care professional involved in their care are requested to contribute to the assessment. A record is held of all those who have contributed to the assessment and given information. The assessment is also an opportunity to identify service users individual preferences and choices to be recorded to enable the home to meet all their needs. The care files for two recently admitted service users were inspected. The assessments were extremely detailed and informative and provided sufficient information to enable a plan of care to be developed. The home does not offer intermediate care. Brooklands Nursing and Residential Home DS0000025092.V365172.R01.S.doc Version 5.2 Page 10 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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Detailed care plans are prepared to provide staff with full information to enable them to meet service users’ health, care and social needs. EVIDENCE: Comprehensive care plans are prepared for each service user to provide staff with full information regarding the care needs and individual preferences of each service user. The care plans of seven service users were inspected and showed that their care needs had been identified and action plans set in place to address those needs. Risk assessments had been undertaken and risk management plans put in place to reduce or remove those risks where necessary to ensure that the service users are protected from harm. The manager has recently completed her degree in Health and Social care. Falls management played a major part in this training and involved a high level Brooklands Nursing and Residential Home DS0000025092.V365172.R01.S.doc Version 5.2 Page 11 audit of the type of falls, the ages of the service users and the time of year. This has had a major impact on the documentation in the home into falls management and all service users now have comprehensive risk management plans to reduce the risk of trips and falls to keep them safe. Evidence of visits to and by GP’s, Chiropodist, Dentist, Tissue Viability Nurse Specialists, Dietician, Speech and Language Therapists and other health care professionals was seen, together with information given to the home by these professionals. The records completed by staff following these visits are detailed and informative and give full information and instruction for the staff team. Care plans are reviewed and updated on a monthly basis and more frequently if the service users needs change. Daily reports provide evidence of the actual care given by the staff. These reports are detailed and informative. All records are clearly written by the staff. Medications are dealt with in accordance with the home’s policy and procedure. Records were well maintained and up to date. The medications storage area was clean and organised. Unwanted medications are stored and disposed of appropriately and no unnecessary medications are held in the home. Information regarding individual medications is held in the home to advise and inform staff as necessary. Service users may meet with their visitors in the privacy of their bedroom or in one of the communal areas as they wish. Service users and visitors spoken to confirmed that they were made welcome at the home at all times and spoke highly of the staff team. Service users confirmed that their privacy and dignity were respected by the staff. Staff were observed to speak discreetly to the service users when referring to personal issues. Brooklands Nursing and Residential Home DS0000025092.V365172.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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A range of activities are offered to provide service users with entertainment and stimulation to enrich their lives. EVIDENCE: As part of the pre-admission assessment and care planning process, the home gathers information regarding the service user’s previous lifestyle. Details are recorded about employment, social life and hobbies. Information is also gathered regarding food likes and dislikes and the time that the service users like to go to bed and rise to enable the staff to meet their individual choices and preferences in all aspects of daily life. A programme of activities is prepared and includes film shows, music, quizzes reminiscence and floor dominoes. The home is close to a major supermarket and shops and, where possible, service users are taken to these to choose their own personal items. Some service users like to go to the local café for Brooklands Nursing and Residential Home DS0000025092.V365172.R01.S.doc Version 5.2 Page 13 coffee and a few like to go for a pub lunch. Trips out are made on a regular basis and the service users choose the places that they would like to go to. Clergy visit the home each week and provide services for all who request this. Visitors are welcome at the home at any time and service users can meet with their visitors in the privacy of their own bedroom or on one of the communal areas as they wish. One visitor said that he was made very welcome by the staff and that he felt that he was able to participate in the care if he wished. Some relatives take service users out during the day and one visitor said that the staff always had her relative ready to go at the time that she had planned. Service users are encouraged to take their meals in the dining room but may take them in the lounge or in their own bedroom as they wish. The dining rooms are bright and welcoming and tables are laid appropriately with cutlery and condiments appropriate to the meal being served. Large trays of fruit are set out in the dining room for service users to help themselves as they wish. Service users spoken to said that the meals in the home were good and said that they enjoyed them. They confirmed that they were offered a choice of meals and could always request something that was not on the menu. Meals are prepared in the main kitchen. The kitchen is clean and organised and food stocks are good. Special diets can be provided on the advice of the GP, dietician or on the request of the service users. Service users are involved with the preparation of menus, which change according to season and following discussion with service users. The meal served on the day of the visit looked and smelled appetising. Service users who require assistance with their meals are given this by staff in a calm and unhurried manner. One service user said ‘The food is lovely. Its just plain home cooking. There is always something else if we don’t like what is on offer. There are two choices, but if I’m not feeling up to a big meal, they will make me something light’. Brooklands Nursing and Residential Home DS0000025092.V365172.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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are protected from abuse through a robust complaints procedure and a well-trained staff team. EVIDENCE: The home has a robust complaints procedure which is displayed on the wall in the foyer and also detailed in the Service User Guide. No complaints have been made to the home or to CSCI since the Annual Service Review. Policies and procedures are in place to protect service users from abuse and encourage staff to raise any concerns. Service users said that they spoke to the manager who was open and approachable. They could raise any issues and these were dealt with so that they had no cause to complain. One service user said that she liked to ‘grumble’ and did so with great regularity, but these were not complaints, but just ‘an enjoyable way to have a laugh with the staff.’ She confirmed that she had no concerns about the home or the care she was given. All staff are given training on abuse during their induction training and further training has been given to all staff. Staff spoken to during the visit were able to demonstrate that they were aware of the different types of abuse and of the action they should take in the event of this being suspected. Records of training are held on the staffs’ individual files. Brooklands Nursing and Residential Home DS0000025092.V365172.R01.S.doc Version 5.2 Page 15 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, 20, 21, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An ongoing programme of improvement ensures that service users have a bright, homely and pleasant home in which to live. EVIDENCE: The home provides accommodation in single bedrooms. Some double rooms are available but only used for shared occupancy on request. The programme of redecoration and improvements continues. New armchairs have been provided in the lounge and new dining room furniture provided. The lounges and dining rooms have been redecorated and provide a pleasant and homely environment. New curtains have been fitted and new linens provided. The home has a dedicated hairdressing room with two appropriate Brooklands Nursing and Residential Home DS0000025092.V365172.R01.S.doc Version 5.2 Page 16 washbasins. Two new hairdresser style hairdryers have recently been purchased. The hairdresser visits the home to provide a full service for the service users. A number of bedrooms have been redecorated and service users are given the opportunity to choose the colour scheme of their room. Plans are in place to replace the carpet on the ground floor corridor. Some of the bathrooms are showing signs of age and the manager stated that these are due to be redecorated and upgraded in the near future. The home provides sufficient toilet and bathing facilities with a wide range of aids and adaptations for those who have mobility difficulties or require a greater level of assistance. The home employs a maintenance person and all maintenance issues are addressed as necessary. The home is maintained to a good standard and all health and safety issues are dealt with as soon as they are identified. Lounges and dining rooms are provided on both the ground and first floors and service users are free to choose which areas they spend their day. The majority of service users have a television in their own bedroom and choose to spend time in their own rooms. Staff and relatives have encouraged service users to personalise their rooms with pictures, photographs and items of memorabilia to further provide a warm and homely atmosphere which reflects their individual choices and personality. One relative said ‘The home is always clean and fresh and my mums room is lovely’. The garden provides lawns bordered by plants and shrubs and is a pleasant place for service users to spend warmer days. Seating is provided and service users are free to use the garden at any time. All areas of the home were clean and fresh. Appropriate disposal arrangements are in place for clinical and general waste. Brooklands Nursing and Residential Home DS0000025092.V365172.R01.S.doc Version 5.2 Page 17 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by a staff team that is recruited and trained to support safe care practices in the home. EVIDENCE: The home employs qualified nurses and care assistants to provide nursing and personal care to service users. The staff rotas provide evidence that the home is employing and deploying staff in sufficient number to meet the needs of the service users. Since the last inspection, the position of senior care assistant has been introduced to give the more experienced and appropriately qualified staff more responsibility in relation to service users who are accommodated for personal care. Additional training has been given to these staff who are aware of their role and responsibilities. A qualified nurse works on each floor and is supported by a team of care staff. The home has introduced two specific teams for each floor to provide a consistent approach to care for the service users and has allowed for staff of a range of skills and experiences to work in each of the teams. The manager works on a full time basis and is supernumerary to the staff on duty. One of the owners, who is also a qualified nurse, also works in the home on a Brooklands Nursing and Residential Home DS0000025092.V365172.R01.S.doc Version 5.2 Page 18 supernumerary basis to provide support and supervision and to ensure that the standards within the home are maintained. Training continues to be given to staff and 70 of the care staff now hold NVQ qualifications. Recent training includes moving and handling, fire, customer service, protection of vulnerable adults, whistleblowing, infection control, first aid, food hygiene and health and safety. All in house training is certificated and detailed records are held on the staff files. External training opportunities are open to all staff. Staff spoken to confirmed that a high number of training opportunities were available. The home has a robust policy and procedure for the recruitment of staff which is in accordance with equal opportunities legislation. All prospective staff are required to complete an application form and then attend for interview. Two references are taken and checks made with the CRB and POVA and evidence of qualifications is required to be produced. The files for four members of staff were inspected and were found to contain all necessary information. Induction training is given to all new staff and records of this training are held on the staff files. Supervision is given to all staff on a regular basis and staff meetings are held to provide a forum for open discussion and the dissemination of information. Brooklands Nursing and Residential Home DS0000025092.V365172.R01.S.doc Version 5.2 Page 19 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, 32, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager is well supported by staff to ensure that service users are protected and provided with a quality lifestyle within a safe environment. EVIDENCE: The registered manager is a qualified nurse who also holds a Diploma in Management, Diploma in Health and a BSc in Health and Social Care. She is currently studying Medical Law. She is experienced in the management of care services for elderly people. She is supported by the owner of the home who is also a qualified nurse and who works in the home on a supernumerary basis as she chooses. Brooklands Nursing and Residential Home DS0000025092.V365172.R01.S.doc Version 5.2 Page 20 Staff and service users spoke highly of the manager, saying that she was approachable and would deal with any issues that arose. One member of staff said that the manager was ‘devoted and would do anything for the service users.’ The manager and staff were observed to speak with service users in a respectful manner. The home does not deal with service users personal monies as this is dealt with by relatives or advocates who are invoiced for costs such as hairdressing and chiropody. Policies and procedures are reviewed on a regular basis to update them in line with changing legislation and good practice recommendations. Tests are made on the fire detection equipment as required and is duly recorded. Training on fire prevention and fire drills is given to all staff on a regular basis. All contracts, tests and safety certificates inspected were found to be well maintained and up to date. Brooklands Nursing and Residential Home DS0000025092.V365172.R01.S.doc Version 5.2 Page 21 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 3 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 3 3 X X 3 X 3 STAFFING Standard No Score 27 4 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 X 3 X X 3 Brooklands Nursing and Residential Home DS0000025092.V365172.R01.S.doc Version 5.2 Page 22 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 Brooklands Nursing and Residential Home DS0000025092.V365172.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection N W Regional Office 3rd Floor Unit 1 Tustin Court Port Way Preston PR2 2YQ 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 Brooklands Nursing and Residential Home DS0000025092.V365172.R01.S.doc Version 5.2 Page 24 - 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!