Inspection on 29/06/05 for Carter House

This inspection was carried out on 29th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Carter House 31/05/07

Carter House 20/06/06

Carter House 16/11/05

Carter House 16/03/05

Carter House 26/08/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Carter House 1&2 Farnham Gardens West Barnes Lane London SW20 0UE Lead Inspector Emma Dove Unannounced 29 June 2005 09:40am and 30 June 2005 11:30am th th 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 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. Carter House G54-G04 S42026 Carter House V238724 290605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Carter House Address 1&2 Farnham Gardens West Barnes Lane London SW20 0UE 020 8947 5844 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Central and Cecil Hilma Dunn CRH (N)- Care Home with Nursing 45 Category(ies) of OP Old Age (23) registration, with number DE(E) Dementia Over 65 (22) of places Carter House G54-G04 S42026 Carter House V238724 290605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Nursing Places To include no more than 15 service users requiring nursing care at any one time. 2. Dementia Places To include no more than 22 service users with Dementia at any one time. 3. Nursing Unit 2nd Floor - Qualified Staff A qualified 1st level nurse must be available on the nursing unit at all times. This person must not have any management responsibilities for the home other than within the nursing unit. 4. Care Staff - all times 07:30 hrs to 14:45 hrs - a minimum of seven care assistants must be available at all times. 14:15 hrs to 21:30 hrs - a minimum of six care assistants must be available at all times. 21:00 hrs to 08:00 hrs - a minimum of five care assistants must be available at all times. 5. Management One full time manager 40 hours per week. One full time deputy manager 40 hours per week. A member of the management team to be available seven days each week. 6. Ancillary Staff Administrative staff 37.5 hours per week Domestic staff 136.5 hours per week Cook 49 hours per week Kitchen assistants 102 hours per week Laundry staff 70 hours per week 7. Reviews The organisation must ensure that the above minimum staffing levels remain under review and that at all times suitably qualified, competent and experienced persons are working in the home in such numbers as are appropriate for the health and welfare of service users. 8. Distribution of staff The number and distribution of nurses, care staff and ancillary staff must be reviewed at regular intervals. If at any time the evidence indicates that there are insufficient staff of any category available to meet the assessed needs of service users, the CSCI will require additional staffing as appropriate. Carter House G54-G04 S42026 Carter House V238724 290605 Stage 4.doc Version 1.40 Page 5 Date of last inspection 16 & 18/03/05 Brief Description of the Service: Carter House is a purpose built care home, which has the capacity to provide nursing care for fifteen older people and residential care for thirty older people, twenty-three of whom may have dementia. Forty five residents are currently residing at the home with three residents in hospital. The home is owned and managed by Central and Cecil, a charitable organisation who own and manage four other similar services in the Merton and Richmond area. Accommodation is provided over four floors with a lounge, dining room, kitchenette, bathrooms and single bedrooms available on all four floors. Residents have access to enclosed gardens to the rear and side of the home. A lift serves all floors of the home. The home is situated in a residential area of Raynes Park, close to local shops, public transport, churches of a number of denominations and leisure facilities. The home is staffed twenty-four hours a day by trained nursing staff and care assistants. Residents receive three meals each day with drinks and snacks available between meal times. Carter House G54-G04 S42026 Carter House V238724 290605 Stage 4.doc Version 1.40 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over the course of ten hours over two separate days by one inspector and a separate day by the pharmacy inspector. The inspection consisted of examination of records, inspection of communal areas of the home and three residents bedrooms, talking with residents, staff and the registered manager. The inspector had the opportunity to speak with sixteen residents, one visitor and ten members of staff. What the service does well: What has improved since the last inspection? What they could do better: The care plans must include more details, to ensure residents needs are fully documented and can be met by staff. A consistent record of residents weight must be maintained to ensure residents health is monitored. To ensure residents health and welfare, all medications must be signed for at the time of administration, accurate records must be maintained of medications and creams currently in use for each resident, medication must be administered as per the prescribers directions, clear directions for the administration of all medication must be in place and eye drops must have the date recorded on them when they were opened. Carter House G54-G04 S42026 Carter House V238724 290605 Stage 4.doc Version 1.40 Page 7 Mealtimes must be reviewed including the number of staff available to assist residents with eating, how staff invite residents to the meal table. The individual dinner trays used for residents who take meals in their bedrooms must have a cover over the meal with condiments and sauces available to residents. The cleaning programme must include regular cleaning of all extractor fans in ensuite toilets, bathrooms and shower rooms. Also systems must be put in place to report any marks on residents bedroom paintwork so that it can be cleaned or repainted as required, to ensure that the home is maintained at a satisfactory standard. The staffing levels must be kept under review, particularly on the ground, second and third floor, to ensure all of residents needs can be met at all times. 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. Carter House G54-G04 S42026 Carter House V238724 290605 Stage 4.doc Version 1.40 Page 8 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 Standards Statutory Requirements Identified During the Inspection Carter House G54-G04 S42026 Carter House V238724 290605 Stage 4.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3 & 5 A Statement of Purpose and Service Users Guide are available, enabling prospective residents to make an informed choice regarding moving into the home. Residents needs are appropriately assessed prior to admission ensuring that the home is suitable to meet their needs. EVIDENCE: A Statement of Purpose and Service Users Guide to the home are in place, providing prospective residents with the information they require to make an informed choice regarding moving into the home. These documents have not changed since the last inspection of the home. The manager or deputy complete assessments prior to a resident being offered a place at the home. This ensures that residents needs are recorded and can be met at the home prior to admission. Staff reported that prospective residents and their relatives are invited to visit the home prior to deciding whether to move into the home. Carter House G54-G04 S42026 Carter House V238724 290605 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 Care plans are in place and have been reviewed regularly, ensuring residents needs are recorded and can be met by staff. Care plans must be more comprehensive and detailed to include more than residents basic needs. The home has arrangements for the safe ordering, storage, recording and administration of medication and has access to a pharmacist for advice. Omissions and errors in recording, and errors in administration were found that might adversely affect the health and welfare of service uses. EVIDENCE: Four case files were examined, care plans include basic information regarding residents needs, which could be developed further to include their social needs. Records are maintained of residents weight, however residents had not been consistently weighed every month since the last inspection. Weight records were all in the same format, enabling staff to assess whether residents have gained or lost weight and take appropriate action. No large weight loss was recorded in the files examined. Staff confirmed that any concerns with residents weight would be referred to the GP for advice. The written policies and procedures regarding medication were found to be adequate on the last inspection and were not reviewed on this visit. Carter House G54-G04 S42026 Carter House V238724 290605 Stage 4.doc Version 1.40 Page 11 All medications administered by staff along with the records relating to receipt, storage, administration and disposal of medication were examined. The deputy manager and person in charge on each unit were interviewed, nine service users rooms were checked and twelve service users medications not supplied in the monitored dosage system counted and compared to the records of receipt and administration. From these discussion and observations no accurate record of what creams were being administered was seen on the third floor. In one instance two creams were found in a service user’s room that were not prescribed on the current administration record. Five service users had missing entries on the current administration record indicating administration/non-administration of medication. One service user had been signed as receiving their morning medication on 28th June 2005. The medication was still in the monitored dosage system container and had not been given. One service user had been recorded as receiving a medication once day when it had been prescribed twice a day. One service user had been recorded as receiving medication twice a day when it had been prescribed once a day. One service user had not received the new dose of prescribed medication since 23rd June 2005, when the dose had been changed by the GP as the home is awaiting a new supply from the pharmacist. The administration record indicated that the new dose of medication had been given since 23rd June 2005. One service user had not received the correct dose of medication when the amount in stock was compared to the amount that should be in stock from the records of receipt and administration. One service user had not received their morning medication on several occasions, as they were asleep at the time. The medication could have been given at alternative times. Fourteen items were found labelled “to be used as directed”. No other written directions were seen for these items. One container of eye drops on the third floor was not dated when opened. A new supply is obtained monthly so the item would not reach its expiry date. All medication was stored securely and under appropriate conditions. All other medication had been administered as prescribed unless a record had been made indicating why medication had not been given. Only designated trained staff administer medication. Staff were observed to ring residents doorbells and wait prior to entering the room. Bedroom and bathroom doors are closed when staff are assisting residents with personal care tasks. These practices ensure that residents are treated with respect and that their privacy and dignity is maintained. Carter House G54-G04 S42026 Carter House V238724 290605 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 The home does not fully meet residents social needs as residents only have access to a few planned activities each week. EVIDENCE: Ten members of staff have been designated to co-ordinate activities within the organisation with the administrator being the designated person at this home. A list of ideas for activities is available to staff and was circulated in the organisation staff newsletter. This should enable staff to develop activities within the home and to co-ordinate visits to local places of interest, offering residents a wider choice of social activities. An aromatherapist and an artist/musician still visit the home alternate weeks, offering residents access to activities at the home. One resident said that they watch television while another resident said that they are ‘not doing much’ and that ‘there isn’t much to do’. Residents are encouraged to maintain contact with family and friends. One resident had a visitor, other residents confirmed that they can have visitors in their bedroom or in the lounge. Birthday cards were ready for one residents birthday the day of the inspection and for another resident the following day. Staff reported that a birthday cake is ordered from the kitchen Carter House G54-G04 S42026 Carter House V238724 290605 Stage 4.doc Version 1.40 Page 13 which is shared with fellow residents if the individuals wish, allowing residents the opportunity to celebrate their birthday. An information leaflet about advocacy services is displayed on the notice board in the entrance hall which is accessible to visitors and some residents, ensuring residents can access appropriate services if required. Residents are able and encouraged to bring personal items to the home. Two residents said that they like their bedrooms and being able to bring their pictures and ornaments. Representatives from local churches visit the home ensuring residents can continue their religious observance. One resident was very pleased to be able to continue practicing their religion whilst at the home. Residents are provided with three meals a day with drinks and snacks available in between meals. The menu is varied and includes a vegetarian alternative. Staff reported a new menu was in place following consultation with residents. The menu is displayed in the kitchens in each unit and was on a board in the lounge/dining room of one unit. The menu was not available on the ground floor. The meal served was not that recorded on the displayed menu on the second floor, this does not offer residents up to date information on the meal provided and will not help those residents with memory problems. The inspector observed one meal served on the first floor and the second floor. Residents may eat in the lounge/dining room or their bedrooms. Residents who eat in their bedrooms received their meals on a tray which was nicely laid with a serviette and cutlery, however, no sauce or condiments were on the tray and one resident had to ring the emergency bell to request these items. This does not enhance mealtimes for residents. Residents were invited to sit at the table for the meal and staff went to get their plated food, on staff’s return to the lounge/dining room some residents had left the table. The mealtimes should be reviewed to ensure residents are offered appropriate meals in a manner that will encourage them to eat. Residents made comments including: ‘the food is always good here’, ‘the food is alright’, ‘the food is a bit repetitive’ and ‘we get a lot of sausages’. Carter House G54-G04 S42026 Carter House V238724 290605 Stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Residents welfare is protected by the complaints procedure. The manager is committed to resolving complaints quickly. EVIDENCE: The complaints procedure is included in the Statement of Purpose and the Service Users Guide to the home, which are available to all residents and visitors. In addition, a complaints leaflet is displayed in the entrance hall of the home which is accessible to all visitors. Records are maintained of complaints received at the home. Residents did not raise any issues regarding the care that they receive at the home. The CSCI have not received any complaints regarding the home since the last inspection carried out in March 2005. Carter House G54-G04 S42026 Carter House V238724 290605 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 25 & 26 Residents live in a safe and well maintained environment with a good standard of cleanliness to promote their welfare. EVIDENCE: The home was purpose built to meet the needs of older people and older people who have nursing needs. Accommodation is provided over four floors with a lounge/dining room, kitchenette, single bedrooms, two bathrooms and separate toilets on each floor. A lift serves all floors of the home ensuring residents can access all communal areas of the home. Residents have access to two small garden areas, one of which is paved, with flowerbeds and the other is laid to lawn with flowerbeds and a paved area for garden furniture. Staff reported that residents use the garden when the weather permits. The home provides comfortable accommodation for residents which is appropriately maintained. One bedroom was found to have dirty marks on the wall which must be cleaned and the extractor fan in one ensuite toilet requires cleaning. Residents said ‘I like my room’, ‘it’s homely here’, ‘I have all I need in my room’ and ‘my room is nice’. One resident was very proud of their room and Carter House G54-G04 S42026 Carter House V238724 290605 Stage 4.doc Version 1.40 Page 16 pleased to have their furniture and belongings around them. Another resident was pleased to have been able to bring some items of furniture to the home. The laundry is sited away from the kitchen and areas where food is prepared and eaten, which reduces the risk of contamination. Staff are employed at the home to complete the laundry seven days a week. Carter House G54-G04 S42026 Carter House V238724 290605 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 29 Residents receive support from a small dedicated core of long standing staff, including agency staff whom demonstrated detailed knowledge of residents needs and how to meet them. This offers consistency of care for residents. New staff have been recruited to the home since it opened. The homes recruitment and selection procedures protect and promote residents welfare. EVIDENCE: Six permanent carers are currently employed at the home with some new carers awaiting recruitment checks prior to commencing employment at the home. This small number of permanent carers is not sufficient to ensure residents receive consistency of care. One carer is on duty on the ground floor, two carers on the first floor, one nurse and two carers on the second floor and one carer on the top floor during the day. These staffing levels are in line with those agreed at the time of registration. Staffing levels must be kept under review to ensure residents needs are fully met at all times. Residents described staff as ‘good’, ‘helpful’, ‘respectful’, ‘alright’, ‘very young’ and ‘ok, especially the one here today who is always cheerful’. Carter House G54-G04 S42026 Carter House V238724 290605 Stage 4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 Residents live in a home which is appropriately managed. EVIDENCE: The manager is committed to providing good quality care to residents at the home. The manager has many years experience as manager of a residential home and working with older people. Carter House G54-G04 S42026 Carter House V238724 290605 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 3 x x x x x 3 2 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 x x x x x x x Carter House G54-G04 S42026 Carter House V238724 290605 Stage 4.doc Version 1.40 Page 20 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15 (1 & 2) Requirement The registered person must ensure that the care plans include more details to ensure all the individuals needs are recorded and can be met by staff. The registered person must ensure that service users weight is monitored and recorded. (timescale of 20/04/05 not met) The registered person must ensure that the administration/nonadministration of all medication in the home is recorded accurately. The registered person must ensure that only currently prescribed medication is in use in service users’ rooms. The registered person must ensure that all medication is administered as the prescriber directed. Where medication is not given as directed, clear reasons must be recorded and alternative arrangements discussed with the doctor. The registered person must ensure that all items of medication are labelled with Timescale for action 30/08/05 2. 8 12 (1) a 30/08/05 3. 9 13 (2) 29/06/05 4. 9 13 (2) 29/06/05 5. 9 13 (2) 29/06/05 6. 9 13 (2) 01/08/05 Carter House G54-G04 S42026 Carter House V238724 290605 Stage 4.doc Version 1.40 Page 21 7. 12 16 (2) n 8. 15 16 (2) g & i 9. 26 23 (2) d clear directions for administration or separate written directions are available. The registered person must ensure that an activities programme is developed in consultation with residents. The registered person must ensure that mealtimes are reviewed to ensure adequate staff are available to meet residents needs and that trays for residents who eat in their bedrooms include condiments and sauces or residents are offered these items when they receive their meal. The registered person must ensure that the cleaning schedule includes the extractor fans in ensuite toilets and removing marks on paintwork in residents bedrooms. 30/08/05 30/08/05 30/08/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 9 Good Practice Recommendations It is recommended that all eye preparations be labelled with the date when opened. Carter House G54-G04 S42026 Carter House V238724 290605 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Ground Floor - CSCI 41-47 Hartfield Road Wimbledon SW19 3RG National Enquiry Line: 0845 015 0120 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 Carter House G54-G04 S42026 Carter House V238724 290605 Stage 4.doc Version 1.40 Page 23 - 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!