Inspecting for better lives Key inspection report
Care homes for adults (18-65 years)
Name: Address: Cavendish House Elizabeth Street Workington Cumbria CA14 4DA 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: Elizabeth Kelley
Date: 1 1 0 3 2 0 0 9 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. that people have said are important to them: They reflect the things 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 Adults (18-65 years) 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 Adults (18-65 years) Page 2 of 28 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (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 Adults (18-65 years) Page 3 of 28 Information about the care home
Name of care home: Address: Cavendish House Elizabeth Street Workington Cumbria CA14 4DA 01900605280 01900871107 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Cumbria Care Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 6 Number of places (if applicable): Under 65 Over 65 0 0 learning disability physical disability Additional conditions: 6 2 The registered person may provide the following category of service only: Care home only- Code PC To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability- Code LD Physical disability- Code PD (Maximum number of places 2) The maximum number of people who can be accommodated is: 6 Date of last inspection Brief description of the care home Cavendish House is run by Cumbria Adult Social Care, formerly known as social services. The home had previously been a large home for people with learning disabilities which has now been scaled down to provide 4 respite beds. Cavendish House is a two-storey building situated a short distance from the centre of Workington a town on the West Coast of Cumbria. The ground floor is used for the Care Homes for Adults (18-65 years)
Page 4 of 28 Brief description of the care home registered care home providing respite breaks for up to four people with a learning disability. There is stairs access between the two floors. The ground floor is comprised of a games room, lounge, dining room, large kitchen, reception area and office. Private bedrooms are situated away from the communal and kitchen areas. There are sufficient bathrooms and toilets and specialist bathing facilities are available. The first floor is used by Adult Social Care as a base for domiciliary staff and office space for meetings. The current scale for charging is £501.81. A Service Users Guide is available for prospective residents, which includes a summary of the homes customer survey findings and details of how to get the latest Inspection report. All referrals and bookings are made through social services. Care Homes for Adults (18-65 years) Page 5 of 28 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home
peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection for this service was completed on the 22nd Feburary 2008. We Commission for Social Care Inspection (CSCI) spent time with people staying at the home and talking to them about their experiences. We also met with the manager and the staff on duty and looked at records relating to the running of the home and how people like to be supported to live their lives. Staff were also interviewed and observed carrying out their duties. Documents examined included sampling care plans, daily notes and safety and maintenance records. We also sent out surveys as part of this inspection to get feedback from people about Care Homes for Adults (18-65 years)
Page 6 of 28 their respite stay, their relatives and other professionals involved with the home. Before the visit the manager was asked to complete an Annual Quality Assurance Assessment which provided information about all aspects of the running of the home. This included a self assessment against the National Minimum Standards recording what the home does well, what has improved, and plans for the future. The service has plans to relocate to a brand new building, and this old building has been recognised as being unsuitable. 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 Adults (18-65 years) Page 8 of 28 Details of our findings
Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 28 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. People using the service are helped to make an informed choice and are carefully assessed before they start using the home which assists in successful placements. Evidence: The way in which people are introduced to the servcie has been improved with the merging of the two staff teams, and the appointment of a new manager. The manager is now given full responsiblility to organise respite breaks and this has helped in ensuring that people are compatible with each other. This has improved the experience of peoples stay. How people are introduced to the home was examined and this was carried out in a very professional way, ensuring that all key information is received before new people come to stay. The manager had identified that they needed to improve the literature to help people make a more informed choice. The AQAA stated: Develop the Statement of Purpose and Service User Guide for the home in a user friendly format so information can be given to the potential clients in different styles
Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: according to their needs. The current statement of purpose had been displayed page by page on a notice board in the recreation room/dining room for people to look at. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices
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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. As efforts are increased to improve peoples care plans this is leading to a more enjoyable and well managed stay for people. Evidence: The AQAA states the improvements brought in by the newly formed management team: The individual support planning is more person centred and incorporates choices in the way people wish to be supported they provide a holistic approach to the Service Users support needs. All Service Users have a designated key worker and advocates are available. All support plans are reviewed regularly and are accessible to Service Users and others only on a need to know basis. These individual person centred plans are developed in consultation with all relevant others. The AQAA also demonstrates a good awareness of where the manager feels they need to improve, for example: raising awareness in staff of the implications of the Mental Capacity Act, implications of positive risk taking, and Safeguarding Vulnerable Adults.
Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: This will help to strengthen staff awareness and accountability of their role as keylink worker. Through increased person centred planning, plans show the persons likes, dreams and aspirations, and they clearly demosntrate how they meet the individuals needs. Risk assessments have a higher profile in the support plan, than at prevoius inspections, which ensures that the users of the service and staff work together to understand the persons strengths and limitations and how they can be supported and encourage to be involved in everyday lifestyles and choices. An example of this was a noticeboard displaying a whole range of food options that each person could select from, and then be supported to go out and shop for. A meeting was taking place on the day of inspection of professionals to risk assess a person who often stays out beyond what ahd been agreed. This meeting was discussing how to get the balance right between keeping this person safe and not unduly restricting their rights. This is in line with good practice and the manager had a good knowledge of how to apply the Mental Capacity Act. As two services have merged the staff team are still developing one format for support plans that incorportates the best of both services, and this demonstrated potential for both health and social needs to be covered in good detail. Staff are able to communicate with people using the service and understand what their needs are. However communication methods are basic and the manager has identified this as an area for improvement with a view to involving people much more in their plans. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle
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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Better staffing levels have helped people go out more and do more things of their choosing. Evidence: The location of the home makes access to local facilities easy for people during their stay. The town centre and a park are a five minute walk away. The town is centrally placed for people to be able to still attend their regular day service during their stay. There are plans to relocate the service to the outskirts of another smaller town with less facilities. Concerns were raised by people using the service, their families and by professionals that this location could limit the options for people. The orgainsation who runs Cavendish House, Adult Social Care, should consider ways to reduce the risk of this happening, for example exploring whether a minibus/people carrier might be a viable option. One person staying at the home said he had enjoyed going into town on
Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: his own and going to a cafe and to the shops. He said of his stay Its great here. The home now caters for people with much more complex needs, after the merging of a social care service and a health authority run service and while adaptations have been made to the building to enable care tasks to be carried out there has been little consideration given to social and recreation input for people during their stay. For example the health authority home previously had a sensory room which was a valuable asset to people who have limited opportunities to use local community facilities. The service should give serious consideration to providing a similar facility at Cavendish House, especially as much of the equipment is portable and could be used at the new respite centre. The service understands the right of individuals to take control of their lives and to make their own decisions and choices. The examination of care plans and risk assessments demonstrates this attitude of supporting and enabling people rather than restricting unnecessarily. Residents are becoming increasingly more involved in meaningful daytime activities of their own choice and according to their individual interests, and capabilities by developing more in-depth care plans. They are becoming much more involved involved in the planning of their lifestyle and on how they spend their time. The home does not have Internet computer facilities and many people using the facility will have this at home, it could be used to expand peoples experiences and help people stay in touch while using respite care. Again this should be looked into to offer a better quality service to people. This has been helped by the merging of two staff teams and more staff being available to spend time with people. Menus were examined and found to be well balanced and healthy and service users questionnaires all stated that they enjoyed the meals. There had been a move to encourage people to chose on a daily basis what they wanted to eat across the day, as would often happen in any home. Food cupboards and freezers contained good quality food such as lean meat and numerous fresh vegetables and fruit. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support
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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. People receive good healthcare and personal care from the staff team to meet their diverse needs. Evidence: Personal support is responsive to the varied and individual needs and preferences of people. The delivery of personal care is individual and is flexible, consistent ,reliable and increasingly person centred. Staff have a good understanding of residents healthcare needs and are managing complex healthcare issues. The staff team work positively with local health care professionals to offer a responsive and supportive approach in assisting people to maintain good health. Records on healthcare needs are well maintained and kept up-to-date these are linked to care plans to alert staff on any changes and include monitoring sheets for specific issues, such as monitoring epilepsy or changes in behaviour. The staff are aware of the personal support that each resident requires from the information gained from families and carers and also from assessment. The personal preferences for each resident were seen in the plans of care these included morning washing and bathing preferences and bedtime routines. Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: Staff respect privacy and dignity and are sensitive to changing needs. People are supported and helped to be independent and can take responsibility for their personal care needs. Staff listen and take account of what is important to them. The manager has identified that staff would benefit by increasing their knowledge of medications preparations, dose, side effects and therapeutic effects of medications. This will be given to staff in-house and on a day to day level by working in pairs and carrying out competency checks. The staff team check medications in and out of the home, and while training is underway it would be good practice to have two staff checking medicines into the home. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. People are safeguarded from abuse and supported to have a voice by a well trained and skilled staff group. Evidence: There have been no complaints since the new six bed service established (September 2008). The service has a complaints procedure that is clearly written and easy for people to understand. It is available on request in a number of formats to help anyone living at, or involved with the service to complain or make suggestions for improvement. Staff have, or are in the process of receiving training on Protection of Vulnerable Adults. This is to ensure they have the knowledge base to protect and safeguard people and to recognise a potentially unsafe or abusive situation. Cavendish House has available copies of the Cumbria Cares procedures for the Safeguarding of Vulnerable Adults, and encourages the appropriate reporting of concerns to the appropriate authorities. The home had polices and practices that safe guarded the handling of residents monies. Personal monies and records were examined and found to be correct, with the signatures of both staff and the resident. The atmosphere developed in the home encourages open discussion and expression of views. The manager was knowledgeable and aware of good practice in safe guarding,
Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: and was for example encouraging staff to read the Cornwall report. Care Homes for Adults (18-65 years) Page 19 of 28 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, 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. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home is suitable for use as a temporary measure while a new facility is being built, and is maintained to basic levels. Evidence: As a temporary solution the building is a satisfactory stopgap. The date of relocation of the service is uncertain but in the meantime the building is safely maintained with all the necessary repairs and annual safety checks being carried out. Efforts had been made recently to make the surroundings more homely, with vases, flower displays and more modern pictures and furnishings. However, it has to be said that the building remains very institiutional in design, and everyone involved is looking forward to a better standard of home. Standards of cleanliness and hygiene are high and the managers carries out a monthly checklist/audit to keep standards high and to make sure the building is safe. . Staff are trained in relation to COSHH, Health and Safety and food hygiene. To improve on all these areas the new manager has given each member of staff an area to champion standards in, for example COSHH and control of infection. Care Homes for Adults (18-65 years) Page 20 of 28 Care Homes for Adults (18-65 years) Page 21 of 28 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 staff team had been strethended by the merger of the two homes and now a good mix of skills is benefiting people during their stay at the home. Evidence: Cavendish House follows Cumbria County Councils recruitment procedures and has access to the Human Resources team for support and guidance. A sample of staff files were examined and these contained all the relevant documentation and were clearly sectioned and well organised. The selection procedure includes obtaining two written references and a formal interview. All staff have CRB enhanced disclosure checks and the supervisor was aware of extra precautions to be put in place if staff had to be started without a full check. These records are held in accordance with the organisations policy. The Home does not use temporary or other employment agency staff. All these measures ensure that staff are well vetted and people have a consistent staff team. Cumbria Care provide a good training network to access the appropriate training for staff members working in the home, as well as corporate training i.e. Equality and Diversity. Cavendish House follows Adult Social Cares policy on continuous professional
Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: development. Staff training needs are identified through supervision and annual appraisal and accessed accordingly to ensure staff have sufficient knowledge to carry out their defined roles and responsibilities. The manager has recenly carried out a training needs analysis to indentify gaps for individuals, and the servcie as a whole. Rotas are done to meet planned Service User needs, and are therefore flexible. Cavendish House have recruited additional relief staff and now have a bank relief staff to cover staff absences, they are included in team meetings and training in the home to provide continuity of care to the Service Users. The new manager and deputy carried out a review of the team to clarifify staff roles and responsibilities to assist the two staff teams to merge. The Manager has strengthened the schedule for supervisions. Staff members have a designated named supervisor who provides supervisions in accordance with Adult Social Care Policies and Procedures. Supervisions and team meetings are planned and have set agendas to ensure all areas of information are cascaded to staff. Team briefs provide another tool for communication and staff feedback. Staff reported that the merging of the two staff teams had gone very well and were pleased to have a manager in post, as the home had been operated through seniors only for a considerable amount of time. The management team was more effective having both a manager and seniors. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 new manager has brought about improvements benefing the running of the home and improving the quality of peoples experience during their stay. Evidence: The manager promotes an open positive and inclusive atmosphere in the home through a variety of ways. For example regular staff meetings and supervision regular residents meetings and frequent reviews and meeting with people to give them the opportunity to speak up. The manager communicates a clear sense of direction and is able to evidence a sound understanding and application of best practice in care and in operational systems. The manager monitors practice and compliance with the homes plans policies and procedures. For example her input and checking of care planning was more in evidence on this visit. Quality Assurance monitoring is effectively implemented as a core management tool giving a framework for close monitoring of the quality of care delivered health and safety matters and on staffing issues. There is full and clearly
Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: written recording of all safety checks and accidents, including analysis and there is no evidence of a failure to comply with statutory reporting requirements and other relevant legislation. For example staff have implemented Safer Food Better Business in the home as recommended by the Department of Health. The home was recently assessed as delivering a five star service by environmental health which is the top rating. The home proactively monitors its health and safety performance and consults other experts and specialist agencies about health and safety issues as required. The organisation uses a fire safety consultant to advise all of its services to ensure they are up to date and comply with legislation. The manager had recently requested advice and help on updating the homes Fire Risk assessment and amendments to follow this advice where well documented. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 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 12 14 Internet facilities and computer should be provide to enrich peoples stay at the home The provision of a sensory room and other types of activities for people with complex needs should be provided Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (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 Adults (18-65 years) Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!