Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 20/05/05 for Dorset House

Also see our care home review for Dorset House for more information

This inspection was carried out on 20th May 2005.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Dorset House has a small group of staff who have worked at the Home for a long time. The turnover of staff within the Home is low. The staff on duty at the time of the inspection were kind, considerate and appeared to have developed warm and caring relationships with the people in their care. Residents were generally satisfied with the care and support provided at the Home. Meals are varied, nicely presented offering choice and variety. The Inspector joined residents for their lunch-time meal and found it to be tasty with good portions served. Dorset House is generally well maintained, attractively decorated with tasteful furniture, fittings and fixings throughout. Great emphasis is placed on the need to ensure that staff receive the training they need to do their job properly. Over 50% of the staff team have obtained a Level 2 NVQ or above. A number of staff have also obtained a qualification which allows them to assess staff undergoing qualifying training. The team at Dorset House provide a good quality service to people with a wide range of care needs in five different units. This is not an easily achievable goal. Staff contribute to the work currently being undertaken by the Council, as it tries to understand what causes older people to fall, and what action can be taken to reduce the frequency of falls.

What has improved since the last inspection?

In 2004, staff employed as care assistants received new employment contracts and training to enable them to take on the role of Care Officers and responsibility for their shift in the absence of senior staff. A part time social worker is currently being recruited to strengthen the Rehabilitation Team. Improvements have been made to the building. Two double sockets have been fitted in each bedroom. New light fittings and thermostatic controls to handwash basins and bathrooms have been provided throughout the Home. Alarms have been fitted to all fire door exits and new parking spaces have been identified at the front of the building. Fly screens have been fitted to all kitchen windows. The Manager hopes that the premises will undergo further refurbishment over the next 12 months, including replacement of kitchens, bathrooms and carpets.

What the care home could do better:

The Manager needs to complete her qualifying training by the end of the 2005. Preventative health based risk assessments need to be completed for all persons living at, or visiting the Home. The dependency levels of people using the Service need to be evaluated and reviewed on a regular basis.

CARE HOMES FOR OLDER PEOPLE Dorset House Off Station Road Wallsend Tyne & Wear NE28 8EN Lead Inspector Glynis Gaffney Announced 20, 22 and 24 May 2005 09:30 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. Dorset House Version 1.10 Page 3 SERVICE INFORMATION Name of service Dorset House Address Off Station Road Wallsend Tyne & Wear NE30 1BB 0191 200 7155 0191 200 7156 pat.golder@northtyneside.gov.uk Mr John Phillipson, North Tyneside Council 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) Mrs Patricia Golder CRH 41 Category(ies) of DE[E] - Dementia over 65 (15) registration, with number OP - Old age (26) of places Dorset House Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 17 and 19 November 2005 Brief Description of the Service: Dorset House is a residential care home for older people run by North Tyneside Council. The Home provides residential care for up to forty one people living in four units known as The Lakes, Ashwood, Oakwood and Rosewood. Dorset House is a single storey building set in the residential area of Wallsend. The Lakes unit provides nine respite care places for people with dementia care needs. Ashwood unit provides ten beds for people who need to be discharged from hospital but are not considered fit enough to return back to their own home. Before being discharged back home, people occupying the rehabiliation beds receive a full assessment of their care needs. A twenty place day care service is provided five days a week. The Home has a central kitchen, a laundry, a large lounge and a dining area. Each unit has its own kitchen, dining and bathing facilities. Toilets are situated close to residents bedrooms and the lounge and dining areas. There are 41 single bedrooms, two of which have en-suite facilities. A bus route, pub and local shops are within easy walking distance. Off street parking is available. Dorset House Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced, took place on the 20, 22 and 24 May over 10 hours and 35 minutes and involved one inspector. A tour of the premises was undertaken and, a sample of care records was inspected, as were a selection of other records. Seven staff and four residents were interviewed and five other residents were also spoken to. What the service does well: What has improved since the last inspection? In 2004, staff employed as care assistants received new employment contracts and training to enable them to take on the role of Care Officers and responsibility for their shift in the absence of senior staff. A part time social Dorset House Version 1.10 Page 6 worker is currently being recruited to strengthen the Rehabilitation Team. Improvements have been made to the building. Two double sockets have been fitted in each bedroom. New light fittings and thermostatic controls to handwash basins and bathrooms have been provided throughout the Home. Alarms have been fitted to all fire door exits and new parking spaces have been identified at the front of the building. Fly screens have been fitted to all kitchen windows. The Manager hopes that the premises will undergo further refurbishment over the next 12 months, including replacement of kitchens, bathrooms and carpets. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Dorset House Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Dorset House Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3, 4, 5 and 6. Residents are provided with a copy of the Home’s Statement of Terms and Conditions at the point of admission into Dorset House. Residents are only admitted into the Home on the basis of a full assessment of need undertaken by people trained to do so. Residents’ care records contained the required documentation to enable staff to properly care for people admitted into the Home. Residents and their families know that once they enter Dorset House, their needs will be met. Service users visiting the Rehabilitation Unit are assessed and provided with the support and care they need to either return home or, into a care home of their own choosing. A range of specialised equipment and facilities have been provided to enable staff to support residents to re-gain independent living skills. Dorset House Version 1.10 Page 9 EVIDENCE: A Statement of Terms and Conditions was available in each resident’s care records, where appropriate. The records for three residents were examined and these included assessments and care plans carried out by each individual’s Care Manager. An assessment process has been put in place to ensure that residents admitted into the Rehabilitation Unit are properly placed. The Occupational Therapist confirmed that potential residents are usually assessed in hospital prior to discharge into the Home. Once admitted, a further assessment is conducted to determine what support is required to enable the individual to return home. The period of assessment can last anywhere between two and six weeks. Where return to the person’s own home is not possible, Dorset House provides a longer placement, to enable a decision to be made about which type of care facility might best meet a resident’s needs. A carer based on the Dementia Care Unit was able to describe how she would access specialist information about the needs of people with dementia. This person confirmed that she had access to various books held in the office, courses detailed in the Council’s training manual and practice information produced by specialist organisations such as the Alzheimer’s Society. A member of staff based in the Rehabilitation Unit told the Inspector that she was able to obtain whatever advice she needed from the Home’s Occupational Therapist and Rehabilitation Officer, as well as from specialist staff based in other Council services. Another carer spoke clearly about the action she would take to meet the needs of prospective residents with different cultural backgrounds. Separate facilities are available for service users visiting the Rehabilitation Unit. Staff working on the Unit said that they had access to a range of equipment to enable them to promote independence and help residents to meet the goals set out in their care plans. For example, the Unit contains perching stools, bathing equipment and a medi-bath, and various items of kitchen equipment. However, one member of staff felt that their work with residents could be further improved if they had access to another wheelchair, dining chairs with side arms, and a separate kitchen cordoned off from the Unit’s dining and lounge area. An examination of the Home’s records confirmed that not every member of staff had received training in all of the recommended areas. The Inspector felt however, that the Manager and her team displayed a real commitment to ensuring that staff received all of the necessary training as soon as possible. It was clear that arrangements had been put in place to enable staff to access specialist training to supplement that already provided by the Home’s Occupational Therapist. Dorset House Version 1.10 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 and 10. A clear and consistent care planning system was in place and provided staff with the information they needed to know to satisfactorily meet residents’ needs. Although the health care needs of residents were generally well met, further work was required to ensure that preventative health based risk assessments were completed. The systems in place to support the safe administration, storage and disposal of medication were considered satisfactory and promoted residents’ good health. Staff provided personal support in such a way as to promote and protect service users’ privacy, dignity and independence. EVIDENCE: Individual plans of care were in place for each person and covered all aspects of health, personal and social care with one exception: plans of care were not in place addressing residents’ needs for assistance with medication. The care plans checked were up to date and had been reviewed monthly. There was also a system in place for recording updates to residents’ care plans. Records Dorset House Version 1.10 Page 11 are completed on a daily basis by staff at the end of their shift. These records summarise how each person has been during the shift. Plans of care had been signed by either the resident or their representative to confirm their agreement with the contents. The senior team had completed regular checks of the quality of the care records. Residents told the Inspector that their health care needs were well met. One resident said that ‘if she felt ill, staff would fetch her a doctor.’ Another person said ‘your health is well looked after, you just have to mention a problem to staff and they sort it out.’ Staff were able to describe how they met residents’ personal care needs, including care of teeth and dentures. However, an examination of residents’ care records showed that the following preventative risk assessments had not been completed for every person living or visiting the Home: preventation of falls, pressure sores and falls. A satisfactory policy covering the promotion of continence was available and there were no unpleasant odours present in the Home. Dietary care plans had been completed. The Home’s Medication Policy included all of the information required to properly protect residents, including a procedure to enable safe selfmedication. Medicines were safely stored, including medication that required refrigeration. There were lockable facilities in all bedrooms. Photos to identify each resident were in place. Hand wash facilities were available in the main treatment room. There were satisfactory records covering medications received, administered and disposed of within the Home. Staff with responsibilities for administering medication had read the Home’s Policy and Procedures. Certificates confirming that senior staff had received accredited medication training were in place. Staff had recently received training in the safe use of Oxygen Therapy. A check of the Home’s medication systems by a local pharmacist had taken place during the previous 12 months. Staff administering medication did so in a safe and professional manner. Staff were observed providing personal care to residents in a kind, considerate and helpful manner. One resident commented that staff ‘always respected her privacy and treated her in a dignified fashion.’ Another resident said that ‘I wear my own clothing and staff always address me by my proper name.’ This person also said ‘you can see the doctor in your own room at any time and receive any treatment you need in private.’ Dorset House Version 1.10 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 and 15. The provision of social activities is good and as such, opportunities for stimulation through leisure and recreational activities, both within and outside of the Home, are available. The meals at Dorset House are of a good standard and nicely presented. Residents receive a varied, appealing, wholesome and nutritious diet. The dining rooms were pleasant and provided residents with nice areas within which to eat their meals. EVIDENCE: A programme of weekly activities is provided within the Home. The programme includes activities such as bowls and chair aerobics. Unit based staff are also expected to provide activity sessions to supplement the day care activity programme. Residents said they were pleased with the range of activities provided. One resident said ‘I play dominoes, cards and go for walks. Staff are good at occupying you here. I never get bored and I am just allowed to see to myself.’ There was a lively atmosphere within the Home and the Inspector observed the activities set out for the day taking place. Residents spoken with confirmed that the activities took place on a daily basis. However, a member of staff told the Inspector that ‘with only one member of staff to nine residents, it was sometimes quite hard to provide activities as well as to care for people’. One resident said that ‘you can pretty much please yourself what you do here and who you mix with. There are routines such as when Dorset House Version 1.10 Page 13 meals take place, but this is just right for me, as I like to know what is going on.’ Plans of care setting out how residents’ social care needs were to be met were in place. A rotating three-week menu cycle was in use. Three full meals a day are offered and choices are available at main meal times. Residents are offered drinks throughout the day. The quality of the lunchtime meal was excellent and appeared to be enjoyed by all the residents. The meal was served in an unhurried manner and residents were given time to eat their meals at their own pace. Staff were on hand to offer residents support and assistance. Dining areas were pleasant and had been nicely decorated. A resident told the Inspector that ‘you get enough to eat and drink here. There are a lot of choices. I can get what I want.’ Another person said that the ‘food is canny. You get a choice. It is alright.’ Dorset House Version 1.10 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) Standards 16 to 18 not assessed on this occasion. EVIDENCE: Dorset House Version 1.10 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) Standards 19 to 26 not assessed on this occasion. EVIDENCE: Dorset House Version 1.10 Page 16 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 and 28. The Home has sufficient numbers of staff on duty to meet residents’ assessed needs. Staff receive suitable training to provide them with the knowledge and skills that they need to properly care for residents. EVIDENCE: A staff rota was in place showing which staff were on duty and in what capacity. The following staffing levels have been agreed with the Commission: Dorset House Version 1.10 Page 17 8.am to 3.30pm Five carers and team leader 10pm to 8am one Two carers and one team leader or a senior carer. The Lakes (Dementia As given for the morning Carers cover all units. Unit - 9 places – one shift carer) Ashwood Rehabilitation Unit (10 places – two carers) Oakwood/Rosewood Units (10 places and one carer each) A Manager is also available during office hours - Monday through to Friday. Following an examination of one week’s rota, it was confirmed that the above levels of staffing had been provided. A carer told the Inspector that ‘although it is very busy, especially at those times when residents are being admitted and discharged, I enjoy the challenge and cope okay with the busy periods’. She also said that ‘I do not feel stressed by my working circumstances and even though there are two residents in wheelchairs on my unit, I can manage okay because of the hoist.’ Residents’ opinions of staff were very positive. A resident said that ‘enough staff were on duty and she had never had to wait to see someone.’ This person also said that ‘when you want to see someone, all you have to do is pull your alarm chord’. Another resident said that ‘staff were kind and no one shouts at you. Staff do what they can. I am quite satisfied with them.’ Carers spoken with felt well supported by their managers. One carer said that ‘the managers did everything possible to try and make working at the Home less stressful.’ A carer based on the Rehabilitation Unit told the Inspector that ‘although two carers are usually rostered on duty, there had been occasions when only one carer had covered the Unit due to staffing difficulties.’ She also said that ‘when the unit is fully occupied, it is difficult to do rehabilitation work when there is only one carer available.’ However, the carer felt that the situation had since been resolved and confirmed that two staff are now scheduled on duty in the Unit. The Manager confirmed that on occasions, shortfalls in staffing had occurred as a result of unforeseen problems. On such occasions, Mrs Golder has advised that either the care/domestic, or the team leader, should provide cover in the Unit. The Home has recently experienced staffing difficulties. Agency staff have been used to cover shortfalls in the rota. For example, agency staff had covered 42 hours on the Rehabilitation Unit during the week preceding the inspection. However, the Manager had just recruited to three vacant posts and was awaiting completion of the required recruitment checks. Dorset House Version 1.10 Page 18 3.30pm to 10pm one Five carers and team leader The Manager confirmed that where concerns had arisen over a resident’s changing needs, an in-house dependency rating tool would be used to measure those changes which could then be shared, as appropriate, with other professionals. An examination of training records confirmed that over 50 of the care team have obtained a relevant care based qualification. Dorset House Version 1.10 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 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 and 32. Residents live in a home which is run and managed by a person who is fit to be in charge, is of good character and able to discharge her responsibilities fully. The Manager provides consistent leadership, guidance and direction to staff and ensures that residents receive good quality care. Staff morale was high. EVIDENCE: A Registered Manager was in post. She has obtained a number of relevant qualifications, is in the process of completing qualifying training and has 20 years experience of working with older people. The Manager confirmed that she regularly updates her training. There is a job description that allows her to take responsibility for carrying out her duties. Staff were clear about who they reported to on their shift. Dorset House Version 1.10 Page 20 Staff interviewed told the Inspector that the Manager had made it clear to them the standards of care that they were expected to work to. One carer was able to clearly describe the purpose, aims and objectives of the Unit within which she worked. Staff felt that they knew what was going on within the Home and felt able to raise any matters of concern with their managers. Staff had been issued with a copy of the General Social Care Council Code of Conduct. Dorset House Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x 3 3 3 x 3 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 x 14 x 15 3 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 2 3 x x x x x x Dorset House Version 1.10 Page 22 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 6 Regulation 16(2) Requirement Provide the Commission with an outline of the equipment and facilities required to deliver rehabilitation services to people admitted into the Home. Please include details of any shortfalls identified and how they will be rectified and within what timescales. Provide handwashing facilities in the laundry. (Announced Inspection - 2004/05) Ensure that the Manager completes the relevant care and management qualification. Timescale for action 01/09/05 2. 3. 26 31 16(2)(j) 2(b)(i) 01/11/05 31/12/05 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. 2. Refer to Standard 8 27 Good Practice Recommendations Complete risk assessments in the following areas for every person living at, or visiting the Home: preventing pressure sores, falls and poor dietary intake. Ensure that the dependency levels of people living at, or visiting the Home, are completed and then updated, on a regular basis. The information obtained should be used to Version 1.10 Page 23 Dorset House ensure that people are appropriately placed and, to confirm that the required staffing levels have been provided. 3. 4. 5. Dorset House Version 1.10 Page 24 Commission for Social Care Inspection Northumbria House Manor Walks, Cramlington Northumberland NE23 6UR 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 Dorset House Version 1.10 Page 25 - 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!