Inspection on 30/08/06 for Elisabeth House

This inspection was carried out on 30th August 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Elisabeth House 05/01/09

Elisabeth House 08/01/08

Elisabeth House 15/08/07

Elisabeth House 17/01/06

Elisabeth House 26/07/05

Elisabeth House 13/01/05

Elisabeth House 01/07/04

Elisabeth House 02/03/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Elisabeth House Rhosweil Weston Rhyn Oswestry Shropshire SY10 7TE Lead Inspector Janet Oxley Key Announced Inspection 30th August 2006 9:45 Elisabeth House DS0000020684.V307259.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Elisabeth House DS0000020684.V307259.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. Elisabeth House DS0000020684.V307259.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elisabeth House Address Rhosweil Weston Rhyn Oswestry Shropshire SY10 7TE 01691 777563 01691 680983 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Sonja Eckert-Hopkins Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Elisabeth House DS0000020684.V307259.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th January 2006 Brief Description of the Service: Elisabeth House is a privately owned care home registered to provide care and accommodation for up to 9 people with a learning disability, 2 of whom are over 65 years old. The home is owned and managed by Mrs S Eckert-Hopkins. It is located in the hamlet of Rhosweil, some 8 miles north of Oswestry in North Shropshire, in a quiet area next to a canal but within easy reach of main roads and the local towns. The home has the use of 3 vehicles for ease of access. Elisabeth House was originally converted from a row of 4 cottages and provides homely accommodation on 2 floors in 2 double and 5 single bedrooms. Bathroom and communal living facilities exceed the required standards and the home has pleasant and well-kept grounds and gardens. The home makes their services known to prospective service users in The Statement of Purpose and Service User Guide. The inspection report is mentioned in these documents and is given out on request. Fees are reviewed annually and range from £352 - £982. Any additional charges are clearly laid out in the contracts. Elisabeth House DS0000020684.V307259.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A range of evidence was used to make judgements about this service. This includes: information from the provider, looking at relevant records pertaining to key standards, chats with residents, discussions with the Trainee Manager and 2 staff on duty, discussions with the Proprietor, tour of the premises, previous inspection reports, quality assurance process, Fire Authority reports, Environmental Health Office reports and observation of care experienced by people using the service. What the service does well: What has improved since the last inspection? The home continues to improve the programme of daily living skills and methods of communication. It was again evident that the Proprietor is continually improving, upgrading and individualising the service users bedrooms and all communal rooms, including the garden area. Since the Random Inspection in June 2006 the staff files and recording systems have been improved and the proprietor and Trainee Manager are reviewing all aspects of the service to achieve best practice and a high quality service. Elisabeth House DS0000020684.V307259.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Elisabeth House DS0000020684.V307259.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elisabeth House DS0000020684.V307259.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The policies and procedures that are in place, and have been professionally followed, ensure that the home undertakes all necessary assessments for successful and satisfactory admissions to take place. EVIDENCE: All the required information for prospective residents is available. The last admission to take place was in July 2004. Full and comprehensive assessments were made, prior to admission, covering all the required elements of these standards, the home fully demonstrated its capacity to meet the assessed needs and the transition to being resident at the home was conducted professionally and sensitively with all relevant persons involved. Pre-admission visits and meetings took place and these were recorded in detail. Elisabeth House DS0000020684.V307259.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each resident has a care plan, which includes aspects of daily living and care they require. Staff evidently respect resident rights and there is a constant monitoring and review process to ensure their identified needs are being met and individualised care given. EVIDENCE: Care documentation pertaining to two residents was inspected. The care plans were comprehensive and provide the staff team with the necessary information required to meet the individual’s needs. It was reported that the formatting of all care plans is currently under review and amendments and improvements will soon take place. Detailed reports are completed in preparation for reviews. The two residents, whose documentation was read, were chatted to and one, who was able, detailed her daily activities, indicated that she was very happy living at the home and could not identify any improvements she would like. Their bedrooms were seen to be very personalised and used as private places and their ‘key’ workers were also chatted to and confirmed the care the Elisabeth House DS0000020684.V307259.R01.S.doc Version 5.2 Page 10 individuals were receiving and that they carried out their key worker duties professionally and sensitively. With staff support, the residents who are able are engaged in all aspects of the running of the home. Individual and generic risk assessments are established. Shortly before this inspection it had been identified that the home could no longer meet the needs of a resident, whose health had significantly deteriorated and it was considered that the home had worked sensitively and professionally with the placing authority to find an alternative and satisfactory placement for the individual, who had lived at Elizabeth House for a number of years. Elisabeth House DS0000020684.V307259.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The lifestyle of the residents living at this home appeared satisfactory and through a framework of activities, independence, personal and social skills they are encouraged to develop. Family ties are maintained and visits and meetings with relatives are encouraged and supported EVIDENCE: The residents disabilities would prevent them from entering a world of work however the majority attend college and participate in basic skills, literacy and numeracy, basic computing, cooking, music and hair and beauty. Local day services are used and the Monkmoor centre, Age Concern and Patchworks are also attended. Many other activities take place eg- one resident enjoys Yoga classes and regularly goes to church. The residents are certainly part of the local community and use a number of community resources on a regular basis. Elisabeth House DS0000020684.V307259.R01.S.doc Version 5.2 Page 12 To the extent they are able, residents are all encouraged to personally develop and those who are able enjoy a number of activities, parties and holidays. This year 3 residents have enjoyed a holiday in Greece, 4 have enjoyed a break in Prestatyn, one has been to Ireland and one who resists leaving the home has been catered for through day trips and outings. Visitors are encouraged and welcomed and residents are supported to maintain links with their families. Evidence from discussions, records and inspection of the kitchen indicated that an excellent diet is offered and residents are fully involved with all catering arrangements, if they are able, and enjoy meals out and take-aways. At the time of this inspection 4 residents and 2 staff went out to lunch at a well known local restaurant. Elisabeth House DS0000020684.V307259.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal needs of resident appeared to be very well met with evidence of regular review and of good multi disciplinary working taking place on a regular basis. EVIDENCE: Residents records seen and discussions with staff indicated that the staff monitor health needs, make appropriate referrals and appointments to health care professionals. The support individuals require is well documented and on inspection it was evident that residents preferences for times of getting up and having meals etc are respected. The Proprietor requests full reviews for residents whose health deteriorates. The support of Doctors and Consultants for all residents is ongoing. Behavioural changes of residents are also monitored and plans and risk assessments for activities are in place. Elisabeth House DS0000020684.V307259.R01.S.doc Version 5.2 Page 14 All staff have attended an external distance learning course and gained the Certificate in Safe Handling of Medicines and at the time of this inspection matters pertaining to medication appeared satisfactory with the exception that the cabinet securing the medicines requires replacement to comply with the laid down guidelines. Elisabeth House DS0000020684.V307259.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has appropriate policies and procedures in place for the protection of the residents and staff on duty indicated that they were fully aware of complaints and adult protection procedures. EVIDENCE: No complaints have been received since the last inspection. A full complaints procedure is available and given that the residents would have some difficulty understanding the concept of a complaint it was evident that staff are sensitive and have developed methods to identify what residents like, dislike or object to and explore new avenues in efforts to overcome the difficulties. At the time of this inspection it was evident that the residents are confident to do what they want within the homes environment. Procedures are in place to protect service users from abuse and are included in all aspects of staff training. Three staff members confirmed this at the time of this inspection. A Protection of Vulnerable Adult referral made in June was satisfactorily followed by the Proprietor and was quickly resolved. Elisabeth House DS0000020684.V307259.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment within the home is very good, providing service users with a warm, safe and homely place to live. EVIDENCE: All areas of the home were seen to be very well maintained and homely. All residents bedrooms are personalised. The home is furnished and equipped to a high standard throughout. Lounges, dining areas and a fully fitted kitchen are provided and outdoor space is proportionate to the number of people residing at the home, is attractive and well maintained with pleasant seating areas. At the time of this inspection the standard of cleanliness and hygiene was excellent and at the time of the most recent Fire Officers and Environmental Health Officers inspections matters were reported to be satisfactory. Laundry facilities are good and all staff have received the necessary training. Elisabeth House DS0000020684.V307259.R01.S.doc Version 5.2 Page 17 Necessary repairs resulting from a recent heavy storm are well in hand and further improvements to the accommodation are planned. Elisabeth House DS0000020684.V307259.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The quality of care provided to service users may be compromised if staff do not receive a structured induction or further training to carry out their roles. Service users are at risk due the home failing to carry out appropriate pre appointment checks. Service users will benefit from staff receiving formal support to do their jobs effectively. EVIDENCE: There are two members of staff on duty between 7.00 am and 9.30 pm. The home employs one member of staff to work over night. On call support is available. The trainee manager spoke of having the flexibility to increase staffing levels to support activities. The rota reflected this arrangement. The rota reflected that these levels are constant for weekdays and weekends. Three staff files were reviewed as part of this inspection. It was found that files were organised but did not contain all required information. The home could not demonstrate that Criminal Record checks are requested upon appointment. One file contained photocopies of such checks requested via previous employers and two of the three files did not contain a Protection of Vulnerable Adult check. Elisabeth House DS0000020684.V307259.R01.S.doc Version 5.2 Page 19 Through discussions with the trainee manager it was identified that the home is due to review the recruitment application form in order to ensure that previous work history including reasons for leaving, is detailed. It was difficult to establish where staff had worked previously. This also made it difficult to validate references. Two of the three references provided for one person were from the same person. The trainee manager was aware of the requirements of Schedule 2 of the Care Homes Regulations 2001 and is in the process of reviewing all files to ensure that recruitment practices are appropriate to safeguard service users. These requirements were also made at the time of the last inspection of the home. Staff files did not contain proof of identity or a declaration that the staff member is physically and mentally fit for the work that they are required to do. One staff member has identified support needs and this arrangement is not supported by a risk assessment. One of the three files reviewed contained evidence of a recent appraisal and a supervision session. The other files did not contain such documents however the trainee manager was able to identify that dates had been set for such sessions for both staff members. The trainee manager has, since her appointment implemented a system of formal supervision that sets an agenda and details strengths and needs of the individual. On all files reviewed there was a declaration of sufficient induction and an induction checklist, all of which had been signed by the staff member. However there was no evidence of the content of an induction package. This was discussed with the trainee manager who is ready to implement an appropriate induction programme but will first research the new core induction standards soon to be launched. One of the three files reviewed contained evidence of induction training in adult protection procedures. The trainee manager reported that she is in the process of ensuring that all staff are booked on forthcoming training dates. Two staff, who have been recruited in the last 6 months, were very complimentary at the time of inspection regarding the induction, support and supervision they have received. It was reported that all staff had been issued copies of the General Social Care Council code of conduct and that there were spare copies in the office for reference. Through discussions with staff and through review of staff files it was evident that staff have received training relevant to the jobs they do. Additional training is being considered in relation to supporting people with challenging behaviour and with mental health needs. Elisabeth House DS0000020684.V307259.R01.S.doc Version 5.2 Page 20 Training in restraint is not provided and currently the homes restraint policy (as detailed in the induction book) states that staff may use restraint in emergencies. The trainee manager (who has been in post since July 2006) has started identifying staff training needs and achievements in supervision sessions. She will use this completed information to develop a training profile and a homes training and development plan. This work is ongoing and will therefore be reviewed at a future inspection. Elisabeth House DS0000020684.V307259.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are clear lines of accountability within the homes management structure and the management approach creates an open and positive atmosphere from which the service users benefit. The home regularly reviews all aspects of its performance and meets the requirements of the Fire Officer and Health and Safety Officer, promoting the health, safety and welfare of the service users. EVIDENCE: The Proprietor is fully qualified and has run the home for over 12 years and continues to attend a variety of relevent training courses to keep herself up to date and to enable her to cascade the training to all staff. In July 2006 a Trainee Manager was appointed and is currently undertaking NVQ4 in care and will then be undertaking the Registered Managers Award. Elisabeth House DS0000020684.V307259.R01.S.doc Version 5.2 Page 22 The manner in which the Proprietor and staff responded to this inspection indicated that a sound management approach is in place and that staff are committed to improving and developing to achieve best practice and to develop equal opportunities. Equality and diversity for the service users were seen to be promoted throughout the home, within the assessments, care plans and activities. The Proprietor is the appointee for 8 residents and appropriate records are maintained. Discussions with the Proprietor regarding DLA mobility took place and the home will now ensure that arrangements for providing transport for residents are detailed in the homes Statement of Purpose/Service User Guide and ensure that records demonstrate that all arrangements are equitable and agreeable by all parties. Health and Safety matters appeared satisfactory and no potential hazards were identified. All necessary records required are maintained and all staff have received training in Health and Safety matters. Elisabeth House DS0000020684.V307259.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 3 26 3 27 3 28 3 29 x 30 4 STAFFING Standard No Score 31 3 32 3 33 3 34 1 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 3 12 4 13 4 14 4 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x Elisabeth House DS0000020684.V307259.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes 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 YA20 Regulation 13(2) Requirement That medicines be stored in a secured metal cabinet in line with guidelines from the Royal Pharmaceutical Society, Two written references must be obtained before making an appointment and any gaps in the employment record explored. This requirement is outstanding and was made following the inspection on June 1st 2006. Staff must not commence work with service users without CRB/POVA 1st checks being undertaken and the appropriate safeguards documented and implemented at the home. This requirement is outstanding and was made following the inspection on June 1st 2006. All staff must receive structured and recorded induction in line with the homes policies and procedures. Timescale for action 30/09/06 2 YA34 19 (1) 30/09/06 3. YA34 19 (1) 30/09/06 4. YA35 18 (1) (c) 30/09/06 Elisabeth House DS0000020684.V307259.R01.S.doc Version 5.2 Page 25 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 YA34 Good Practice Recommendations The home’s application form should require applicants for employment to disclose their full employment history and account for any gaps Elisabeth House DS0000020684.V307259.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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 Elisabeth House DS0000020684.V307259.R01.S.doc Version 5.2 Page 27 - 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!