Inspection on 07/04/05 for Greenslades Nursing Home

This inspection was carried out on 7th April 2005.

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

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

Other inspections for this house

Greenslades Nursing Home 12/11/07

Greenslades Nursing Home 22/08/06

Greenslades Nursing Home 21/12/05

Greenslades Nursing Home 12/10/04

Greenslades Nursing Home 07/05/04

Greenslades Nursing Home 10/02/04

Greenslades Nursing Home 05/12/03

Greenslades Nursing Home 09/05/03

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

CARE HOMES FOR OLDER PEOPLE Greenslades Nursing Home Willeys Avenue Exeter Devon EX8 4DD Lead Inspector Rachel Doyle Announced 7th April 2005 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. Greenslades Nursing Home Version 1.00 Page 3 SERVICE INFORMATION Name of service Greenslades Nursing Home Address Willeys Avenue, Exeter EX2 8BE 01392 274029 01392 279089 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) Sanctuary Housing Association [trading as Sanctuary Care] CRH/N Care Home with Nursing 67 Category(ies) of DE[E] Dementia over 65 [36]; registration, with number MD[E] Mental Disorder over 65 [36]; of places OP Old Age [31] Conditions of registration Date of last inspection YES 12/10/04 Brief Description of the Service: Greenslades Nursing Home was built approximately fifteen years ago. It is a three-storey red brick building. Access is via a side road off one of the main routes into the city near the centre of Exeter. There are local shops and amenities close by, the city centre being approximately one mile away. ISCA wing is primarily for 36 older people with mental health/dementia related needs. Belvedere wing is for 31 older people with more general health care needs. Nursing care is provided for 67 service users, in all areas of the home, by nursing care assistants who are supervised by Registered Nurses. Greenslades Nursing Home Version 1.00 Page 4 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 7 hours and was conducted by 4 inspectors, 2 on each unit, due to the size and layout of the Home. A tour of the Home took place and staff and care records were inspected, four care files in depth on Belvedere and 3 on Isca. A pre-inspection questionnaire and 10 comment cards from service users and relatives were received by CSCI. There were 29 service users in residence on Isca and 31 on Belvedere. One carer had called in sick on Belvedere and the manager was trying to cover the shift. The inspectors spoke with the regional manager, home manager and acting deputy manager as well as 4 staff on Belvedere and 4 staff on Isca and 1 relative. Six service users were spoken with on Belvedere and thirteen on Isca, 4 of whom understood what the inspectors were saying. Two inspectors ate lunch with the service users. The Home will soon be advertising for a permanent deputy manager and are currently recruiting for a senior staff nurse on Isca. The report is written for the whole Home and Belvedere and Isca Units are referred to separately where there are concerns or good practice. It is clear that there are more concerns on Isca Unit than on Belvedere Unit. What the service does well: What has improved since the last inspection? Since the last inspection there has been an improvement in the staffing records and details of the checks made as part of the recruitment process. The Home has improved the standard of basic health care on Belvedere and there are now two extra carers working on Belvedere during the day. Greenslades Nursing Home Version 1.00 Page 5 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. Greenslades Nursing Home Version 1.00 Page 6 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 Greenslades Nursing Home Version 1.00 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,5 The home’s Statement of Purpose and service user guide are good providing service users and prospective service users with details of what should be provided. Detailed assessments are carried out so that the Home can see if they meet service users’ needs before they move in. EVIDENCE: The Statement of Purpose and Service Users’ Guide contain the information required by the Regulation to enable service users to make an informed choice. However, it needs to be updated to show current management. Both documents are available at reception. Seven service users’ records seen on both units contained clear assessment information gained through use of professionally recognised tools. Assessments indicated that they are reviewed regularly. Those service users spoken to who could communicate said that their relatives had been able to visit the Home on their behalf prior to admission. Greenslades Nursing Home Version 1.00 Page 8 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10,11 Personal and nursing care in both units for service users who lack capacity is not offered in such a way as to promote and protect service users dignity, independence and safety. On Belvedere there is no clear or consistent care planning system in place to adequately provide staff with the information they need to meet the service users’ needs. On Isca the care planning system is adequate to meet the needs of the service users. EVIDENCE: Care plans on Belvedere contained some good information about how service users’ needs were to be met but they were mainly vague, not reviewed and with no clear outline of identified issues. Actions taken were often difficult to find within daily notes and one service user did not have their mental health issues documented appropriately. One health professional commented that care plans for their client were poor and did not reflect the action required or progress. Carers spoken to who had worked at the Home for some time indicated that they did not use the care plans even though they were teaching a large number of new staff. They were aware of residents’ basic needs. On Belvedere appropriate communication with service users who had difficulty communicating was poor, especially during lunch. However, one staff member Greenslades Nursing Home Version 1.00 Page 9 was particularly good at communicating with a service user who had suffered a stroke. Service users have been referred for additional medical support and assessment, although actions to be taken or outcomes of visits were not always clear in the plans. There are 19 residents with pressure sores at the Home. The Tissue Viability team were involved but the homes documentation was often poor. A service user had made good progress with mobility and in general staff were seen to promote independence. Basic health care on Belvedere had improved since the last inspection although there was some delay in basic nursing care for those service users who lacked capacity to ask for help. An example of this was service users being left with dirty mouths. Some residents could not reach their call bells to call for help. On Isca residents’ care plans provided clear sufficiently detailed information and showed evidence of regular review; in one instance the changed needs of one person were not shown on their care plan. On Isca one service user did not have any shoes or socks on. Their toe-nails were very long and discoloured and their feet were very dirty. Staff said though the chiropodist visited, service users did not always see them, and no care staff cut toe-nails. Three staff on Isca commented on the shortage of staff in the unit and said that this meant that they were very rushed and felt they could not always meet the personal care needs of service users to a satisfactory standard. Staff rarely spoke to the service users on Isca while tasks were being performed for them such as helping with their meals, helping to get up and move. During the afternoon activity, staff rarely spoke to the service users. One service user, who was trying to get up from their chair, was continually told to sit down. There was no attempt by any of three staff present to find out why the service user wanted to get up. Service users were not asked what they wanted to do at anytime during the inspection. Medication on both units was inspected. Records and storage were found to be correct. No service users are self-medicating at present. Creams prescribed for another service user were being used for some one else. This must stop. The home’s fridge temperatures are monitored daily although no action had been taken when temperatures had exceeded those recommended. Eye drops on Isca were not labelled to say when they were opened, as they should be. Staff, in general, did observe service users’ privacy, although one service user comment card said that they did not. Privacy locks have not been fitted to all toilet and bathroom doors as previously recommended. Greenslades Nursing Home Version 1.00 Page 10 There were no clear records of service users’ wishes in relation to terminal illness, including health care decisions and death. Issues were also raised by two staff, about lack of respect during these times by other staff. There are multi-denomination services on some Sundays at the Home. Greenslades Nursing Home Version 1.00 Page 11 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) 12,14,15 There is limited opportunity for service users to choose what they wish to do. Social activities are provided but individual needs are not always met. Dietary needs are well catered for apart from the provision of different fresh fruit. EVIDENCE: There is a new activities co-ordinator and the activity assistant is doing extra hours. The Home does invite external entertainers to the Home at times and there is an activities newsletter. There were no records of individual activities or ‘one to ones’ in residents’ files and any likes/dislikes were irrelevant to possibilities at the Home such as ‘cycling’. Records on Isca contained information about residents’ interests and social histories. The activities worker was observed trying to engage service users in a game of skittles and a ball game; there were 18 people in the lounge and few of them were able to engage in the activity given their levels of confusion. One resident told the inspector that they would like more to do in the home and go out, three others would sometimes like to be more involved. All service users spoken to on Belvedere said that there were aspects of their life where they were not given choice. Examples included bath days, where to sit, television channels, when to get up (comment by relative) and whether to have the radio on or not. One service user wanted to doze but a carer just Greenslades Nursing Home Version 1.00 Page 12 came and put the radio on next to them with no communication. Staff said that residents were increasingly being moved into different rooms or units. There were no records to state that consent or consultation with the resident and/or multidisciplinary team had been sought. An important decision about terminal care had been made in one care plan but the source was unclear. Service users are asked the previous day for their choice and size of main meal and tea. Five service users had all forgotten their choice and said that they would like menus on the tables. On one of the returned survey cards a relative said that if cheese on toast was served it was toast with un-melted grated cheese on top and that the only fruit available is bananas. The main meal alternative is usually an omelette. The chef confirmed this. He said that other fruit is not provided as the service users are thought not to be able to eat it. This does not take into consideration individual service users’ needs. The meals on the day of the inspection looked appetising but staff said that sometimes they were not very good. Three comment cards said that the food was not good. Condiments were available in the kitchen cupboard but staff did not offer any. Some residents were seen to choose to take meals in their rooms. Staff were attentive as they helped residents to eat but residents were not offered a choice of meal or told what they were being given. One resident was unhappy about the food saying there is little choice and that they can not have a drink when they want one only at set times. Food was hot when it reached the table and nicely presented. Greenslades Nursing Home Version 1.00 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 The complaints process is good but the protection of service users from abuse is being compromised by the non-recognition of adult protection issues. EVIDENCE: Service users have a copy of the home’s complaints procedure on the inside of their wardrobe door and a copy was seen displayed in the main entrance hall and Service Users’ guide. A comprehensive record is maintained of complaints in a file with a chart at the front, which indicates the outcomes. Within the file are copies of letters and statements for each complaint. There were eight complaints recorded since the last inspection. Two complaints should have been investigated under Adult Protection procedures but were not referred by the home and the Commission was not notified of them. On Isca one resident said that they are told to “mind their own business if they complain”. On Isca four staff were spoken with and all said they had recently received training in recognising and dealing with abuse. All four gave an appropriate response as to what they would do if they saw a service user being abused. Consent to use bed-rails were seen on both units, signed by relatives, in residents’ files. No evidence of the use of covert medications was seen but one plan said that a resident had ‘been noisy and medication given’ with no further discussion. None of the four staff were aware of a whistle-blowing policy for the home and two staff were worried that talking to the inspector would be seen by management in a ‘bad light’. The manager disagreed with this. Greenslades Nursing Home Version 1.00 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,22,23,24,25 and 26 The standard of the environment within this home is good, providing the service users with an attractive and homely place to live. On Isca there is an unacceptable odour, which is not pleasant for residents. EVIDENCE: In general residents’ rooms suit their needs and have been personalised. On Isca privacy locks have not been fitted to all toilet and bathroom doors as previously recommended. The Home are in the process of fitting appropriate locks to residents’ bedroom doors and risk assessing their use as necessary. The standard of cleanliness on Belvedere was very good and residents said that the unit was usually kept clean. Staff were seen wearing disposable gloves and aprons throughout the Home and they confirmed that they were available all the time. Greenslades Nursing Home Version 1.00 Page 15 Two staff on Isca told the inspector that they were concerned that the level of cleanliness within the unit was very poor. They said that although a special effort had been made for the inspection, standards were still low. The inspector saw the arms of chairs that service users were using were very grubby. There was an unpleasant, underlying odour throughout the unit. No unmanaged threats to the safety of service users were seen, although it was noted that the ceiling in the corridor of Belvedere was bulging in one place. On Belvedere staff documented and explained thoroughly to two residents why the use of a hoist was necessary and staff used equipment appropriately. Footplates were used well. On Isca several people were transferred bodily from chair-to-chair by two care staff; at no time manual handling equipment was used. Footplates for wheel chairs were available but not used on every occasion. Residents sitting in wheelchairs were on pressure relieving cushions. Residents did not always have access to call bells in the lounges but staff were visible. Greenslades Nursing Home Version 1.00 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) 27,28,29 and 30 Service users are supported and protected by the home’s recruitment methods. The lack of staff with relevant training/skills compromise service users’ health, personal, social and safety needs EVIDENCE: Staffing levels on both units were within levels agreed by CSCI. Two housekeepers also work 09.00-15.00 every day and a maintenance man. The visitor and all service users, who were able to say, indicated that care staff are kind and helpful and hard-working and that they could have a joke with them. Staff on Belvedere said that in general the unit had enough staff although it was felt by two staff that an extra Registered Nurse may be beneficial. On Isca three staff members said that there were not enough staff on duty to meet the needs of the service users. There were long periods when service users in the main lounge were unsupervised. The inspector had to prevent one service user from hitting another with their walking stick. Staff said that the two service users did not get on together and often argued. Despite this one service user was sat next to the other by a member of staff. Recruitment records were looked at for the last sixteen staff employed. They were seen to be well organised and the required documentation in place. It was noted that for some overseas staff the references were those which they had brought with them. The administrator said that the staff were recruited through an agency and the agency checked these references as part of their contract with Sanctuary Housing. Greenslades Nursing Home Version 1.00 Page 17 Training has been provided for the main core training, including English lessons for staff whose first language is not English. Not all staff have training in dementia care. During the inspection most staff did not communicate clearly with residents who had difficulty communicating on occasions. A group of new senior care assistants with little dementia/general older people care had received little training. The manager said that they are now going through induction programmes. One Registered General Nurse spoken with (in post 2 months) said that they had no psychiatric nursing experience and had received no training regarding the care of older people with dementia/mental health problems since arriving at the home. This person was usually on duty with another qualified nurse. Greenslades Nursing Home Version 1.00 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 36, 38 Service users are at risk because of the lack of fire safety training. The staff morale in the home is low with high levels of sickness and this has a detrimental impact on the standard and consistency of care offered in the home. EVIDENCE: Records indicate that several staff had not received fire safety training since March 2004. All staff on Belvedere during the inspection had worked at the Home for some time. They all said that staff morale was low due to new care staff being given senior positions. There are 6 staff disciplinary actions in progress due to sickness levels. Three staff on Isca said that they felt staff morale was very low, due to the staff shortages, and felt that service users’ care was poor because of this. Greenslades Nursing Home Version 1.00 Page 19 All staff confirmed that they received regular supervision, and all felt supported by the unit manager and said that management was approachable but only 15 staff attended a recent staff meeting. Two staff said that they did not bother to attend meetings at all. Greenslades Nursing Home Version 1.00 Page 20 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 3 x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 1 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 x 14 1 15 2 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 x 1 STAFFING Standard No Score 27 1 28 x 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 x 1 x x x 3 x 1 Greenslades Nursing Home Version 1.00 Page 21 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 OP7 Regulation 15 Requirement Timescale for action 7/07/05 2. OP8 and OP11 12 (1) (b) (2) 3. OP10 and OP11 12 (4) (a) 4. OP14 12 (3) Care plans must clearly set out in detail the action which needs to be taken by staff to ensure that all aspects of the health, personal and social care needs of the service user are met ensuring that all identified long term and short term needs are included.(Timescale 12/01/04 not met). 7/06/05 You must ensure that the Home is conducted so as to make proper provision for the care, including mental health care and, where appropriate, treatment, education and supervision of service users.You must so far as practicable enable service users to make decisions with respect to the care they receive. (Timescale 12/12/04 not met). You must ensure that the Home 7/06/05 is conducted in a manner which respects the privacy and dignity of service users with due regard to..any disability. You shall, for the purpose of 7/06/05 providing care to service users, and making proper provision for their health and welfare, so far Version 1.00 Page 22 Greenslades Nursing Home 5. OP18 13 (6) 6. OP26 13 (3) 7. OP27 and OP30 18 8. OP38 13 as practicable ascertain and take into account their wishes and feelings.(Timescale 12/01/04 not met.) You must make arrangements to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse.(Timescale 12/01/04 not met). You shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the Home (this refers to the unpleasant odour on Isca) You must ensure that at all times suitably qualified, competent and experienced persons are working in such numbers as are appropriate for the health and welfare of service users.(this refers to reviewing the numbers of staff on Isca and that the skill mix reflects competency in caring for service users living with dementia and communication difficulties). You must ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. (this refers to staff fire safety training). 7/05/05 7/05/05 7/06/05 7/06/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations It is recommended that topical medication is only used for the named person, appropriate actions are recorded if the fridge temperature exceeds correct levels and that medication with a use by date is labelled when opened. Version 1.00 Page 23 Greenslades Nursing Home 2. OP15 3. OP32 It is recommended that service users are assisted to make informed choices or are given appropriate information at mealtimes and that there are choices of fruit and alternative menus. It is recommended that the management team address issues relating to low staff morale. Greenslades Nursing Home Version 1.00 Page 24 Commission for Social Care Inspection Suite 1 Renslade House, Bonhay Road Exeter EX4 3AY 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 Greenslades Nursing Home Version 1.00 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!