CARE HOMES FOR OLDER PEOPLE
Greenways 720 Preston Road Bamber Bridge Preston Lancashire PR5 6AL Lead Inspector
Val Turley Unannounced Inspection 30th May 2006 09:30 X10015.doc Version 1.40 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 Greenways DS0000005926.V290945.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 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. Greenways DS0000005926.V290945.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Greenways Address 720 Preston Road Bamber Bridge Preston Lancashire PR5 6AL 01772 339083 01772 339083 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) Ark Care Services Limited Mrs Sandra Clements Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Greenways DS0000005926.V290945.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 30 service users in the category of OP - Old age, not falling within any other category. 5th January 2006 Date of last inspection Brief Description of the Service: Greenway is a residential care home providing 24-hour personal care and accommodation for 30 older people. The home is owned by Mr and Mrs Ajisebutu, who also own a second home in the South of England. The home is located in a residential area on the outskirts of Bamber Bridge, close to all local amenities and the motorway network. The home is a two-story building. Accommodation is provided in single bedrooms, the majority of which have ensuite facilities, comprising of a wash hand basin and WC. Although the rooms are pleasantly furnished, service users are also able to take personal possessions with them when they come to live at the home. Bedrooms are located on both the ground and first floor. There is a passenger lift. Accessible toilets and bathrooms are located on both floors near to bedrooms and living rooms. There are three dining areas; two of these are combined lounge with a dining area. A separate conservatory is also available. The home is a no smoking home. The fees at the home range from £310.50 -£360 per week. There are additional charges for hairdressing and newspapers. Greenways DS0000005926.V290945.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over one day in May 2006 by one regulatory inspector. The inspection involved discussion with service users living at the home, a visiting relative and also discussion with and observation of the staff working there, an examination of records, policies and procedures and a tour of the premises. As part of the inspection, the inspector used “case tracking” as a means of assessing some of the National Minimum Standards. This process allowed the inspector to focus on a number of the service users living at the home. All records relating to those individuals were inspected and discussion took place with the service users where possible. What the service does well:
The home provided a comfortable, clean, well-maintained and homely environment for the service users and staff. There was a good rapport between the service users and the staff team, with staff being observed to speak to the service users sensitively and politely. The atmosphere in the home was relaxed and routines were flexible. A range of activities was arranged for the service users to take part in if they wished and visitors were made to feel welcome. The service users expressed their satisfaction with the meals provided and snacks and drinks were available throughout the day and night. The home had some good systems in place to ensure that they were aware of the support needs each of the service users had and staff were provided with the information that they need to provide the care and support required. Community health and social care professionals were involved in the home appropriately and they provided additional advice, guidance and aids and equipment. The staff team was generally well established and settled and there were sufficient numbers of staff on duty at any one time. The member of staff who was responsible for staff training was enthusiastic about her role and this enthusiasm had been transferred to the rest of the staff team. As a result of this, over 50 of the staff team had a nationally recognised qualification in care. There were clear lines of accountability in the home and the staff stated that they appreciated and benefited from the support provided by the management team within the home. The home had a number of quality assurance monitoring systems in place to help ensure that the home was run safely and with the wishes and needs of the service users in mind. The home had made a commitment to equal opportunities in respect of both staff and service users.
Greenways DS0000005926.V290945.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
Wherever possible the home should support service users or their representatives to become involved in the development and review of their care plan. This would help ensure that the care plans meet the needs of the service users. Some additional improvements could be made to the homes management and administration of medication, helping to safeguard service users still further. Some work needs to be undertaken to ensure that the homes policies and procedures which deal with complaints and the protection of vulnerable adults, contain all of the relevant information and guidance for staff and also where applicable for service users and their representatives. This would help to make sure that all parties are clear as to their responsibilities in terms of the protection and well being of the service users. Staff in the home received good training, however the training records did not provide a clear overview of the homes achievements. The development of a training matrix would help with this and would also allow staff training needs to be easily identified. The results of a service users survey undertaken by the registered person should be made available to the manager, enabling her to act upon any concerns or criticisms received or indeed to make her staff aware of any positive remarks made about the home. The homes quality assurance processes should be extended to take into account the views of relatives and involved health and social care professionals. The electrical systems at the home must be inspected and any remedial work undertaken to ensure the safety of the service users and staff. The homes policies, procedures and risk assessments in respect of safe working practices should all be reviewed to ensure that they reflect current legislation and good practice.
Greenways DS0000005926.V290945.R01.S.doc Version 5.2 Page 7 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. Greenways DS0000005926.V290945.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greenways DS0000005926.V290945.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, Standard 6 was not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service The pre-admission process is in sufficient detail to ensure that prospective service users supports needs are fully assessed before admission. EVIDENCE: The files of three service users were examined during the inspection. These showed that the home had undertaken a full assessment of the service users support needs before admitting them to the home. The home was therefore able to decide before admission that they could provide the support that the service users needed. A care plan for each of the service users had been developed based on the information collected before admission. Greenways DS0000005926.V290945.R01.S.doc Version 5.2 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 the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans and records were detailed and personalised to help ensure that staff were able to provide appropriate support to service users. EVIDENCE: The care plans examined, included all the detail needed to help the staff at the home provide each service user with the support that they needed. The plans were reviewed on a monthly basis and were also checked by the manager of the home. A number of assessments were undertaken on a monthly basis and the information from these was included in the care plans to help ensure that the service users changing needs were met. There was however no evidence that the service users or their representatives had been involved in the development or review of the care plans. There was evidence that community health professional provided additional support and guidance to the home and aids and equipment were provided for the service users. The home had acted upon the requirements and recommendations made by the pharmacy inspector at the last inspection and the medication in the home appeared to be well managed with records correctly maintained. Some
Greenways DS0000005926.V290945.R01.S.doc Version 5.2 Page 11 additional recommendations were made to help maintain and improve the homes management of medication and so safeguard service users still further. It was observed that the staff spoke to the service users sensitively and that their core practice reflected the homes policies, procedures and guidance on privacy and dignity. There was a good rapport between the service users and the staff team. Greenways DS0000005926.V290945.R01.S.doc Version 5.2 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 the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The routines within the home were flexible to meet the needs of the service user allowing them to make individual choices and decisions. EVIDENCE: The atmosphere at the home was relaxed. The service users spoken to said that the routines were flexible and a visitor spoken to agreed with this. Visitors were able to visit at any reasonable time and it was observed during the course of the inspection that visitors were made to feel welcome and that they had a good relationship with the staff. Activities were arranged within the home and the service users spoken to said they could choose to join in these if they wished. Details of service users individual interests were recorded in the care plans enabling staff to support them to follow these interests. One member of staff had some responsibility for arranging activities in the home and she was observed to do this on the day of the inspection. One service user said ‘activities are organised regularly and entertainers come in about once a fortnight’. Service users were able to take personal possessions into the home with them. Information about the local advocacy service was made available for service user and their representatives.
Greenways DS0000005926.V290945.R01.S.doc Version 5.2 Page 13 Meal times at the home were observed during the inspection. These were relaxed occasions with staff offering assistance appropriately. Staff were also heard to ask service users if they would like alternatives to the main meal that was on offer. During the course of the day it was noted that service users were offered drinks on a very regular basis. All of the service users spoken to expressed their satisfaction with the meals provided. Information provided in questionnaires completed by service users also indicated that there was a general satisfaction with the meals. When asked if she could ask for a drink or a snack at any time one service user said ‘I’m sure I could, but I have never had to, there is plenty of food and drinks are always being made’. Another service user said she often got up in the night when she couldn’t sleep and would sit with the night staff who made her a drink. The cook had a good knowledge of the individual likes and dislikes of the service user meal preferences and was also aware of any specific dietary needs of the service users. A record of the service user weights was maintained and this was used to alert staff to any health difficulties that the service user may have. The kitchens were inspected during the course of the inspection. They were well stocked with the food being of an acceptable quality. There was evidence that the dietary preferences of any service user from a minority group were catered for. Greenways DS0000005926.V290945.R01.S.doc Version 5.2 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 the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had policies and procedures in place in order to protect service users. These included most of the necessary detail but some changes were needed to ensure that service users were protected as far as possible. EVIDENCE: The home had policies and procedures in place in relation to complaints and the protection of vulnerable adults. The complaints policy and procedure contained all of the necessary detail although the contact details of the Commission for Social Care Inspection needed to be updated. Although the policy and guidance contained all of the detail as specified with in the National Minimum Standards and the Care Home Regulations, the tone was concise and abrupt; it could be rewritten to encourage both service users and/or their representatives to report any concerns that they may have. Information provided within the service users questionnaires and by the service users spoken to on the day of the inspection indicated that they were clear who they could complain to if they had any concerns. The homes policy on the management of challenging behaviour should be extended to include the need to involve relevant health professionals when developing strategies to manage challenging behaviour. This will help to safeguard both the service users and the staff. Although this detail wasn’t included in the policy the manager was aware of her obligations in this area. The home had a policy in place regarding the protection of vulnerable adults although this was only in relation to employment. Additional detailed
Greenways DS0000005926.V290945.R01.S.doc Version 5.2 Page 15 information was available for staff including information about abuse and a copy of ‘No Secrets in Lancashire’. Guidance should be provided for staff so that they are clear as to the actions they must take should they become aware of any allegations or suspicions of abuse. Training was provided for staff in this area, but written information would reinforce this and provide clear guidance for them to follow. Greenways DS0000005926.V290945.R01.S.doc Version 5.2 Page 16 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 the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service The home was clean and comfortable and provided a homely and safe environment for both the service users and support staff. EVIDENCE: The home was clean, comfortable, homely and well maintained. The grounds were tidy and accessible to service users. One service user wrote that the home was always ‘fresh smelling’ and that ‘the bedrooms were exemplary’. A visitor spoken to on the day of the inspection stated that the home was always clean when she visited. The laundry was well equipped and with both washing and drying equipment. The home had policies and procedures in place in respect of infection control. Discussion with a member of staff indicated that routines within the home ensured that laundry was managed efficiently. Greenways DS0000005926.V290945.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had a positive attitude towards its staff team, good recruitment practices and a range of training opportunities. This helped ensure that staff were able to support service users appropriately. EVIDENCE: The staff team at the home was settled and well established. The rota indicated that the home had sufficient numbers of care staff and ancillary staff on duty at any one time. The staff spoken to stated that they appreciated the support that they received from the management team and also appreciated the training opportunities that they were presented with. Over 50 of the staff team had achieved a nationally recognised qualification in care, giving the home a skilled work force. The member of staff who was responsible for staff training was enthusiastic about her role and this enthusiasm had been transferred to the staff team. One recommendation was made in respect of training and that was that a training matrix should be developed, as this would provide an immediate overview of training achievements and needs. The manager of the home was fully aware of her responsibilities in respect of the recruitment of staff and the need to protect service users by undertaking the necessary checks. However, since the previous inspection an enforcement notice had been issued to the registered person as they had continued to recruit staff without ensuring that the required checks and references had been undertaken. A further visit had been made to the home to ensure that
Greenways DS0000005926.V290945.R01.S.doc Version 5.2 Page 18 recruitment processes were satisfactory and there was evidence that the registered person had reviewed her recruitment processes satisfactorily. No new staff had been appointed since the last visit to the home and at that time all staff had had the appropriate checks undertaken with a view to protecting the service users as far as possible. Greenways DS0000005926.V290945.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was essentially well managed but there was room for improvement in some areas to ensure that the home was safe and run in the interests of the service users. EVIDENCE: The registered manager at the home was well established in her role and had achieved the relevant qualifications. There were clear lines of accountability in the home and the staff team felt well supported. The service users were very much aware of the management arrangements and both they and the staff team found the manager and deputy manger to be very approachable and responsive. A commitment had been made to equal opportunities within the organisation for both staff in respect of both staff and service users. The home had a number of quality assurance monitoring systems in place. The registered provider visited the home on at least a monthly basis and provided
Greenways DS0000005926.V290945.R01.S.doc Version 5.2 Page 20 the Commission for Social Care Inspection with a report on her findings. There were a number of checks undertaken within the home, including checks on the environment as well as checks to ensure that care plans were updated on a monthly basis, all helping to ensure that the service users were supported appropriately according to their needs. Staff meetings were held on approximately a quarterly basis enabling staff to air their views. At the previous inspection a requirement had been made that the results of a service users survey undertaken by the registered provider should be made available to the manager of the home and to other interested parties. There was no evidence available that this information had been passed on leaving the manager unaware of any concerns or indeed any favourable comments that the service users may have made. It was also recommended that the views of relatives and any involved health and social care professionals should be sought. Policies and procedures in the home were last reviewed in 2003 and it was recommended that these be reviewed to ensure that they comply with changing legislation and good practice advice. The home did not handle any service users monies although this situation was due to change in respect of one service user. The home did not have a policy in place regarding the management of service users monies and this is now required to ensure that there are clear guidelines in place for both service users and staff. The home had a safe to keep any valuables on behalf of service users. In terms of health and safety the homes equipment and systems were maintained on an appropriate basis with the exception of the electrical system. The five-year certificate had expired and the home had no arrangements in place for an inspection. An Immediate requirement Notice was issued in respect of this to ensure as far as possible the safety of the service users and staff. The staff had received training in all expected areas of health and safety and the home had received a good report from the Environmental Health Officer. The homes risk assessments in respect of safe working practices were due to be reviewed to make sure that these were in line with current legislation and good practice. Greenways DS0000005926.V290945.R01.S.doc Version 5.2 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. 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 1 Greenways DS0000005926.V290945.R01.S.doc Version 5.2 Page 22 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 OP7 Regulation 15(2) Requirement Service users and/or their representative must be involved in the development and review of the care plan wherever this is possible. The homes policy on the protection of vulnerable adults must be extended to include guidance for staff on the action they must take should they become aware of any allegations or suspicions of abuse. The homes policy on the management of challenging behaviour must be extended to emphasize the need to consult at a multi-disciplinary level when developing management strategies. The homes complaints policy and procedure must be amended to include the correct contact details of the Commission for Social Care Inspection The results of service user surveys must be made available to interested parties. (Timescale of 28/02/06 not met) Timescale for action 31/08/06 2. OP18 13(6) 31/08/06 3. OP18 13(6) 31/08/06 4. OP16 22(7) 31/08/06 5. OP33 24(2) 31/08/06 Greenways DS0000005926.V290945.R01.S.doc Version 5.2 Page 23 6. OP35 13(6) 7. OP38 13(4) A policy outlining the homes approach to the management of service users monies must be developed. The registered person must ensure that the electrical systems within the home are inspected and any identified remedial work must be undertaken 31/08/06 30/06/06 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. 3. Refer to Standard OP9 OP9 OP9 Good Practice Recommendations Competency checks should be undertaken on all staff administering medication and a record kept of these. When service users spend the day away from the home a record should be kept of any medications that are sent with them and of the administration arrangements. Guidance should be provided for staff regarding the administration of medications prescribed on an as required basis (PRN), especially for those service users who are unable to request medication themselves. The complaints policy and procedure should be rewritten with a view to encouraging service users and/or their representatives to report any concerns they may have about the home. The home should develop a training matrix to enable training needs to be monitored more easily. The views of families and involved health and social care professionals should be sought. The homes policies and procedures should be reviewed to ensure that they are in line with current legislation and good practice. The homes risk assessments in respect of safe working practices should be reviewed. 4. OP16 5. 6. OP30 OP33 8. 9. OP33 OP38 Greenways DS0000005926.V290945.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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 Greenways DS0000005926.V290945.R01.S.doc Version 5.2 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!
