Inspection on 13/07/06 for Hornegarth House Nursing Home

This inspection was carried out on 13th July 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Hornegarth House Nursing Home 28/11/07

Hornegarth House Nursing Home 28/11/05

Hornegarth House Nursing Home 28/06/05

Hornegarth House Nursing Home 21/02/05

Hornegarth House Nursing Home 21/09/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hornegarth House Nursing Home 204 Walsall Road Great Wyrley Walsall West Midlands WS6 6NQ Lead Inspector Mrs Joanna Wooller Key Unannounced Inspection 13 July 2006 09:00 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 Hornegarth House Nursing Home DS0000022342.V303601.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. Hornegarth House Nursing Home DS0000022342.V303601.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hornegarth House Nursing Home Address 204 Walsall Road Great Wyrley Walsall West Midlands WS6 6NQ 01922 701702 01922 411115 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) Southern Cross Care Homes Limited Mrs Heather Ann Hunter Care Home 45 Category(ies) of Dementia (45), Dementia - over 65 years of age registration, with number (10), Mental disorder, excluding learning of places disability or dementia (45) Hornegarth House Nursing Home DS0000022342.V303601.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 45 Dementia (DE) - Minimum age 60 years on admission Date of last inspection 28 November 2005 Brief Description of the Service: Hornegarth House offers nursing care to 42 service users with mental health problems and long-term mental illness. The home has 38 bedrooms with en-suite facilities. There are 34 single bedrooms and 4 double bedrooms. The home promotes and encourages full community involvement. The home is situated within a thriving village on a bus route between Walsall and Cannock. It is within easy walking distance of the main Stafford to Birmingham railway line. This purpose built home has wide corridors and ramps for easy access by wheelchair users. The home is on two levels and has access via the stairs or a passenger lift. There are two lounges, a large dining room and a conservatory. A secure garden is planted out with bushes and plants and has seating. Many recreational and diversional activities are carried out daily and this is displayed on the notice boards and in the homes Newsletter. Hornegarth House Nursing Home DS0000022342.V303601.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced. The Manager and her Deputy had planned to be on a company training day however on my arrival to the home they were informed of the visit and returned to the home. The home was found to be in good order and well managed by two registered nurses. The atmosphere was calm with some Service Users in the lounges and some finishing breakfast in the dining room. The homes occupancy was full and staffing was evidenced as being in line with the Notice of Staffing and individual dependencies. A large notice board in the entrance hall displayed a range of activities to cover all individuals’ choices and the diverse range of individual abilities. Service Users were freely moving around the home observed by staff as required. What the service does well: What has improved since the last inspection? The homes has become much more stable over the past 6 months, the Manager has settled well and has built a strong team of efficient and professional staff. The atmosphere in the home is much calmer and Service Users needs are being considered at all times. Service Users natural waking after a night’s sleep has been promoted in the home along with choice relating to bed times. Hornegarth House Nursing Home DS0000022342.V303601.R01.S.doc Version 5.2 Page 6 Service Users told the Inspector they loved the staff and the home and they appeared content. 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. Hornegarth House Nursing Home DS0000022342.V303601.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hornegarth House Nursing Home DS0000022342.V303601.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1-5 The quality outcome in this group is good. The manager completes the pre admission assessments or senior nurses who continue to ensure that there individual Service Users need will be identified. Relatives or representatives of the prospective Service Users are fully informed as part of the preadmission process that their individual needs can be met. EVIDENCE: Each service user had been assessed prior to admission either in their present abode or a pre admission visit can be arranged if required. Multidisciplinary involvement continues to be evident in most Service Users care records. Any special needs of the individual including cultural, social and personal needs are fully discussed and documented. This comprehensive assessment initiates the process of care, so that each individual have a plan of care, which includes a daily living plan and longerterm goals and outcomes. Hornegarth House Nursing Home DS0000022342.V303601.R01.S.doc Version 5.2 Page 9 Relatives and representatives are invited to be involved in the preadmission assessments if they wish to ensure the individual’s needs are identified, to discuss the plan of care and the documentation which they are asked to agree and sign. The home confirms in writing to the service user or their next of kin, that they will be able to meet the individuals assessed needs. Hornegarth House Nursing Home DS0000022342.V303601.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 - 11 The quality outcome for this group is good. The individually assessed health and personal care needs of each Service Users had been documented as being met, with good standards of care being delivered. Documentation that is used to record care is extensive. There was a safe system for the receipt, storage, administration and disposal of medicines monitored by in house audits. There was positive evidence that service users were treated with respect, privacy and dignity. EVIDENCE: The service user plans and documentation continue to be well written, meaningful and reflected the current condition of residents. The documentation seen evidenced that health and personal care needs were being well met. Hornegarth House Nursing Home DS0000022342.V303601.R01.S.doc Version 5.2 Page 11 NHS facilities and multi-disciplinary professionals including community nurses, medical consultants and clinical nurse specialists had all been accessed when required, and these events were seen recorded. A local GP practice and a local pharmacist (8pm Chemist) continue to service the home. It was observed that a safe system of medication administration and disposal was in place, and that the comprehensive medicines policy documentation seen was being complied with. The documentation seen evidenced that only trained nurses administered medicines. The inspector observed the nurse completing a medication round and was impressed with her professional manner and compassion shown to the Service Users. Again, it was possible for the inspector to observe that privacy and dignity were being afforded to residents, and there was very good interaction with staff. Staff are supported by management during difficult times such as a Service Users death and support and comfort is offered to relatives. Polices and procedures are complied with at such times. Hornegarth House Nursing Home DS0000022342.V303601.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 - 15 The quality outcome for this group is good. The lifestyle provided by the home appeared to be meeting the needs of the residents, and links with family were being observed. The diet of residents was being provided in line with their choices and/or assessed needs. With the diverse needs of the individuals being considered this was leading to a much calmer atmosphere and Service User contentment. EVIDENCE: The activity organiser was in the home she was involving some Service Users in group activities of reminiscence and some Service Users preferring one-toone activities were enjoying sensory games. Plans for the month of July were displayed and Service Users had attended a village carnival, a tea party and other community events. The staff was compiling a monthly newsletter and this was sent to relatives and the GP. Notice boards were full of Service Users’ photographs whilst at the events and some in the garden at the home. Hornegarth House Nursing Home DS0000022342.V303601.R01.S.doc Version 5.2 Page 13 All staff were observed re-assuring Service Users who were unsettled. The Snoezelen room had been reinstated and the room was being used for defusing aggression, frustration and agitation in confused Service Users. All visitors are welcomed into the home to support the Service Users in their daily life. The Vicar visits the home at least monthly. Meals are provided form a well-run kitchen. The inspector found the window grills, windows and cooker fans to require a deep clean. The need for a dishwasher is also required, the existing sterilizer serves little if no purpose and is currently leaking. Seasonal changes add variety to the menus and cultural and health needs are catered for as required along with individuals likes and dislikes being displayed discreetly in the kitchen area. A five-week menu avoids meals being repeated too often. The care staff were observed assisting and observing those Service Users who require support whilst feeding. Pasta dishes have been introduced to serve Service Users meals on, to encourage Service Users to be independent whilst eating, as the lip on the bowl assists them to feed themselves. During the hotter weather staff have been offering and encouraging an increase in cold fluids to avoid dehydration. Hornegarth House Nursing Home DS0000022342.V303601.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 - 18 The quality outcome for this group is good. The complaints procedure was in place and displayed in the entrance hall of the home so this is visible to all visitors to the home. Legal rights for residents are respected and staff are trained appropriately to ensure residents are protected from all types of abuse. EVIDENCE: Southern Cross Healthcare policies, procedures and relevant documentation are working documents for the staff. The Manager is using the policies and procedures are part of the ongoing staff training. The complaints record was evidenced. The commission had been informed of no complaints since the last inspection and two had been received in the home. The Manager had satisfactorily resolved both of these. Staff are fully aware of the different types of abuse through robust training at the home. Staff told the inspector that they are observant to look for signs of abuse. Residents’ legal rights are protected and documented. Advocacy services are available and displayed for residents that do not have relatives or representatives. Hornegarth House Nursing Home DS0000022342.V303601.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 - 26 The quality outcome for this group is adequate. The refurbishment had continued in the home with several carpets being replaced. Residents’ rooms were personalised and generally comfortable. The residents live in a safe environment with safety checks being made by the staff and Manager. The home was generally clean and tidy in most areas, with exception of one bedroom, the laundry and the kitchen. EVIDENCE: Externally the home was neatly presented with well-maintained gardens, which were inviting to the Service Users and their families. Internally, the home was again showing signs of improvement with the fitting of seven more carpets. The Snoezelen room was in full working order and well equipped. The hairdressing salon/activities room had been reorganised at the last visit and Hornegarth House Nursing Home DS0000022342.V303601.R01.S.doc Version 5.2 Page 16 this had worked well along with the nursing office, which had been recited off one of the lounges. The ancillary staff were working hard to ensure the environment was of a good clean standard. The cleaning products they showed me they were generally satisfied with and they were aware of the bedroom the inspector had identified. The domestic supervisor makes regular checks to ensure the standards of the homes cleanliness is acceptable. With the exception of one bedroom as identified on this visit the cleanliness of the home was of a good standard. This room had new carpet fitted but the malodour was still evident even though the carpet had been cleaned and special deodorising liquids used. The Manager is to contact the cleaning product company to inform them. Bedrooms were nicely personalised and safely arranged. Necessary equipment was available for individuals who require assistance. No Service Users share bedrooms now, which the Service Users, staff and relatives prefer. The communal lounges are pleasantly arranged to offer a choice of seating and surroundings. The French door was left open to allow Service Users access to the enclosed garden area. Assisted bathrooms and toilet were in working order and in a hygienic state. Specialist equipment is provided for the Service Users as required and serviced as necessary to ensure Service Users and staff safety. The inspection took place on a very hot, sunny day. The Service Users were all in areas where the windows were open and fans were used to keep the atmosphere cool. Bedroom curtains were kept shut until mid-afternoon to keep bedrooms cool. The 1st floor bedrooms were much warmer than the ground floor rooms. The emergency lighting, water temperatures and boilers are all regularly tested and the Inspector evidenced the test results in Southern Cross Record Books. All were satisfactory. Laundry facilities were not to the standard required for good working conditions. The laundry does however now have an entrance and a separate exit to avoid cross infection of clean and dirty laundry. Hornegarth House Nursing Home DS0000022342.V303601.R01.S.doc Version 5.2 Page 17 The following issues were raised: • • • • The walls need making good following some alterations. The room needs a deep clean. The sink unit needs replacing for a more suitable one that should be repositioned in the corner of the room. A short hanging rail must be purchased (Which will fit in the lift) to allow items of clothes, which have been ironed to be put straight in to wardrobes and not folded. Many staff at the home have undertaken infection control training and no outbreaks or infections had developed at the home. Hornegarth House Nursing Home DS0000022342.V303601.R01.S.doc Version 5.2 Page 18 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 - 30 The quality outcome for this group is good. The assessed needs of service users are met by an adequate number of suitably trained staff. The Nurses using a individual Service User dependency score, monitor this. Recruitment procedures had been followed which had contributed to the protection of service users. Staff training was well documented and stored on a computer to ensure training needs are monitored. EVIDENCE: Staffing levels were being maintained as required, using the evidence of the dependency score, the Managers ongoing observation of care delivery and ongoing discussion with the staff. Staff agreed and there was evidence to the inspector that the shift cover was adequate. Staff were evidenced being able to monitor and assist Service Users safely and without feeling rushed. There are two registered nurses on duty 8am to 8pm in addition to the minimum of seven care staff on each morning shift and six care assistants on each evening shift. Three carers are on duty during 8pm to 8am and they support one registered nurse. Hornegarth House Nursing Home DS0000022342.V303601.R01.S.doc Version 5.2 Page 19 Adequate ancillary staff had been provided each week. The laundry and housekeeping are on a seven day rota. The new manager had previously introduced a three weekly rota; to give the team of staff some stability and to avoid issues of off duty arising and this change had been well received by the staff proved to be working exceptionally well. The home adheres to robust recruitment policies and procedures set by Southern Cross Healthcare. Staff files that were inspected had been subject to POVA/CRB comprehensive checks, and these were recorded. All necessary processes had been followed and were evidenced. Training had been ongoing for staff in the awareness and management of dementia related conditions with the support of the Nurse Specialist for Mental Health in Care Homes. Statutory training is ongoing but presently up to date.. Some staff was completing a distance-learning course for infection control and all staff will complete this in the future. Hornegarth House Nursing Home DS0000022342.V303601.R01.S.doc Version 5.2 Page 20 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): 31-38 The quality outcome for this group is adequate. The home is being well managed by a Manager with strong leadership skills and a professional team of Senior Nurses. Quality assurance processes were now in place and proving to be very beneficial. Financial aspects were correctly addressed and recorded with safeguards to residents. Health and safety issues had been given a high priority and were generally well managed except the need for some risk assessments and a faulty fire door. EVIDENCE: The Manager is now registered with the CSCI (Stafford office). She has successfully completed the Registered Manager Award. Hornegarth House Nursing Home DS0000022342.V303601.R01.S.doc Version 5.2 Page 21 Mrs Hunter displays positive interest for the home and a real enthusiasm to achieve excellence for the home. She continues to wish to recruit more registered nurses with an interest in mental health to balance the skill mix although the Nurses are very interested in Mental Health care and have been attending relevant update training. A requirement was made for the Supervision of care staff to be reinstated and continued. At the last visit a new induction pack procedure and documentation has been introduced in to the home for new staff and this had proved to be much better. Quality audits are completed with monthly area manager visits (Reg.26) and a validation audit follows. Medication, care records and accident audits also have to be completed. Financially the home showed no obvious signs of problems, carpets had been purchased and the upgrade is ongoing. Residents’ moneys were handled in house appropriately and advocacy services were available. Almost all the staff are first aid trained in the home and food hygiene updates are continuous. Fire safety training was in order. Health and safety checks of equipment and systems within the home were evidenced to be in order. However one fire door leading into the first lounge was wedged open due to the door retainer being broken. This was awaiting repair. Several problems with the lift have continued to be a major problem in the home and this is had now been replaced. The Manager kept the Inspector fully informed of the progress at the time. Hornegarth House Nursing Home DS0000022342.V303601.R01.S.doc Version 5.2 Page 22 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 1 3 2 Hornegarth House Nursing Home DS0000022342.V303601.R01.S.doc Version 5.2 Page 23 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. 2. 3. 4. 5. 6. Standard OP26 OP15 OP15 OP36 OP26 OP26 Regulation 16 (2k) 16 (2g) 16 (2j) 18 (2) 23 (2c) 23 (2c) Requirement Malodorous rooms must be addressed immediately. A dishwasher is required in the kitchen. The kitchen requires a deep clean. Staff supervision is to be carried and recorded. All toilet rolls must be stored on a holder. The laundry requires a suitable new sink unit and a rail to hand ironed shirts upon it. The rail must fit in the lift for transfer to Service Users wardrobes. The laundry requires a deep clean and the walls need repairing and painting. Risk assessments must be in place for use of garden furniture. Door wedges must not be used in the home. DS0000022342.V303601.R01.S.doc Timescale for action 13/08/06 13/08/06 13/08/06 13/08/06 20/07/06 13/08/06 7. OP26 23 (2b) 20/08/06 8. 9. OP38 OP38 13 (4c) 23 (4c) (iv) 20/07/06 20/07/06 Hornegarth House Nursing Home Version 5.2 Page 24 10 OP38 23 (4c) (iv) Fire door retainers must be repaired within a reasonable time scale. 20/07/06 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 Refer to Standard OP8 Good Practice Recommendations To seek advice from the Continence Nurse Specialist. Hornegarth House Nursing Home DS0000022342.V303601.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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 Hornegarth House Nursing Home DS0000022342.V303601.R01.S.doc Version 5.2 Page 26 - 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!