Inspection on 31/10/06 for Lukestone

This inspection was carried out on 31st October 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

Lukestone 28/10/08

Lukestone 13/01/06

Lukestone 19/07/05

Lukestone 28/03/05

Lukestone 19/07/04

Lukestone 24/02/04

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

CARE HOMES FOR OLDER PEOPLE Lukestone 7 St Michaels Road Maidstone Kent ME16 8BS Lead Inspector Maria Tucker Key Unannounced Inspection 31st October 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 Lukestone DS0000052544.V309888.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. Lukestone DS0000052544.V309888.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lukestone Address 7 St Michaels Road Maidstone Kent ME16 8BS 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) 01622 755821 01622 675432 Lukestone@nellsar.com Nellsar Limited Mr Emilio Fesser Care Home with nursing 44 Category(ies) of Dementia - over 65 years of age (44) registration, with number of places Lukestone DS0000052544.V309888.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate services users over the age of 50 years Date of last inspection 13th January 2006 Brief Description of the Service: Nellsar Ltd purchased Lukestone in 2004 and the premises were then extensively refurbished. The home is a large detached property in its own grounds situated approximately one mile from the centre of Maidstone, in a residential area a short distance from the main road. The home is registered for 44 residents; bedrooms are on three floors with access to upper levels via a shaft lift. The ground floor comprises of bedrooms, staff offices and a nursing station, dining and activities areas and a large lounge room. There is a secure patio area with flowerbeds accessible to residents. Local shops and amenities are nearby and bus stops are located on the main road into Maidstone. The fees range from £517.00 to £700.00 per week. Social services have a block contract for services. Extra charges are made for: - Chiropody £13.50 Hairdresser £9.50 to £23.50. Lukestone DS0000052544.V309888.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 key inspection. The visit lasted from 9.45am until 16.00pm. The visit was spent talking directly with the director of operations, manager, deputy manager, service users, care staff, and relatives. Some judgements about quality of life and choices were taken from direct conversation with service users followed by discussion with care staff and evidencing from records held at the home. A partial tour of part of the premises was undertaken. The pre inspection questionnaire has been received. Comment cards have been received these were very positive about the care in the home and of the running and management. What the service does well: What has improved since the last inspection? The statement of purpose has been revised so that it includes all items required. The infection control measures in relation to the kitchen area such as dates put on food when opened and cleaning regimes have been improved. The care plans continue to be improved upon to ensure that they are very comprehensive and have easily assessable information for staff. Lukestone DS0000052544.V309888.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Lukestone DS0000052544.V309888.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 Lukestone DS0000052544.V309888.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, 2, 3, 4, 5, 6 The quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. Prospective service users and their relatives / representatives have access to information about the home to enable them to make an informed choice. Needs are fully assessed prior to admission and a place only offered if they could be fully met. EVIDENCE: A copy of the Statement of Purpose was sent to the commission prior to the inspection it has had further items added to include all items required. As discussed during the inspection the service users guide will have the relevant details included and further copies of both documents will be forwarded to the commission. Service users who are private have a residents (term) contract these are signed by the service user or representative. Those service users who are funded by social services have a contract through social services. The Manager is aware of the changes in the information about fees and as an organisation they are reviewing the information contained in the current contracts. Lukestone DS0000052544.V309888.R01.S.doc Version 5.2 Page 9 Service users are admitted following full and comprehensive assessments including joint health and social care assessments. Information is gathered from relatives and representatives so that a full picture of individual needs can me made. The care plans are developed from the information gathered and a visit to the service users at their current place of residence so that the manager or deputy manager can meet the prospective service user and general observations and discussions with carers and service user are made. Service users and representatives are invited to informally visit the home prior to the formal assessment process. The home do not write to confirm that following the assessment the home are to meet their assessed needs. The home does not provide intermediate care. Lukestone DS0000052544.V309888.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,n 9,n 10, 11 The quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. Service users can expect a high level of care that is based upon a comprehensive care planning system designed to meet individual needs and preferences. The PRN medication procedure needs to be improved. EVIDENCE: The care plans are based upon Roper, Tierney and Logan models of care. They are complied following robust assessments by qualified staff this being either the manager or deputy manager. There is an assessment summery contained in the files for a quick overview of needs. The care plans are personalised with the service users name throughout the documentation, as stated by the deputy manager “we must personalise care plans so the service users name is used”, which provides the base for a person centred approach to care. There is a named nurse system in operation so that the service users are allocated a specific person who oversees the care plans and ensures that the reviews are planned and take place. Relatives are included in the reviewing process. Relatives sign care plans where appropriate. Lukestone DS0000052544.V309888.R01.S.doc Version 5.2 Page 11 The daily records are written by care staff and trained staff. These are informative and relate to the care plans, although they do need to have more detail on the daily life experience of the service user so that the care plans can be easily monitored and information drawn from the daily notes for reviewing purposes. It is acknowledged that this is a work in progress and some notes were very well written. ABC charts are used to record behaviours as a monitoring process. It was discussed that these should be used in conjunction with risk assessments as part of the overall behavioural management process. The pre inspection questionnaire states that there are 41 service users whom require support with eating; dressing; toileting and are incontinent. Two service users require assistance from 2 staff. Ten service users have been identified as exhibiting extreme behaviour and 7 service users are bedfast. Throughout the inspection staff were seen to be supporting service users with their needs and anticipating what they require based on a good sound knowledge of the individual. Staff spoken with were familiar with the individual needs and care plans. The pre inspection questionnaire lists a range of support services used including a dietician, dentist, chiropodist and general practitioner. Referrals are made to outside clinics fro the optician and audiologist. One service user admitted with a pressure sore has been successfully treated with good evidence recorded of this. Comment cards received from relatives were positive about the home and the care that was being provided comments included “The home provides for (service user) very well” another stated that “The home provides adequate medical care” another They seem to call the Doctor when needed. Part of the medication administration round was observed and good practice adhered to. All medication was seen to be stored appropriately and the mar sheets signed accordingly. It was discussed that the PRN (when required) medication procedure needs to be improved so that more detail is given as to what dose and to what medication i.e. pain relief is prescribed for. It was also discussed that a front sheet would be of benefit to record extra information such as preferred name, any specific details around preferences in taking medication and a photograph for identification purposes. Lukestone DS0000052544.V309888.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, 15 The quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. Service users have a range of leisure and recreational activities on offer that they are supported to engage in. Relatives are made welcome with links with families and friends maintained. Service users have a good range of home cooked meals. EVIDENCE: The home has an activity co-ordinator who works directly with service users and staff in supporting leisure and recreation. During the inspection service users were being gently encouraged to partake in activities these included ball games; weaving; singing; dominoes and puzzles. The pre inspection questionnaire lists other recreational and activities on offer in the home these include entertainers; mini bus; social events such as parties and BBQ; games; art and crafts; outings and a piano player / singer. The home has a designated hairdressers room complete with a back wash sink, this provides a sense of being at the hairdressers. Relatives are made welcome and a room is available for private visits. No visitors were spoken with during the inspection as it was stated that this was Lukestone DS0000052544.V309888.R01.S.doc Version 5.2 Page 13 not a good day for visitors as many tended to visit on other regular days and those visiting were just ‘popping in’. Visitors are invited to attend functions and activities one comment received in relation to the food on such an occasion stated “any buffets that are held are always good”. The activity co-ordinator stated that extra staff are provided to assist when required i.e. for special functions or specific activities. The pre inspection questionnaire states that breakfast is taken between 8 and 10am; lunch 12 to 2pm; evening meal 5 to 7pm and that supper is from 8.30pm onwards. The menu offers choice and variety of well cooked and presented meals. Service users were observed during the mealtime to be well supported by staff in a relaxed and unhurried manor. The choices of meals are on display. Service users with particular dietary needs have these catered for and supplementary milk shakes are made as a way of complementing food intake. Lukestone DS0000052544.V309888.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 in this outcome area was good. This judgement has been made using available evidence including a visit to this service. Service users and their representatives can feel confident that any concerns, complaints or suggestions would be well received and acted upon. Service users are protected through the home’s policies and procedures on adult protection. EVIDENCE: The pre inspection questionnaire states that no complaints have been made. This was confirmed during the inspection. There are procedures in place and formats for recording any complaints. All service users and staff spoken with had no issues that they felt needed addressing or complaints. Comment cards from relatives with the exception of 1 ticked to say no complaints have been made. Some cards had ticked to say that they were not aware of the homes complaints procedure. A comment received by a relative “I have never had reason to complain”. The home are pro active in ensuring that any issues that may arise which could lead to a complaint are dealt with and suggestions for improvements or feedback from relatives are conducted the last one was in June 2006. A comment received in a comment card by a relative “Suggestions always acted upon. I am happy to have my (service user) at Lukestone’’. The pre inspection questionnaire states no adult protection alerts have been raised. The home has adult protection policies and procedures in place. Lukestone DS0000052544.V309888.R01.S.doc Version 5.2 Page 15 The pre inspection questionnaire states that due to the service users suffering from dementia their next of kin act as representatives. Lukestone DS0000052544.V309888.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, 20, 21, 22, 23, 24, 25, 26 The quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. Service users live in a well-maintained and homely environment that is pleasantly decorated with good quality furniture. EVIDENCE: Lukestone is very well maintained and decorated. All areas of the home were found to be very clean and tidy. The home has designated staff for cleaning and maintenance. Service users have access to a well-maintained garden area, there is an alarm fitted to alert staff of an outside door being opened. The pre inspection questionnaire states there are 40 single rooms with en suite facilities and 2 double rooms with en suite facilities. The home has 5 toilets; 3 bathrooms and 3 shower facilities. The bedrooms are located on all three floors with access via a shaft lift. Lukestone DS0000052544.V309888.R01.S.doc Version 5.2 Page 17 Service users bedrooms that were inspected had call bell points; these were risk assessed as to the safety of the leads. The rooms were individual with personal effects making them homely and comfortable. All rooms have a hospital bed. The shared rooms have screening provided. There is a companion room assessment tool that is filled out to ensure compatibility. The laundry is located away from any food preparation areas. Lukestone DS0000052544.V309888.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, 28, 29, 30 The quality in this outcome area was adequate. This judgement has been made using available evidence including a visit to this service. Service users are well supported from a stable staff team who have a good skill mix. EVIDENCE: Lukestone employs carers and trained nurses who have qualified in this and other countries. There is designated staff for cleaning, maintenance and cooking. The rota detailed 7 staff on duty am and 5 staff pm with four care staff at night. There is a manager and deputy manager. Extra staff are employed to work when needed i.e. for activities and a kitchen assistant from 4 to 7 pm. The activity co-ordinator works for 3 days a week although the home has advertised for staff to cover the other 2 days. The residential forum calculations based upon the information from the pre inspection questionnaire that there are 38 service users with high dependency needs and 3 with medium needs is total care hours 855.01; total duty 1087.69; full time staff 27.9. The staffing levels calculated by the home in the pre inspection questionnaire totals 883 staff hours required with 1099 staff hours provided a plus of 215.81 hours. The pre inspection questionnaire lists staff training that has been planned this includes fire training; challenging behaviour; health and safety and food hygiene. Staff spoken with detailed training undertaken and planned training. There is not a staff trained in first aid on duty at all times. The home does not Lukestone DS0000052544.V309888.R01.S.doc Version 5.2 Page 19 have 50 of the care staff trained to NVQ level 2 or above although it is acknowledged that only 2 of the care staff have not been trained in their country of origin some of whom are waiting to do or have commenced the adaptation course. The target of 50 trained to NVQ level 2 still needs to be met. It was discussed during the inspection that the manager needs to seek discuss this with the Skills for Care who can be contacted through the website www.skillsforcare.org.uk. Agency staff are used although for consistency the same staff would be used. A comment made by a relative in the pre inspection questionnaire “I am very happy with the care my (service user) receives. I feel after tea at 3.30 to 4 there needs to be more than 2 staff in the lounge while others take a break. Staff are all very king and helpful” anther relative stated “They are all very obliging and helpful when I ask for help”. Evidence from staff files and discussions that the home have stringent recruitment policies and procedures in place, which they operate. Lukestone DS0000052544.V309888.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, 32, 33, 35, 36, 37, 38 The quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. A competent manager and dedicated staff team run the home in the best interest of the service users. EVIDENCE: The manager has successfully completed the registration process with the CSCI to become the registered manager. Staff expressed how well run the home is and how the manager and deputy manager acts promptly and efficiently to things that are reported. One comment made by a staff that the home is “very well organised and smoothly run”. Overall staff expressed that they believed the home to be very well run and managed as echoed in the comments made by relative as received by the CSCI. The home has clear lines of accountability both internally and externally. Lukestone DS0000052544.V309888.R01.S.doc Version 5.2 Page 21 The home has an open ethos with systems in place to seek the views of staff, service users and relatives. A relatives meeting held was well supported. Throughout the inspection staff were observed to be relaxed and confident in their role and to have a good rapport with each other the service users. The pre inspection questionnaire lists policies and procedures and has been ticked to say these have been reviewed on March 2004. The pre inspection questionnaire states that the home does not act as appointee for service users this role is undertaken by relatives or representatives. The pre inspection questionnaire lists maintenance and associated records these include central heating system checks; temperature checks; electrical wiring certificates; hoists and adaptations checked and the disposal of waste / SHARPS. These were spot checked during the inspection. The home have conducted a survey to seek relatives feedback this has been given to the CSCI. Overall the findings in this were very positive. Staff confirmed that regular supervision takes place; records of these were seen (but not read) to be kept. The home has an accident monthly audit of falls and other accidents. This enables any action that may be needed to minimise risks to be identified and provides a good method of working pro actively to ensure that service user and staff are as far as reasonably practicable safe. All records were seen to be kept secure and those inspected were well maintained. Lukestone DS0000052544.V309888.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 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 3 X 3 3 3 3 Lukestone DS0000052544.V309888.R01.S.doc Version 5.2 Page 23 No 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 OP3 Regulation 14(c) Requirement Timescale for action 19/12/06 2 OP9 13 (2) 3 OP28 19(5)(b) The registered person shall confirm in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service users needs in respect of his health and welfare. The registered person shall make 19/12/06 arrangements for the recording, handling, safekeeping, safe administration, and disposal of medicines received into the care home and to prevent infection, toxic conditions and the spread of infection at the care home In that the PRN (when required) medication policy and procedure be firmed up as detailed in the text. 19/12/06 For the purposes of paragraphs (1) and (4) a person is not fit to work at a care home unless – (b) he has the qualifications suitable to the work that he is to perform in that 50 of care staff are trained to NVQ level 2 or above Lukestone DS0000052544.V309888.R01.S.doc Version 5.2 Page 24 4 OP30 19(5)(b) For the purposes of paragraphs (1) and (4) a person is not fit to work at a care home unless – (b) he has the qualifications suitable to the work that he is to perform in that • A proportion of staff have training in first aid to ensure that there is a staff trained in first aid on duty at all times. 19/12/06 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 Refer to Standard OP7 OP37 Good Practice Recommendations It is strongly recommended that formal risk assessments for the management of behaviours be devised and implemented as part of the care planning system. It is recommended that to a policy for shared rooms be devised to accompany the capability tool used. Lukestone DS0000052544.V309888.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Lukestone DS0000052544.V309888.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!