Inspection on 04/09/06 for Lyttleton House

This inspection was carried out on 4th September 2006.

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

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

Other inspections for this house

Lyttleton House 10/06/09

Lyttleton House 03/07/08

Lyttleton House 27/11/07

Lyttleton House 18/05/07

Lyttleton House 01/03/06

Lyttleton House 12/09/05

Lyttleton House 24/03/05

Lyttleton House 25/08/04

Lyttleton House 04/03/04

Lyttleton House 09/09/03

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Inspirations

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

CARE HOMES FOR OLDER PEOPLE Lyttleton House 1 Ormond Road Frankley Birmingham B45 0JD Lead Inspector Susan Scully Unannounced Inspection 4th September 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 Lyttleton House DS0000033561.V306854.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. Lyttleton House DS0000033561.V306854.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lyttleton House Address 1 Ormond Road Frankley Birmingham B45 0JD 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) 0121 460 1150 0121 457 7302 Birmingham City Council (S) Linda Wohler Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Lyttleton House DS0000033561.V306854.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. That the home is registered to accommodate 30 people over 65 years who are in need of care for reasons of old age which may include mild dementia. Registration category will be 30 (OP) That minimum staffing levels are maintained at 4 care staff throughout the waking day of 14.5 hours. The home must adhere to a laundry policy which ensures that soiled laundry is not transported through dining areas when meals are served or consumed. That additional to above minimum staffing levels there must be two waking night care staff. 1st March 2006 Date of last inspection Brief Description of the Service: Lyttleton House is owned and managed by Birmingham City Council and is registered to provide care for 30 older adults who may have mild dementia. The building is a bungalow construction and divided into three separate units, each with their own dining area, kitchen and lounge. Facilities briefly include 30 single bedrooms, the majority of which are less than 10 square metres and therefore cannot contain all the items of furniture specified in the standards. Each bedroom has a call system. There is a large communal area in which service users can socialise, this is equipped with a TV, video and music system. The home is situated on a corner plot in a cul-de-sac. It has a beautiful open plan frontage with lawn, shrubs and flowers. There is level access to the front door and parking to the front and side of the property. Lyttleton House is located close to local shops and facilities, including public transport. Lyttleton House DS0000033561.V306854.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced fieldwork visit took place over a one-day period. Information was obtained from relatives, service users, and health professionals to establish whether or not the home is providing an effective service. In order to compile this report a number of people using the service, and members of the organisation’s management and staff team were interviewed. Records were sampled during the visit and these included service users’ plans of care, health and safety documentation and records relating to the homes policies and procedures. The inspector would like to thank service users and staff for their contribution during the visit. What the service does well: What has improved since the last inspection? What they could do better: Record management is not adequate to ensure service users needs are met. On the day of the visit the inspector was informed that a summary is completed on a monthly basis pertaining to daily notes completed by staff. Records where staff have retrieved the information from are destroyed. Records pertaining to service users must be kept for a minimum of three years. If the manager and staff continue to complete a summary then the records where they have retrieved this information must also be maintained to ensure daily records and care plans are contemporaneous. Lyttleton House DS0000033561.V306854.R01.S.doc Version 5.2 Page 6 Risk assessment must be able to ensure staff know what the risks are and how to minimise the risk to service users. The manager must ensure that any contractors the home uses have the relevant skills and competences. 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. Lyttleton House DS0000033561.V306854.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 Lyttleton House DS0000033561.V306854.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&3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A full assessment is completed for all prospective service users to ensure the service can meet the individual needs before a placement if offered. EVIDENCE: The policy for admitting new service users remains as the previous inspection. Evidence was seen that a thorough pre admission assessment is carried out for all prospective service users, to determine if the service is able to meet the assessed needs of the individual. The manager carries out an assessment using a form that prompts the evaluation of the service users general needs and capabilities. The service users family or representatives will be involved whenever possible. All prospective service users are invited to the home enabling them to view the facilities, meet staff and meet other service users. Other information is provided in the form of a Statement of Purpose and Service Users Guide that give the service user additional information about the service. Service users and family attend a 28 day review to ensure the service can continue to meet Lyttleton House DS0000033561.V306854.R01.S.doc Version 5.2 Page 9 the individual needs of the service user and that the service user is satisfied they want to becomes a permanent resident. Lyttleton House DS0000033561.V306854.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): 7,8,10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Information contained in service users files, daily records, and risk assessments do not ensure the health and welfare of service user. EVIDENCE: Care plans and risk assessments and daily records were sampled. The inspector could not complete an adequate audit. Risk assessment for the files sampled could not be located. There were a number of folders containing different information about each service user. The staff had difficulty in locating information the inspector requested such as risk assessment and daily records. While the information contained in different folders gave a full history of the service user and their individual needs, it is envisaged that any care staff not knowing where the information is located could present a risk to service users. The inspector was informed that staff complete a monthly summary of all events that has taken place. When these were sampled they did not include how each service user was supported on a daily basis. When the inspector asked for the notes that related to the summary, the inspector was informed Lyttleton House DS0000033561.V306854.R01.S.doc Version 5.2 Page 11 these had been destroyed. This is not acceptable and all information pertaining to service users must be kept for a period of no less then three years. The practise of destroying service user information must cease immediately. The Commission regarding this practice will contact the team manager for this service. Service users spoken with said the staff were very pleasant and always helpful. One service user said, “We do lots of things here, like go on trips and holidays, staff are very good to us they treat us as people not old people’’. “ I was always worried about coming into care but its quite nice here you still get to do the things you use to do’’. When the inspector asked one service user if they assisted in their planned care the inspector was informed “I don’t get involved in that they know what they are doing, I am very happy, they talk to my family and if my family is ok I am ok’’. The care plans for each service user continue to require development to clearly guide staff on how to provide personal, health and social care. Entries in daily records that were found showed staff entries such as “all personal care given’’, “assist with personal care’’. One service user’s daily record noted, the service user had said their legs were painful. There was no information to say what action had been taken with this statement? All files need to be more accessible and give the correct and adequate information to staff without having to sift through numerous folders. Care plans must simplify the general care and support required by service users on a daily basis Records sample pertaining to health care such as doctors, dentist, and chiropody, hospital and weight were recorded to ensure service user had access to other healthcare professionals. All service users spoken with said staff treated them with respect and always asked what they wanted, if they were ok and all staff were polite. The inspectors observed one service user have dressings put on their legs in the lounge in full view of other service user, the inspector could not establish if this was the service user choice and if it was then the manager must consider other service users who may not want to witness such procedures. The manager must ensure that all service users having any medical procedure undertaken are given the opportunity of privacy. The practice of medical procedures being completed in the lounge is not good practise and alternative must be sought. Service users looked well presented, they confirmed they were able to make choices in respect of daily living, take meals where they wished and found the staff approachable and willing. Lyttleton House DS0000033561.V306854.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The activities on offer meet the expectation, interests and abilities of service users. Service users are given the choice and freedom to make decisions about their daily lives and this ensures their independence and individuality are maintained. The choice of wholesome food and well-presented meals are available to meet any special dietary needs of service user for reason of health. However the menu did not demonstrate that a choice of cultural or religious meal were available. EVIDENCE: The home is conducted in a manner that promotes the service user’s capacity to make choices and exercise personal autonomy. Service users are encouraged to exercise choice in leisure and social activities, mealtimes, personal and social relationships. Service users spoken to stated that rising and retiring times are flexible. Service users spoken to stated that they had plenty to do, and that many trips out were offered, and service users were free to choose whether to go or not. In discussion with staff, service users, and families of service users, the staff are to be commended on their commitment to raising funds and arranging holidays for service uses on a regular basis. Lyttleton House DS0000033561.V306854.R01.S.doc Version 5.2 Page 13 All staff spoke with said how important it was to ensure service users continued with their past and present activities, this was their choice. One service user said “I use to go on holiday all the time when I was at home, and I though when I came into the home that would all stop but you can go if you want to, and staff come with you to make sure you are alright’’. Entertainers of various kinds also visit the home. From discussion with service users it was apparent they were happy and content in the home, were able to make choices and maintain their independence. In addition, service users meetings are being held regularly enabling them to discuss any areas they wish. One service user said, “ we are lucky here, they look after us very well”. The home ensured that people with physical impairments were not excluded from activities such as going shopping. The staff showed that they included service users with communication difficulties and a number of staff were able to pick up signs from service users that could not communication effectively and use them to help service users in making choices. Regular contact with family and friends is encouraged, visiting time are not restricted unless it is the service user’s choice. Meal presentation was seen and showed care and attention to detail. Service user spoke with said the food was normally good. One service user said “there is the odd occasions that I don’t like the food, some times the sandwiches are cold at tea time, but in general I have no problems. “ there is normally a choice and nine times out of ten I enjoy the food’’. The inspector was sent the menus before the inspection that show predominately white European meals are catered for. They do not demonstrate all cultural and regional meals are catered for. It is appreciated the home mainly accommodate white European service users however, a choice of cultural meals must also be available on request and staff must have the relevant skills and ability to this. Included in the menus is the suppertime meal available. Lyttleton House DS0000033561.V306854.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents opinions are listened to and acted upon, the complaints procedure is satisfactory. The arrangements for the protection of residents are satisfactory. EVIDENCE: The complaints procedure is comprehensive and available to service users and relatives. There is a tool for the logging and monitoring of complaints. A summary of complaints are sent to the Commission on a monthly basis. All accidents are records and action taken. Again a summary of all accident is sent to the Commission monthly. The written policy regarding adult protection provides adequate information and instruction to staff in how to respond to concerns raised or witnessed. There is also a policy advising about whistle blowing. Staff have had training in adult protection. The two staff interviewed displayed appropriate knowledge and their responsibilities where there is an allegation of abuse. Lyttleton House DS0000033561.V306854.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a homely, comfortable environment. There were appropriate aids and adaptations in the home for service users to use if required to ensure their comfort. Risk assessments must be completed to minimise the risk to service users and ensure their safety at all time. EVIDENCE: Records pertaining to health and safety are well maintained. Service users bedrooms were clean and decorated to the individual’s preference. Personal belongings were seen and service user said they could go to their room when they wanted to and have visitor if they wished. The home in general was clean and fresh. Some general repairs are required and the manager must ensure they are completed within a reasonable time scale. These include: The extractor fan in the parker bathroom. Lyttleton House DS0000033561.V306854.R01.S.doc Version 5.2 Page 16 A blender must be purchased for the main kitchen. Area where a risk assessment is required includes the smoking room, as the door is not link to the fire alarm. The charging of wheel chairs in the main corridors an alternative site must be sought. Jugs must be removed from bathrooms and all toiletries and pads. A risk assessment must be completed for the animals of the home. Lyttleton House DS0000033561.V306854.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): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a stable staff team which ensures service users receive continuity of care. Staff recruitment procedures are robust and ensure the right people are employed after undergoing all the relevant checks to ensure the safety of service users. Staff training ensures that staff acquire the appropriate knowledge to support service users in a competent manner. EVIDENCE: Staffing levels appeared to meet the needs of the current service users. Staff morale is high resulting in an enthusiastic workforce that works positively to improve service users quality of life. Records sampled show all the relevant checks are completed when recruiting staff. The inspector spoke with a number of staff during the visit. Staff were aware of service users needs and likes and dislikes. Staffing rotas were sent to the Commission before the inspection, when an analysis was completed based on the information received it was evidenced that staffing levels were maintained at a satisfactory level. Training records indicate further planned training for POVA (protection of vulnerable adult), health and safety, and training in dementia awareness. Newly appointed staff are expected to complete an induction programme. Lyttleton House DS0000033561.V306854.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This is a well managed home and systems for service users consultation are good ensuring that they are able to put their views forward about the service provided. There are robust systems in place for the safe keeping of service user personal allowance should they choose to use this facility. Staff receive ongoing training with the exception of the contractor the home use for domestic duties. Equipment used at the home is checked on a regular basis. Records keeping require further development and a general tidy up of service user records is required to ensure all the identified needs of service user are met. EVIDENCE: Lyttleton House DS0000033561.V306854.R01.S.doc Version 5.2 Page 19 The manager was not on duty during the visit, the representative said things have improved since the management has become more stable, certain records were not available such as supervision records which is to be expected in the absent of the manger. However when speaking with staff they confirmed they had regular supervision with the manager. The service user gave positive comments about the staff and management of the home. During the tour of the building certain staff were spoken with. Also members of staff from the contractors the service use in respect of cooks and domestics. It was of concern that the domestic staff member did not know what COSHH data sheet were. The member of staff had an injury to her hand and informed the inspectors that she was on a return to work induction. The member of staff also informed the inspector that no recent manual handling had been completed or training in COSHH, health and Safety and fire safety. When speaking with the supervisor of the contracting team the supervisor said no risk assessment had been completed, no supervision and no return to work induction for the member of staff with the injury. The inspector raised these concern with the team manager of the home who said he would investigate. The manager must ensure that all employees whether contacted or not is able to work in line with health and safety. It is the manager responsibility for all contractors to be suitable supervised and were a concern is identified the manager must ensure the prospective supervisor or manager of the contractors takes the appropriate action. Once the investigation has been completed this must be forwarded to the Commission to ensure the member of staff has the relevant support to complete the work delegated and that no service users are placed at risk through lack of supervision, training and a risk assessment being completed. The management of health and safety in the home was found to be satisfactory. Service users finance records are maintained to a good standard. All transactions are recorded and receipts maintained. A handover is completed on each shift where money is counted and recorded. Lyttleton House DS0000033561.V306854.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. 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 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 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 3 17 X 18 3 2 X X X X X X 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 X 3 X 3 X 3 2 Lyttleton House DS0000033561.V306854.R01.S.doc Version 5.2 Page 21 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) (a,b,c) 17(3) (a,b,) Requirement Care plans must give consistent information to show how service users needs are being met reviewed and monitored. Daily records must show how personal care is provided on a daily basis. All records pertaining to service users must not be destroyed and kept for a minimum of three years and be contemporaneous Risk assessment must be completed for all identified risks, such as the building, fire, staff, and service users. All repairs must be completed within a reasonable time scale. There should be an effective quality assurance system in place, the results of which are made available to service users, their representatives and the Commission. Outstanding form the last inspection Records not available for inspection Timescale for action 01/10/06 2 OP8 01/10/06 3 OP19 14(4)(c ) 01/10/06 4 5 OP26 OP33 23(2)(b) 24 (1,2,3) 01/10/06 01/10/06 Lyttleton House DS0000033561.V306854.R01.S.doc Version 5.2 Page 22 6 OP33 26(4)(c) A written report on the conduct of the care home (Regulation 26 visit), must be available for inspection. Outstanding from the last inspection. Records not available for inspection The Registered Person must ensure that staff supervision takes place on a regular basis, and at minimum at least 6 times a year. Previous requirement Records not available for inspection. The manager must ensure all contractor are suitable supervised and action taken with when there is an identified risk to service users or staff. 01/10/06 7 OP36 18(2) 01/10/06 8 OP38 13(4)(c) 01/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Lyttleton House DS0000033561.V306854.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Lyttleton House DS0000033561.V306854.R01.S.doc Version 5.2 Page 24 - 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!