Inspection on 17/10/05 for Manon House

This inspection was carried out on 17th October 2005.

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 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

Manon House 02/07/07

Manon House 24/07/06

Manon House 06/02/06

Manon House 16/11/04

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

CARE HOME ADULTS 18-65 Manon House 82 Mayfield Road Sanderstead Surrey CR2 0BF Lead Inspector Barry Khabbazi Unannounced Inspection 17th October 2005 9:30 Manon House DS0000028584.V258732.R01.S.doc Version 5.0 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 Manon House DS0000028584.V258732.R01.S.doc Version 5.0 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 Adults 18-65. 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. Manon House DS0000028584.V258732.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Manon House Address 82 Mayfield Road Sanderstead Surrey CR2 0BF 020 8657 9202 020 8657 0313 kishnama@hotmail.com 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) Mrs Kishnama Shunmoogum Mrs Kishnama Shunmoogum Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places Manon House DS0000028584.V258732.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th January 2005 Brief Description of the Service: Manon House is situated in a residential area of Sanderstead. It is approximately one point five miles from Croydon Town Centre. Mayfield Road is served by one bus that leads directly to the centre of Croydon. The home is currently registered to provide accommodation and personal care to five younger adults with a mental health issue. The home offers five single rooms. The kitchen and dining area link directly onto the second lounge that serves as a smoking area for those service users that smoke. There is also a communal lounge. Manon House is described by the owner(s) as being a Rehabilitation Unit where service users are supported and encouraged to develop/re-develop the necessary skills to move on to more independent living. Two care staff are on shift during the day time hours. At night one of the owners undertake a sleepin shift at the home. Manon House DS0000028584.V258732.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was a combination of an un-announced inspection on the 23/9/2005 and announced inspection on the 17/10/2005. The second inspection was required as the manager was leaving for a holiday abroad on the day of the first inspection and records and files needed to be accessed as a part of the inspection process. All the residents were met over both inspection days. During the inspection the manager and staff were met. Records, policies and care plans, and the building were examined, as were the residents’ bedrooms. The home was found to be generally well run with areas of good practice and few areas needing improvement. No major concerns were identified. What the service does well: What has improved since the last inspection? What they could do better: To provide potential new service users, relatives and professionals with all the information needed to make an informed decision about the home, the Statement of Purpose needs to contain the qualifications and experience of the and staff and the number and size of the rooms in the home. The service users guide also needs to contain the views of the service users. A record of all of a service user’s needs to be met or supported by the home must be recorded in their plans of care to ensure that these are known and met. Manon House DS0000028584.V258732.R01.S.doc Version 5.0 Page 6 Free access to the sharp kitchen knives should be risk assessed to reduce the risk of injury. Consent to medication and first aid should be recorded to respect service users’ rights and protect staff where they administer medication or first aid. The results from user/relatives satisfaction surveys must be collated. An annual development plan must then be produced which reflects the survey’s results, and information from other quality assurance tools. This then needs to be made open to the service users, to allow measurement of achievement in improving quality. The results from the bacterial analysis of the water supply must be sent to the Commission to reduce the risk of infection. 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. Manon House DS0000028584.V258732.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Manon House DS0000028584.V258732.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. Although the home provides most of the information needed for potential residents to make an informed decision about moving in to the home, the residents do not have all the information they need. Prospective service users’ aspirations and needs are assessed before admission. EVIDENCE: The Statement of Purpose was examined and contained all the elements required under Standard 1 and schedule 1, except the relevant qualifications and experience of the managers and staff, the number of staff and the number and size of the rooms in the home. The following requirement is set to address this shortfall: The Statement of Purpose must contain all the elements of Schedule 1, in particular, the relevant qualifications and experience of the managers and staff, the number of staff and the number and size of the rooms in the home. The Service Users Guide contained all the elements required under Standard 1, except it did not contain the views of the service users. The following recommendation is set to address this: The Service Users Guide must contain the views of the service users. All of the assessment documentation under Standard 2 was observed to be present in service users’ files. All files sampled contained assessments and care plans/ CPA’s {Care Programme Approach}. Manon House DS0000028584.V258732.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, and, 9. Residents assessed needs, changing needs and how the home meets these needs are not all fully recorded. This could effect the home’s ability to meet and show how it has met all a resident’s known and changing needs. Service users make decisions about their lives with support where needed. The service users are generally well and safely supported to take risks as a part of independent living. EVIDENCE: Files were sampled and care plans were available for all service users. These were all regularly reviewed and updated but they did not reflect all the elements required under Standard 6.2. In particular social, educational, employment and religious and cultural needs were not included. The following requirement is set under Standard 6 to address this shortfall. A record of all of a service user’s needs to be met or supported by the home must be recorded in their plans of care. In particular social, educational, employment and religious and cultural needs must be included. Manon House DS0000028584.V258732.R01.S.doc Version 5.0 Page 10 The service users are offered the opportunity to participate in the day to day running of the home and to contribute to the development and review of policies and services through regular house meetings and individual discussions with their key workers. Risk is assessed prior to admission and continually updated. Risk assessments were available and had recently been updated to show what other options are explored before any restriction of liberty required for the protection of service users is implemented. Risk assessments have also now been completed for all existing restrictions of liberty required for the protection of service users. The risk assessment records were generally comprehensive, however following discussion with the manager about the risk of kitchen knives being used as a weapon in potential incidents of violence, the following recommendation is set: Free access to the sharp kitchen knives should be risk assessed. Manon House DS0000028584.V258732.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16, and 17. Residents have the opportunity for self-development, are part of the local community and are able to take part in appropriate activities. Residents are encouraged to have a healthy diet and support is provided where required. Residents are supported in maintaining appropriate relationships, so that their social lives are maximised within chosen boundaries. The daily routines and house rules promote residents’ rights, to ensure equality and that all rights are enjoyed by all residents. EVIDENCE: Counselling is provided at the home by a qualified counsellor. Service users have access to education regarding numeracy and literacy where required. Spiritual needs are supported at this home. The following good practice was identified under Standard 11: The home has a good record of supporting service users in a way that reduces the incidents of relapse and also has a good record for rehabilitating service users and moving them on to independent living. The latter was also supported by comments from the service users. Manon House DS0000028584.V258732.R01.S.doc Version 5.0 Page 12 Service users all either attend college, are employed or are in supported employment schemes. Service users access the community independently and engage in activities of their choice. Service users were observed accessing the community during this inspection. Information about local community resources is included in the induction to the home. Evidence of the home promoting appropriate relationships and providing service users with information and access to health professionals was provided during the inspection. Home visits are supported, visitors to the home are also supported up to 10pm. Visits can occur in private and one service user’s husband visits regularly. The daily routines do promote independence. All service users are offered keys to the front door and their rooms. There is a telephone for use by service users, as confirmed by certain of the service users during the inspection. Service users can choose when to be alone or when to be in company. Independence skills are promoted as a part of the care plan where required. The setting up of a cooking rota and a household task rota encourages the promotion of independence within the home. Tasks are rotated to ensure fairness of allocation. Staff are available to offer support as necessary. The level of support offered is geared to meet the individually assessed needs of each service user. The service users are supported to buy and cook their own food on an individual basis. Where required support from dieticians was seen to have been sought by the home. Manon House DS0000028584.V258732.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, and 20. Residents’ personal support needs and emotional health needs are met well by this home. This ensures that the residents’ physical and emotional health is well maintained and therefore the quality of life experienced is also maximised. Residents’ medication is also well managed to ensure maximised good health. EVIDENCE: Personal care is not provided by the home or required by the service users. All the service users met except one were content with the support received from staff. The Registered Manager has an arrangement with each service user individually to meet once per week. The aim of this meeting is to provide the service user with a chance to talk if they wish to. This meeting is in addition to a weekly key worker meeting, or any other meetings with their CPA Coordinator, CPN or care manager. Inspection of the service users’ files confirmed that all are registered with a G.P. and all have been supported to gain access to NHS resources as required. Regular health checks are also offered and specific referrals are made as and when identified as needed. All except one service user manage their own medication. Records for medication administration were examined and found to be clearly and regularly recorded. A British National Formulary is available for guidance for staff. Manon House DS0000028584.V258732.R01.S.doc Version 5.0 Page 14 All staff who administer medication have had accredited training and additional in-house training. Consent to medication was not recorded on files sampled. The following recommendation is therefore set: Consent to medication and first aid should be recorded. Manon House DS0000028584.V258732.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Complaints are generally managed well so that service users usually feel their views are listened to. The home’s policies and procedures relevant to this Standard facilitate protecting residents from abuse, neglect and self harm. EVIDENCE: The home has a complaints procedure in place, which clearly states how complaints will be investigated, recorded and redressed. This procedure contained all the elements required under Standard 22, including a 28 day response time and details of how to contact the Commission. Records are kept of all complaints. Service users also have the opportunity to raise issues directly with staff individually or in group meetings, before they develop into a complaint. Most service users emphasised how good the home was although one stated that they were not happy there. The home has a copy of Croydon’s Vulnerable Adults Policy. All the policies relevant to this Standard were in place. These were checked at this inspection and included the following: A restraints policy, an adult protection policy, a physical and verbal aggression policy, a whistle blowing policy, an access to files policy, and a gifts and wills policy. All the above policies were present and known to staff. Manon House DS0000028584.V258732.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, and 30. The environment is homely comfortable and safe and the environment does promote the residents well being. The home is hygienic and clean. This environment therefore facilitates the residents’ health and emotional well-being. EVIDENCE: The kitchen and dining area were the areas frequented by the service users on this visit, as opposed to the main lounge. Others opted to spend time relaxing in their rooms. The home’s premises are accessible to the current service user group, in keeping with the local community, and are suitable for their purpose. The premises were clean, and well maintained. There was suitable domestic lighting and ventilation. At the time of the inspection the premises were well furnished and in an appropriate style. Over the last year the home has been decorated throughout. The building was observed to be clean and tidy. The home gave the impression of a clean home. Manon House DS0000028584.V258732.R01.S.doc Version 5.0 Page 17 The home has specific policies covering the disposal of clinical waste, control of infection, use of cleaning materials, storage and preparation of food, and dealing with spillages. Laundry facilities have easily cleanable non-permeable floors and easily cleanable walls. Manon House DS0000028584.V258732.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, and 36. The residents are generally supported by appropriately numbers of suitably qualified staff. The home’s recruitment procedures protect the residents through vigorous staff vetting. Induction and foundation training programme are within Sector Skills Council training specifications and timescales which facilitates the staffs’ ability to meet all a resident’s needs and raises the quality of staff and their practices. Staff are well supervised to ensure that they receive appropriate training and perform in a manor conducive to the service users well being. EVIDENCE: Manon House DS0000028584.V258732.R01.S.doc Version 5.0 Page 19 The home is continuing to support staff with accessing NVQ training, to facilitate achieving 50 of staff with a NVQ2 by the end of 2005. This will be fully assessed following this time and requirements made then if needed. In addition to the Registered Manager/provider, her husband Mr Shunmoogum also works in the home. Since January 2004 they have employed a male psychiatric nurse as a member of the team. He is not employed as a nurse but is placed on shift as the designated person in charge, in the absence of the Registered Manager of her husband. There are also two support workers employed in the team. There are two staff per shift, one of which is the designated person in charge of the shift. At night, either of the two owners, or both will sleep in at the home. The rota indicated the Registered Manager as sleeping in each night. No shortfalls were identified in the recruitment process at this inspection. This home has an Equal Opportunities Recruitment Policy. Criminal Record Bureau checks were present in all files sampled. Staff files also all contained two written references, a photo, copies of two forms of identification, and the application form. There had been no incidents requiring staff to be referred to the Protection of Vulnerable Adults register. Staff supervision records were sampled. These showed that supervision was at least of the frequency required under Standard 36. The supervision pro-forma provides for a structured supervision session. Both the supervisor and supervisee sign the record of supervision. The following good practice was identified under this Standard: In addition to normal staff supervision records, additional brief supervision sessions also occur and are recorded. Manon House DS0000028584.V258732.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, and 42. Service users benefit from a well run home. Although there is a quality assurance system there is no annual development plan which would provide service users with fuller inclusion in developments in the home and a way for them to measure improvements in quality for themselves. The health and safety, and welfare of the residents is generally well promoted and protected. EVIDENCE: There was a clear line of accountability within the home and the owner/manager demonstrated a good knowledge of residents and the staff team. Manon House DS0000028584.V258732.R01.S.doc Version 5.0 Page 21 The Registered Manager and the Registered Provider are undertaking the Registered Manager’s Award. This combines the Certificate in Management Studies and the NVQ Level 4.The Certificate in Management Studies has been completed by both of the owners. The course is nearing completion. The Registered Manager is originally a Registered Mental Health Nurse. She and her husband previously owned/managed a 14-bedded care home for the elderly. There is a quality assurance system, which involves service users. The quality assurance tools include the complaints system, service user meetings, one to one discussions, user satisfaction surveys, and inspections. There was however no annual development plan to record improvements and to allow the service users concerns to be included in development and improving quality. The following requirement is set to address this: The results from user/relatives satisfaction surveys must be collated. An annual development plan must then be produced which reflects the survey results and information from other quality assurance tools. This then needs to be made open to the service users, to allow measurement of achievement in improving quality. Moving and Handling, Fire Safety, First Aid, Food Hygiene, Infection Control, and Handling and Disposal of Clinical Waste policies are all included in staff induction. Control Of Substances Hazardous to Health policies were observed and these substances were all locked away. Risk assessments covering safe working practices were present and these included individual resident and environment specific risk assessments. All of the health and safety policies and procedures relevant to this Standard were seen to be present. All of the procedures and testing of systems required in Standard 42 were also present, except the record of regular tank testing and system cleaning to control the risks of Legionella. This had however been applied for. The following requirement is set to address this: The results from the bacterial analysis of the water supply must be sent to the Commission. Manon House DS0000028584.V258732.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 x x x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 x 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 x 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score x 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Manon House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 x 2 x x 2 x DS0000028584.V258732.R01.S.doc Version 5.0 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 1 Regulation 5 Requirement The Statement of Purpose must contain all the elements of Schedule 1, in particular, the relevant qualifications and experience of the managers and staff, the number of staff and the number and size of the rooms in the home. The service users guide must contain the views of the service users. A record of all of a service user’s needs to be met or supported by the home must be recorded in their plans of care. In particular social, educational, employment and religious and cultural needs must be included. The results from user/relatives satisfaction surveys must be collated. An annual development plan must then be produced which reflects the survey results and information from other quality assurance tools. This then needs to be made open to the service users, to allow measurement of achievement in improving quality. The results from the bacterial DS0000028584.V258732.R01.S.doc Timescale for action 06/06/06 2 3 1 6 5 12[3] 15 06/06/06 01/01/06 4 39 24,1,2,3 01/04/06 5 42 12 01/11/05 Page 24 Manon House Version 5.0 analysis of the water supply must be sent to the Commission. 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 9 20 Good Practice Recommendations Free access to the sharp kitchen knives should be risk assessed. Consent to medication and first aid should be recorded. Manon House DS0000028584.V258732.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Manon House DS0000028584.V258732.R01.S.doc Version 5.0 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!