Inspection on 28/11/06 for National Autistic Society, 4 Heath Rise

This inspection was carried out on 28th November 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 no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

National Autistic Society, 4... 08/08/07

National Autistic Society, 4... 30/11/05

National Autistic Society, 4... 14/07/05

National Autistic Society, 4... 07/12/04

Similar services:

Hunter`s Lodge

Hillside

Applegarth

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Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

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

CARE HOME ADULTS 18-65 National Autistic Society 4 Heath Rise 4 Heath Rise Wellingborough Northants NN8 5QN Lead Inspector Ms Sarah Jenkins Key Unannounced Inspection 28th November 2006 07:30 National Autistic Society 4 Heath Rise DS0000061905.V318104.R02.S.doc Version 5.2 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 National Autistic Society 4 Heath Rise DS0000061905.V318104.R02.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 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. National Autistic Society 4 Heath Rise DS0000061905.V318104.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service National Autistic Society 4 Heath Rise Address 4 Heath Rise Wellingborough Northants NN8 5QN 01933 676786 01933 676786 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) Vanessahalfacre@nas.org.uk National Autistic Society Miss Joanna Hughes Care Home 4 Category(ies) of Learning disability (4) registration, with number of places National Autistic Society 4 Heath Rise DS0000061905.V318104.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 4 Heath Rise care home is registered to provide personal care to male and female service users who fall within the following categories: Learning Disability (LD) 4 Persons accommodated in 4 Heath Rise care home must be diagnosed with an Autistic Spectrum Disorder. That the age range of persons accommodated at 4 Heath Rise care home is 18 to 40 years of age. The maximum number of persons to be accommodated at 4 Heath Rise care home is 4. 30th November 2005 Date of last inspection Brief Description of the Service: 4 Heath Rise is a large modern house in a residential area on the outskirts of Wellingborough. It is run by The National Autistic Society. 4 Heath Rise is on a quiet road but is close to a main road with a regular bus service to the town centre. Service Users each have their own bedrooms and there is a pleasant garden area. The range of fees at the home was not known by the Registered Manager, and it was not possible to reach the person who could give this information by the time of the writing of this report. Information about the home is available from the National Autistic Society in the form of a Statement of Purpose and Service Users Guide. National Autistic Society 4 Heath Rise DS0000061905.V318104.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for Service Users and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. The primary method of inspection used was ‘case tracking’ which involved selecting 2 service users and tracking the care they receive through meeting with the service users, a review of their records, discussions with the care staff and observation of care practices. The Inspector spent three hours reviewing information and planning the Inspection. 10 comment cards have been received since the last inspection, including three from service users and feedback therein was broadly positive. The pre-inspection questionnaire also informed the inspection process. The inspector spent just over seven hours in the home from 7.20a.m, to observe practices and to meet with service users. Service users have Autistic spectrum disorders and Learning Difficulties and thereby communication for some is difficult. Establishing Service Users choices and informed decisions is dependant to some extent upon the consistency of staff, service users relationships with staff, and the quality of communication. Feedback obtained from Service Users in this report was in part through observations of their relationships with staff, and also through interpretations of their general levels of happiness with their routines. What the service does well: What has improved since the last inspection? National Autistic Society 4 Heath Rise DS0000061905.V318104.R02.S.doc Version 5.2 Page 6 Improvements have been made to the premises since the last inspection such as a new shower in the upstairs bathroom and further landscaping work in the garden. The medication was better managed and organized than at the last Inspection and previous Requirements and Recommendations have been met. 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. The summary of this inspection report can be made available in other formats on request. National Autistic Society 4 Heath Rise DS0000061905.V318104.R02.S.doc Version 5.2 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 National Autistic Society 4 Heath Rise DS0000061905.V318104.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1.2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission process has potential to be supportive of service users care needs. EVIDENCE: There have been no recent admissions to the service and the current Registered Manager did not feel that she was fully up to date with the processes due to the pressure of work that she has had over recent months. She was however able to describe a flexible process with a full assessment adapted to the potential service users wishes and needs. Documentation such as the Statement of Purpose had not been updated for some time and needs to be addressed prior to the start of any new admission. National Autistic Society 4 Heath Rise DS0000061905.V318104.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6.7. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care does not always meet service users needs and identified gaps have the potential to put service users at risk. EVIDENCE: Service users files contained much detailed information on service users needs and the action that had been taken by the home to obtain professional guidance where necessary. However Service users changing needs were not always detailed in care plans (known in this home as Behaviour support guidelines). For example there was insufficient detailed direction to staff about how best to address a conflict between two service users, or the eating habits of a service user. Guidance obtained from professional services such as a Dentist and a Dietician had not been transferred to the care plan, but were elsewhere in the file and possibly not accessed by staff. Care plans were not easily accessible or used properly, by busy staff who said that they read through them but relied on word of mouth to hear of any changes in the National Autistic Society 4 Heath Rise DS0000061905.V318104.R02.S.doc Version 5.2 Page 10 delivery of care. It was evident from records and observations that at least one service users needs were not being properly met. Some care plans had not been updated despite the indication of a review date, which was past by the time of the inspection. Information on service users review reports was not always accurate or was misleading, due to processes that were poorly developed or used, or cumbersome, or overwhelming, and led to difficulties for staff extracting and summarizing information. For example the number of notifiable incidents a service user was involved in was inaccurate. When the inspector tried to access the information herself with the Registered Manager, a problem with the system was established. Staff at the home try to enable reasonable risk taking and to manage this but in the present circumstances of staffing it is not clear whether this is being adequately addressed. Service users decisions appeared to be compromised by an ongoing difficulty at the home within the client group, affecting the general atmosphere and stability of the home. For example there was evidence that a service user had on at least one occasion chosen to eat their meals in their room. Another service user was recognized to be withdrawing from the community more frequently. Two service users were seen to express general lack of satisfaction although they were unable to explain why. One of these appeared unsettled and anxious and told the inspector that they were unhappy but could give no reason. One service user appears to be taking them self out of the home more frequently and it has been observed that this sometimes occurs when the service user is distressed. There was a lack of clarity that the reasons for these behaviours had been adequately explored or addressed. Staff felt the atmosphere at the home had deteriorated over recent months and that this had definitely affected the quality of life of service users. Whilst staff do advocate on many occasions for service users, and this is evident in records, there are times when the relevance and need for strong advocacy has been poorly understood. Service users non-verbal choices or decision making is not always recognized or responded to. National Autistic Society 4 Heath Rise DS0000061905.V318104.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12.13.15.16.17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users generally lead active, stimulating, and fulfilling lifestyles and are enabled to maintain and develop appropriate relationships. EVIDENCE: Service users are enabled to take part in fulfilling opportunities at their day or work placements and at local colleges, and are supported to participate in the local community. Two service users spoke enthusiastically of the opportunities afforded to them in this respect. There was evidence in records of the way staff offer effective support to Service Users in maintaining their relationships with families and friends. National Autistic Society 4 Heath Rise DS0000061905.V318104.R02.S.doc Version 5.2 Page 12 Service users have an opportunity to discuss their choices of activities and holidays at the regular residents meetings chaired by staff and staff ensure that they keep service users appropriately informed at these meetings about details of the running of the home. Staff were seen to give sensitive encouragement to Service Users in their routines during the morning, and there was evidence that the daily routines promote independence and choice. Menus are planned on a weekly basis at the residents meeting and Service Users are fully involved in the preparation on a rota’d basis. The Inspector observed that service users were helping themselves to breakfasts of their choice, with assistance and support from staff where required. Menus show a variety of appetizing and nutritious foods. National Autistic Society 4 Heath Rise DS0000061905.V318104.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18.19.20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally personal and healthcare support is sensitively and effectively delivered. EVIDENCE: Staff are providing sensitive and flexible personal support to service users with a proper awareness of service users privacy dignity and rights. Staff are aware of ways in which to empower service users and follow good practice guidelines in many areas of care. There was evidence that service users healthcare needs were properly observed and responded to by staff, but there were difficulties in the recording and transfer of information. Advice was given to chronologically number the healthcare record sheets as a safeguard. Medication management is generally good with effective procedures for ensuring service users are fully informed and involved in their treatment, but National Autistic Society 4 Heath Rise DS0000061905.V318104.R02.S.doc Version 5.2 Page 14 medication profiles on files had not always been updated and it was therefore difficult to establish histories. National Autistic Society 4 Heath Rise DS0000061905.V318104.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst there is documentation and process relating to safeguarding adults, there are shortfalls in some of the actions or interpretations by management and staff, which has the potential to put service users at risk. EVIDENCE: No complaints have been formally notified to the home, and the complaint procedure has therefore not been utilized. Documentation is available in the home on both Complaints and protection of Vulnerable Adults. Staff do not appear to be fully recognizing the issues between service users which should be being dealt with under the safeguarding adults procedures, and notifications have not always been made appropriately with view to this. The Registered Manager acknowledged that there was an urgent need to review the ways in which incidents were evaluated and for staff to attend refresher training in this area, and was receptive to advice given. Although the Registered Manager had taken advice from the Adult Care Squad about recent action taken to protect a service user, this was not properly considered in relation to the service users rights. Full consultation and appropriate processes therefore did not take place until prompted by the Inspector. The Inspector noted a difference in the atmosphere of the home to that of calm content observed at the last inspection. Service users appeared National Autistic Society 4 Heath Rise DS0000061905.V318104.R02.S.doc Version 5.2 Page 16 less relaxed and confident in their home life. Some unhappiness was evident and staff felt that at least some of this was due to problems they were having within the client group. These problems, compromising the quality of life, and sometimes the safeguarding of service users, were evidenced in records. National Autistic Society 4 Heath Rise DS0000061905.V318104.R02.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24.30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The premises are comfortable and homely, and conveniently suitably for reasonable access to the town for mobile people. EVIDENCE: The home is bright airy and generally well maintained (but see also under Management). The garden area is pleasant, and well used by service users. Service users did not comment about the homes premises but seemed satisfied. There is plenty of room to move around in the home and it is appropriately equipped. The home was found to be clean and hygienic. National Autistic Society 4 Heath Rise DS0000061905.V318104.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a competent qualified core staff team but service users care needs may not always be met due to the shortfalls in levels of experienced staff on the roster and some gaps in the roster cover. EVIDENCE: At the time of the inspection there was one staff on duty between 7am and 7.30a.m. The staff member stated that she had been on a sleep in duty and that she felt confident in the back up arrangements. One staff sleeping in on another shift has concerns and her request for there to be two staff on duty at night has been recognized and responded to on her shifts. There are generally 2 staff on shift during the day. At the time of the inspection one of these was an agency staff member who did not have sufficient knowledge of the means of communication of one of the service users to provide adequate care. The rota showed that agency staff were covering 14 shifts in a sample fortnight, and that none of the three agency staff concerned had been working National Autistic Society 4 Heath Rise DS0000061905.V318104.R02.S.doc Version 5.2 Page 19 at the home for more than a month due to a recent change in the agency used. In the current circumstances staff were aware that two staff on duty is not always sufficient to properly meet the needs of all service users. Staff records showed that regular staff are generally well qualified, trained and supervised, and that recruitment procedures, discussed with the Registered Manager, are appropriate and meet Standards. The support for agency staff in the form of a file of essential information provided is very good and the agency staff member on duty at the time of the inspection said that she felt the induction process had been useful and appropriate. National Autistic Society 4 Heath Rise DS0000061905.V318104.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37.39.42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are many positives about the management of the home but shortfalls are sufficiently serious in relation to the potential outcomes for service users that the area overall cannot be described as good. EVIDENCE: The Registered Manager has been appointed to her post since the last Inspection. Staff report confidence in her and that she is approachable and helpful and responds appropriately to issues raised. There was evidence of some good management processes and organization in place, and a prompt and effective response to issues raised at this inspection. National Autistic Society 4 Heath Rise DS0000061905.V318104.R02.S.doc Version 5.2 Page 21 The Registered Manager was advised on some criteria for notifications. A recent requirement was made on staffing levels in a letter to the National Autistic Society prior to the inspection. The timescale for meeting this requirement had been exceeded by a few days at the time of the inspection and the Requirement was judged at the inspection not to have been fully met. Proper systems have been set up to deal with Health and Safety issues, most of which are being properly addressed, however shortfalls identified at the inspection leave service users at risk. For example the safety of the environment was compromised in relation to the electrical provision associated with behaviour management issues and presented a risk. Action was taken immediately by the Registered Manager to address the issues, but it was of concern to the Inspector that these matters had not been picked up by staff. No check on the effectiveness of the homes hot water systems to control the risk of Legionella infection has been undertaken. National Autistic Society 4 Heath Rise DS0000061905.V318104.R02.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 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 Standard No Score 1 2 2 x 3 3 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 1 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 x x x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 x 2 x x 1 x National Autistic Society 4 Heath Rise DS0000061905.V318104.R02.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 2 3 4 Standard YA6 YA33 YA42 YA42 Regulation 12 18 13 13 Requirement Service users care plans must be kept under review and updated appropriately. Sufficient staff must be provided to meet service users assessed needs at all times. Service users must be safeguarded from unnecessary risks to their Health and Safety. Arrangements must be in place to prevent risk to the Health and Safety of service users from other service users without compromising their rights. Timescale for action 01/01/07 04/12/06 14/12/06 14/12/06 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 YA1 YA7 YA39 Good Practice Recommendations The Statement of Purpose and Service Users Guide should be updated to reflect the current situation of the home. Staff should receive further advice about good practice in relation to advocacy on behalf of service users, in order to DS0000061905.V318104.R02.S.doc Version 5.2 Page 24 National Autistic Society 4 Heath Rise YA23 3 4 YA20 YA39 YA42 5 6 YA42 YA39 YA37 promote recognition and understanding of how to respond to service users non verbal cues, thereby better protecting service users from circumstances which could amount to neglect of their emotional needs. Medication profiles should be kept up to date to serve the purpose for which they are designed. The reasons for staff failing to be aware of the risk, which arose in relation to the environment, should be investigated and explored by the Registered Manager as part of her Quality Assurance processes, to prevent recurrence. A check should be undertaken in relation to the risk of Legionella infection. Criteria for Notification under Regulation 37 should be considered and agreed, in order that Notifications are always undertaken appropriately and that the Registered Manager may act autonomously in accordance with her position as a Registered person. National Autistic Society 4 Heath Rise DS0000061905.V318104.R02.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 National Autistic Society 4 Heath Rise DS0000061905.V318104.R02.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!