Inspection on 31/05/06 for Oak Tree House

This inspection was carried out on 31st May 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

Oak Tree House 01/05/07

Oak Tree House 30/11/05

Oak Tree House 18/05/05

Oak Tree House 19/10/04

Oak Tree House 17/06/04

Similar services:

Ravensworth Lodge

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

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

CARE HOMES FOR OLDER PEOPLE Oak Tree House Oak Tree Estate Station Road Preston East Yorkshire HU12 8UX Lead Inspector Lynne Busby Unannounced Inspection 31st May 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 DS0000047696.V298503.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. DS0000047696.V298503.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oak Tree House Address Oak Tree Estate Station Road Preston East Yorkshire HU12 8UX 01482 899169 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered provider/manager (if applicable) Type of registration No. of places registered (if applicable) www.pwccare.co.uk PWC Care Limited Mrs Pamela Joy Cawkwell Care Home 23 Category(ies) of Dementia - over 65 years of age (23), Old age, registration, with number not falling within any other category (23) of places DS0000047696.V298503.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 30th November 2005 Brief Description of the Service: Oak Tree House is a private residential home. The home is registered for 23 people over the age of 65 years of either sex. It also provides for those service users who may have dementia. Presently the home has no vacancies. The home is situated in the village of Preston within easy access of local facilities and being close to the city of Hull. It is located a short distance from the main road where public transport may be accessed. There are bedrooms on the ground and first floor with a stair lift for those service users who are less mobile. There are five shared rooms one which is used as a single room and fourteen single rooms; seven have ensuite facilities. The home has two lounges and a separate dining room all located on the ground floor. To the rear of the premises is a small car parking area and a garden area that is accessible to service users. The weekly charges are £291.00 to £375.00 and there are additional charges for hairdressing, manicures, chiropody and magazines. Information is available about the service through the statement of purpose and service user guide. DS0000047696.V298503.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced site visit that took place over one day from 9.30 am to 5.45 pm with a previous two days inspection preparation. As part of the inspection, comment cards were sent out. Nineteen relatives and visitors surveys and seven health and social care professionals comment cards were returned. In addition, three service users completed service user surveys with the inspector and a further 10 were completed by service users with the staff assistance. Responses to this consultation about the service are referred to in the report. The visit consisted of a tour of the premises and a review of the documentation, including three care plans and recording systems. Time was also spent with residents in the communal areas. The inspector spoke to a number of service users and three of these were engaged in longer conversations. Discussions were held with staff, the provider/manager and a visitor. What the service does well: What has improved since the last inspection? The maintenance within the home has improved; the electrical installation has been checked and there has been a new boiler fitted. The activities programme for the service users is advertised on a board that is changed daily so service users are kept informed of the choices available. DS0000047696.V298503.R01.S.doc Version 5.2 Page 6 Staff have undertaken a variety of training including an introduction to dementia. This provides information to assist in the care of some of the service users accommodated in the home. 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. DS0000047696.V298503.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 DS0000047696.V298503.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): 1,3,6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective service users and their representatives are provided with information so they can make an informed decision before being accommodated. Service users are assessed prior to being accommodated to ensure that the home can meet their individual needs. EVIDENCE: The service users and their relatives are given a statement of purpose and a service user guide on the home prior to being accommodated. This is also available in each service user’s room. Nine of the comment cards received from relatives/ friends stated they did not have access to an inspection report. However, three commented, “I am sure I would be provided with any information…should I ask”. DS0000047696.V298503.R01.S.doc Version 5.2 Page 9 The service users are admitted to the home following a community care assessment or the home’s assessment of needs. Three service users files were examined and all had an assessment completed. A plan of care is generated from these. The home’s assessment covers all the areas identified in the standard. The provider/manager said that she will visit service users in hospital or at home to complete the assessment where necessary but has rang the hospital for information instead of visiting for some service users. The home does not provide intermediate care. DS0000047696.V298503.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): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service users’ health, personal and social care needs are met. EVIDENCE: Three service users files were examined and all had a plan of care. For service users referred through the local authority care management route, the plan of care is generated from the community care assessment. This provides the basis for the care to be delivered. The plan of care is presently being changed and the provider/manager is working closely with an assessment officer from the community care team to develop these. The service user’s plan is reviewed every month in the home and yearly by the care management team. One visiting relative said they were invited to reviews and dates had been changed in order for the family to attend. DS0000047696.V298503.R01.S.doc Version 5.2 Page 11 Service users are involved in the drawing up of the plan. However, the plan needs to be agreed and signed by the service user whenever capable and/or their representative. The provider/manager advised that this is in the process of being actioned. As the new plan of care is completed, the agreement of the service user will be sought. Service users’ health care needs are monitored. Health professional visits are recorded and the district nurse visits regularly. Advice is given on the prevention of pressure sores and the promotion of continence. The home has two service users with pressure sores. The home monitor the service users’ psychological health and community psychiatric nurses are involved when required. Service users have access to chiropody, dental and optical services. Appointments for these were on individual service users files. One service user said the staff ring the doctor straight away if required and they also said, “ I have kept my own GP”. Another service user said they liked their GP as they felt they could talk to them. Concerns have been raised by a health professional. These include service users who have had skin tears, staff were taking service users to use the commodes in bedrooms belonging to other service users and the cupboard that stores the nurses’ equipment is located in one service user’s room. This was addressed with the provider/manager and the it was found was that some service users had some skin tears but this had been dealt with last year. The practice of taking service users to use commodes in other peoples’ rooms had been standard practice before the present provider/manager had taken over. The provider/manager stated this no longer happened. All equipment had already been moved to individual service users’ rooms. The medications are held in a lockable metal trolley. The home does not presently have anyone who self medicates. The medications are provided by a local pharmacist and the home use a monitored dosage system. Controlled drugs are stored and recorded separately. In examining the accident records it was noted that one service user had taken someone else’s medication when it had been placed in front of a service user on the dining table. The staff had handled the situation correctly and the doctor was called. The home had a review of practice and all staff giving medication had been supervised to ensure safe practice was completed. The CSCI had not been notified of this incident, as required. Medications are signed for on the medication administration record (MAR). It was noted that one service user who had medications not in the monitored dosage system had more left than indicated on the record. This should be reviewed so quantities are accurate. All service users have access to a telephone. It was noted that some service users have their own telephone. The staff were observed using the service DS0000047696.V298503.R01.S.doc Version 5.2 Page 12 users’ preferred form of address and this is recorded on individual service users files. Staff were observed knocking on service users doors and this was confirmed in discussion with service users. DS0000047696.V298503.R01.S.doc Version 5.2 Page 13 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 adequate. This judgement has been made using available evidence including a visit to this service. Service users are able to take full advantage of activities and interests and participate in community and family life. The meals in the home offer some choice and variety to the service users. EVIDENCE: Family and friends are welcome to visit the home and all comment cards received indicated that they are welcomed at any time. One relative/ friend and two health and social professional comment cards indicated that they could not see service users in private. The provider/manager said that service users could be seen in private. A concern may be where service users share rooms and health and social care professionals visit. It was recommended that visitors are made aware that they are able to see service users in private. The service users’ files inspected had service users’ likes and dislikes recorded. However, daily activities that the service users choose to participate in were DS0000047696.V298503.R01.S.doc Version 5.2 Page 14 not recorded. This would ensure that staff could monitor participation and that service users needs are being met. The inspector observed that two service users go to the local day centre, and individual service users completed crosswords and crocheting. There is an activities board, which is up dated daily in the lounge. The home has a musician once a month and one service user said they particularly enjoyed a church choir that visited the home. Local church representatives will visit the home. All service users are asked when accommodated about arrangements for their religious observation. Service users can handle their own money for as long as they wish. Service users have information on how to contact advocates who will act in their interests. The home has a new dedicated cook; previously a few staff members did the cooking. Service users said that the food was good. One service user said “its all home made” another said, “ I eat most of it”. And another said she thought it would be better now it was one person doing the cooking. Menus were available for inspection, the cook said she is seeking the service users’ views and recently more homemade pies have been requested. The lunchtime was observed by the inspector and the meal was well presented. One service user did not want the vegetables and was getting upset. Staff handled the situation in a caring manner. Staff assisted service users where necessary in a sensitive way. One staff member did stand up whilst assisting a service user. However, the provider/manager intervened and asked the staff member to sit next to the service user. There is a choice at teatime and staff were observed asking service users what they would like. At lunchtime there is one main meal but service users can ask for an alternative. DS0000047696.V298503.R01.S.doc Version 5.2 Page 15 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 adequate. This judgement has been made using available evidence including a visit to this service. Service users can make complaints and are listened to. The recruitment process does not fully protect service users from abuse. EVIDENCE: The home has a complaints procedure. Service users spoken to were aware how to make a complaint and said any concerns would be listened to and acted upon. Six of the 18 comment cards received from relatives and friends stated they had received the complaints procedure. One relative said, “I have not had any complaints. I am sure inspection reports and complaints procedures would be available if I asked”. There have been no complaints since the last inspection but a concern was raised. This was dealt with by the provider/manager under the home’s procedures (see health and personal care). The home has a Hull and East Riding Protection of Vulnerable Adults procedure. The provider/manager has developed in house procedures on the protection of vulnerable adults and whistle blowing. There are policies and procedures on service users’ money and financial affairs. This requires further development to include safe storage of valuables, consultation on finances in private and advice on personal insurance in line with the standard. DS0000047696.V298503.R01.S.doc Version 5.2 Page 16 DS0000047696.V298503.R01.S.doc Version 5.2 Page 17 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): 19,21,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users live in a safe and comfortable ‘homely’ environment. EVIDENCE: The home is set in its own grounds, which are well kept. There is a gardener/ maintenance person employed and work is continuing to ensure service users can access the gardens. The home was described by a relative as “always clean and tidy”. There is a programme of routine maintenance available. There are no outstanding requirements from the fire officer or the environmental health officer. Service users have access to all parts of the building via a stair lift. There have been continued improvements in the decoration of the home. One shared room has been redecorated and carpeted. During the tour of the DS0000047696.V298503.R01.S.doc Version 5.2 Page 18 premises it was noted that two rooms required new carpets. The provider/manager informed the inspector that these were on the maintenance programme, as was the redecoration of some of the rooms. Toilets are appropriately sited on each floor and seven rooms are provided with ensuite facilities. Two bathrooms are accessible to service users. Only one bathroom is equipped with a hoist and this has been serviced. The second bathroom has a medi-bath available. There are three toilets on the ground floor; staff advised that the layout of these could make it difficult to manoeuvre in for some service users. The provider/manager advised that she is reviewing these and is looking at alternatives. The premises are clean and offensive odours are kept to a minimum. There is a large laundry that includes a washing machine that can be programmed to meet disinfection standards. All service and facilities comply with the Water Supply (Water Fittings) regulations 1999. DS0000047696.V298503.R01.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using available evidence including a visit to this service. Service users are not fully protected by the home’s recruitment practices. Service users are cared for by trained staff. EVIDENCE: The inspector checked three staff files and found that all had completed CRB checks. One staff file had no references, however, this staff member had been in post for a number of years. There is one staff member who has not had employment checks. The provider/manager said that this person does not have unsupervised access. Full employment checks must be carried out to ensure service users are fully protected. All staff receive a statement of terms and conditions. There are six staff who have completed NVQ level 2 and a further four staff are working towards this. Two staff have completed NVQ Level 3. The staff have attended a number of training events including a basic course on dementia. A more in depth 14-week course is planned for later in the year. All new members of staff receive induction training and in 2 of the 3 files inspected an induction checklist had been completed. The third had been in post for a number of years. DS0000047696.V298503.R01.S.doc Version 5.2 Page 20 There is a staff rota available. This indicated that there are 4 staff on duty in a morning and three in the evening and two night staff. The morning staff also undertake laundry and cleaning duties. The provider/manager advised that she is to appoint a housekeeper who will be responsible for laundry and cleaning this will free staff to be dedicated to service users care. Staff and a service user spoken with said this would be beneficial and give staff more time with individual service users. DS0000047696.V298503.R01.S.doc Version 5.2 Page 21 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. The home is well run with the exception of the requirement to notify the commission of incidents, which may put service users at risk. Service users best interests are provided for and their financial interests are safeguarded but policies need to reflect practice. The environment is safe and the welfare of staff and service users. EVIDENCE: The manager is also the provider and has 26 years experience as a qualified nurse; she has retained her Professional Identification Number (PIN) up to date. She undertakes training with staff to update her skills and knowledge. The local authority has a quality system for care homes that is awarded in two parts. The home has undertaken this assessment and has achieved part 1 and DS0000047696.V298503.R01.S.doc Version 5.2 Page 22 part 2 and has developed an in house quality assurance system. However, this does not seek the views of other stakeholders for example GP’s, district nurses and care coordinators. From the comment cards received from health and social care professionals one stated “ I found this home to be very caring when I have visited. Management are always there and are approachable.” The provider/manager said that the home is presently being assessed for the Investors in People award. The service users manage their own money for as long as they wish, or families are responsible. The provider/manager is an appointee for one service user with the agreement of the family. There is a safe available to securely store money and valuables. The inspector examined two service users’ records; the records are kept on computer and receipts are kept. There were maintenance records available for gas, electrical installations and portable appliance testing. Fire checks were completed. The inspector was informed that the fire alarm had activated resulting in the fire service attending. This was a false alarm but a new alarm board was required. The provider/manager had not informed the CSCI as required. Staff have had updated training on fire awareness. Service users have risk assessments on individual files. Some of these were not dated so it was not clear that they had been reviewed. It was noted that some service users use the stair lift without the lap strap provided. The home must ensure that manufactories instructions are clearly followed. The Control of Substances Hazardous to Health (COSHH) risk assessments were in place. There is an accident book available. It was observed that one service user had a fall resulting in a broken arm. The provider/manager had not notified CSCI of this accident. DS0000047696.V298503.R01.S.doc Version 5.2 Page 23 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 X 3 X X X X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 3 X X 1 DS0000047696.V298503.R01.S.doc Version 5.2 Page 24 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 OP18 Regulation 16,20 Requirement The registered provider must ensure the homes policies and procedures and practices regarding service users money and financial affairs covers all areas identified in the standard. (Previous requirement -timescale 31/03/06 - not met). Timescale for action 31/07/06 2. OP29 18 The registered provider must 31/07/06 ensure the recruitment and employment policies and practice comply with the standard. All records in Schedule 2 of the Care Homes Regulations 2001 must be in place for staff. (Previous requirement -timescale 30/06/05- not met). The registered provider must ensure that an annual development plan for the home, based on systematic cycle of planning is produced. The results of surveys must be published and made available to service users and representatives and the Commission for Social Care Inspection. DS0000047696.V298503.R01.S.doc 3. OP33 24(a)(b) (2)(3) 30/09/06 Version 5.2 Page 25 The views of stakeholders in the community e.g. GP’s, chiropodists etc must be sought. 4 OP38 37 The CSCI must be notified of all incidents identified under regulation 37. 30/06/06 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. 3. 4 5 Refer to Standard OP9 OP12 OP28 OP38 OP38 Good Practice Recommendations Stock control of medications should be reviewed. The service users’ interests and activities undertaken should be recorded on individual files. 50 of the staff should be trained to NVQ level 2 or equivalent. All risk assessments should be dated. Manufacturer’s instructions should be followed regarding the use of the stair lift. DS0000047696.V298503.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 DS0000047696.V298503.R01.S.doc Version 5.2 Page 27 - 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!