Inspection on 21/12/05 for Oaklands

This inspection was carried out on 21st December 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Oaklands 08/08/07

Oaklands 29/08/06

Oaklands 19/04/06

Oaklands 04/08/05

Oaklands 14/09/04

Oaklands 15/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Oaklands Shaw Road Royton Oldham OL2 6DA Lead Inspector Michelle Haller Announced Inspection 21st December 2005 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 Oaklands DS0000005513.V264574.R01.S.doc Version 5.1 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. Oaklands DS0000005513.V264574.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Oaklands Address Shaw Road Royton Oldham OL2 6DA 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) 0161 627 1142 0161 627 1142 Oaklands Rest Home Limited Amanda Dack Care Home 18 Category(ies) of Dementia - over 65 years of age (8), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (1), Old age, not falling within any other category (10), Sensory Impairment over 65 years of age (2) Oaklands DS0000005513.V264574.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 18 service users to include: *up to 10 service users in the category OP (Old age not falling within any other category). *up to 8 service users in the category DE(E) (Dementia over 65 years of age). *up to 2 service users in the category SI(E) (Sensory impairment over 65 years of age). *up to 1 service user in the category MD(E) (Mental disorder excluding learning disability or dementia over 65 years of age). The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 4th August 2005 2. Date of last inspection Brief Description of the Service: Oaklands Rest Home is a privately owned care home with 18 registered places for people over 65 years of age and whose needs fall within the following categories: dementia; physical disability; mental disorder and old age. The building, which is a detached property, is situated on the main Shaw Road in the Royton area of Oldham. It is approximately two miles from the town centre and is in easy reach of public transport and community facilities. Accommodation comprises of three single en-suite bedrooms, three single and six double bedrooms with shared en-suite toilet facilities. Lounge/dining facilities are provided in three adjoining areas, which comprise two lounge areas and a dining area, the latter being situated to the rear of the building and next to the kitchen. Oaklands DS0000005513.V264574.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over a period of seven hours by one inspector with additional input of approximately four hours from regulation inspector, Mrs Tracey Rasmussen. We told the home we were coming to do an inspectionthis is called an announced inspection. The inspection process included the examination of four service-user assessments and care plans, examination of other documents concerned with the care of service users and the running of the home, including the staff roster, staff files, the homes policy’s and procedures, medication records, the accident book and other records and reports. An observation of the interactions between staff and service users was also undertaken. Over the course of the inspection a number of service users, relatives and staff were also interviewed. A tour of the communal, public and private areas of the building was also undertaken. At the time of writing the report three service-user representative and one general practitioner comment card had been returned, and all comments about the running of the home were complimentary. Service users returned no comment cards. On the day of inspection the home appeared calm and efficiently run. Comments from relatives included: ‘I have always found the standard of care given at Oaklands to be 100 and would not hesitate in recommending it to other parties’ Those interviewed were positive about the manager. What the service does well: The home provides a good level of personal and health care. The home provides pleasant and caring care assistants. The home provides opportunity for service user to develop personal relationships between themselves, and professional relationships with staff. Oaklands DS0000005513.V264574.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? 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. Oaklands DS0000005513.V264574.R01.S.doc Version 5.1 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 Oaklands DS0000005513.V264574.R01.S.doc Version 5.1 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 and 5 Oaklands Rest Home provides, sufficient information and opportunities for visits, to assist potential service users in making an informed decision about moving into the home. Oaklands Rest Home ensures that service users have their health needs assessed prior to becoming resident in the home, however social care needs are not fully assessed. EVIDENCE: Oaklands service user guide was examined and contained information detailing the philosophy of care provision, how health care is accessed, recreational and social activities, staff skills, visiting arrangements and other information concerned with making a choice about moving into Oaklands. Four service user files were examined and each contained a completed assessment of needs and risk assessments concerning health. It was noted, however, that social needs were not fully assessed. Oaklands DS0000005513.V264574.R01.S.doc Version 5.1 Page 9 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 and10 The health care needs of service users are well documented and known to staff, which ensures that such needs are met. Medication in the home is not stored in safely and securely, which potentially puts service users at risk. The care practice in place does not fully promote the dignity of service users. EVIDENCE: Four care plans were examined and instructions about meeting health needs were, for the most part, clearly identified. Records and reports for service users confirmed that all routine and specialist health care including pressure area care is provided. Service users were keen to verify that all health care is provided, including opticians, dentist, influenza injection and podiatry as well as out patient appointments, nursing care and other specialist input as required. Oaklands DS0000005513.V264574.R01.S.doc Version 5.1 Page 10 One general practitioner and three relatives comments cards were returned and no concerns were raised about the health care provided in the home. Service user comments included: ‘I have always been satisfied –they are very good to me’ When questioned, service users could not categorically confirm that their dignity and privacy was always upheld. It was also noted that privacy screens were not available in all shared bedrooms. Oaklands DS0000005513.V264574.R01.S.doc Version 5.1 Page 11 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 and 15 There are insufficient activities taking place in the home to ensure service users are well stimulated and entertained. Visiting time in the home is flexible and in line with the needs of service users ensuring that they maintain good contact with family friends. The nutritional value of meals provided in the home is in keeping with current guidelines, and there has been an improvement in choice offered to those on special diets. EVIDENCE: Although an activities chart has been developed, the home was unable to demonstrate an increase in activities undertaken by service users. Those interviewed confirmed that though there had been some improvement over all, the feeling was that there were insufficient activities in the home or organised excursions. Discussion with the manager highlighted her continued attempt to establish meaningful activities for service user. Improvements include, introduction of arts and crafts sessions and the involvement of local schools for Carol Concerts over Christmas. Oaklands DS0000005513.V264574.R01.S.doc Version 5.1 Page 12 Staff have completed an Age Concern course about developing activities in residential homes and some of these ideas are about to be implemented. Funding of activities remains an issue, as an activities budget for the purchase of equipment has not been established. Residents meetings do not occur on a regular basis and service users have not been given opportunities to make suggestions about activities that they would like to be made available. Observation of interactions in the home identified that service users relate well to each other and staff. Relatives stated that staff welcomed them and they continue to be complimentary about the manager. Service users with particular routines are able to maintain them when they move into the home, for example service users can get up and go to bed when they are ready. Service users were observed spending time in their rooms as they wished. The menu indicated that three meals are offered to service users each day. Items on the menu included hot pots, salads, stews, pies and sausages. The menu also indicated that diabetic choices had increased to include puddings, jellies and fruit salads. The manager stated that fresh fruit is now provided and offered on a daily basis either as fruit salad dessert or as a snack. Examination of the food stores confirmed that improvement had occurred in respect of the provision of fresh fruit in the home. Records also verified that information concerning the nutritional intake of the most frail service users was now maintained. Discussion with the cook demonstrated that a training course about nutrition had been completed and she was confident that the use of frozen vegetables was as equally nutritious as fresh. Oaklands DS0000005513.V264574.R01.S.doc Version 5.1 Page 13 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 and 18 The home has a robust complaints procedure, which is known and available to all. Guidelines in place for the protection of vulnerable adults are inadequate. Leaving service users potentially at risk from abuse or harm. EVIDENCE: The complaints procedure was examined and assessed as satisfactory and allowed service users and their relatives to be confident that complaints would be taken seriously and acted upon. The manager stated that she had not received any complaints from service users staff or others involved in the home. Discussion with service users and relatives confirmed that they knew who to approach with complaints and felt that any issues would be dealt with fairly. The home does not operate a whistle blowing policy, furthermore, adult protection training has not been provided. Discussion with staff indicated that, though well intentioned, their knowledge of the different types of abuse, identification of possible abuse and the action that must be taken, was very basic. The manager acknowledged that providing adult protection training was to be priority in the coming months. Oaklands DS0000005513.V264574.R01.S.doc Version 5.1 Page 14 Oaklands DS0000005513.V264574.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20,21,22,23,24,25 and 26. Some aspects of the environment in this home fail to provide service users with a comfortable clean and homely environment. The home provides sufficient bathing and toileting facilities to meet the needs of service users. Equipment is available which ensures that the service users independence is maximised. Service users rooms are flexible and can be furnished to meet their needs. EVIDENCE: In the process of this inspection a tour of the private and communal areas in the home was undertaken. Oaklands DS0000005513.V264574.R01.S.doc Version 5.1 Page 16 The furniture in the communal areas is domestic in appearance and there is sufficient lighting to enable service users to read if they so wish, however the sofa and chairs in the lounge area nearest the kitchen were worn and stained. Since the last inspection three new beds have been purchased and carpets have been cleaned, it was evident however, that the frequency of cleaning needs to be increased as many carpets were stained. The flooring in some of the en-suite and bathroom areas is in poor condition. Other maintenance work and refurbishment is required for example the bath lift chair is stained and the casing for the frame cracked, and the majority of commodes were rusty, with the plastic coating disintegrated and missing lids. Inspection of the bedrooms found that a number continued to have a musty smell. A significant number of bed bases and mattresses are still heavily stained, although three have been replaced since the previous inspection. The furniture provided in the majority of bedrooms is in poor repair and broken furniture repaired with visible screws furthermore many chest of draw units had chipped and broken surfaces. The laundry area is unsatisfactory and does not meet the required minimum standard, the floor and walls are permeable, and the walls and pipes were covered in cobwebs and dust. The area is also damp. Laundry baskets have now been supplied, however dirty clothes and soiled bedding were piled together on the laundry floor, demonstrating that closer supervision in respect of cross infection is necessary. The dampness makes the laundry unsuitable for storing clothes, and it was noted that clothing for a number of service users was been kept in an occupied bedroom until staff could put them away. Although the registered provider did not see this as an issue for the occupant, and no complaints were made, it highlighted the problem of storage and lack of usable laundry space in the home. The washing machine offers a programme to disinfect soiled bedding and underwear. Staff have been provided with an alcohol spray to clean their hands between dealing with service users, and it was observed that protective clothing was used when moving between the kitchen and other areas. Furthermore the kitchen is no longer used as thoroughfare for staff and visitors. Issues of concern were discussed with the registered individual who agreed to supply CSCI with a refurbishment plan concerning the upgrading of fixtures, fittings and furniture in the home in the timescale given by the Commission. Oaklands DS0000005513.V264574.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 and 30 The numbers of staff in the home is sufficient to meet the needs of the service users. Staff require further training to ensure that they are fully competent to do their jobs. The home’s recruitment practice is satisfactory ensuring that all new staff are suitably vetted which protects service users from harm. EVIDENCE: On the day of this announced inspection there were, 3 care staff, the manager, domestic staff and a cook meeting the needs of 18 service users. The roster demonstrated that this was the usual complement of staff during the morning and early afternoon, in the late afternoon there was generally one senior care assistant plus two care assistants and at night two staff were employed to wake and watch. Recently the majority of staff have been enrolled on the NVQ 2 in care. An induction package for new staff has been established and includes an introduction into physical care, the philosophy of care with regard to dignity, choice and respect, moving and handling and the complaints procedure. The manager continues to investigate sources of free training for staff and planned courses includes health and safety training, food hygiene and first aid Oaklands DS0000005513.V264574.R01.S.doc Version 5.1 Page 18 in January 2006. Training priorities were also discussed and, adult protection, medication training, dementia care and pressure area care were identified. The manager confirmed that the registered individual had agreed to provide cover in the home so that staff could attend courses. Observations made throughout the inspection demonstrated improvements in care due to in-house training provided in respect of cross-infection and the manager acknowledged her awareness of additional training needed for all the staff. Staff files were examined and that of the most recent recruit contained two references, CRB and POVA first declarations. This member of staff was interviewed and she confirmed that she had been introduced into the routine of the home gradually and had been shadowed in respect of using equipment and working with service users for the first time. Oaklands DS0000005513.V264574.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,36 and 38 The manager at Oaklands Rest Home is competent and well qualified. The home needs to establish a quality assurance monitoring system that will enable service users, relatives and others coming into the home to comment on the care and support provided. The health and safety arrangements in place do not fully ensure that the home is a safe place to live, work and visit. EVIDENCE: The manager has successfully completed a Fit Person interview with the Commission for Social Care Inspection (CSCI) and had previously achieved the National Vocational Qualification level 4 management award. Oaklands DS0000005513.V264574.R01.S.doc Version 5.1 Page 20 Discussion with the manager indicated that she continues to keep up to date with new developments in care and has recently completed courses includes a food nutrition and the Age Concern course about activities in residential settings. The manager works alongside staff and those interviewed were keen to confirm that the management style in the home was open, with guidance provided in a balanced and fair manner. Supervision and appraisal has been introduced for all staff including night staff. Records demonstrated that team meetings have also commenced and issues discussed include the role and responsibility of staff, writing up and following care plans and risk assessments, health and safety issues such as accessing the kitchen, suggestions for training, information about tissue viability and the system for staff supervision and appraisals. Discussion with service users indicates that though they are satisfied with the overall care in the home there are issues that they may not have had the opportunity to address. It was clear that those interviewed did not want to complain but it was evident by their muted response that there were issues such as the repair of the home, activities and privacy. No service user comment cards were returned to the commission. The introduction of quality assurance monitoring must be developed to provide an opportunity for those involved in the home to comment from their own perspective as service user, relative, health professional or staff. A development plan for the home has been written, but this does not address all the requirements concerning the repair of the furniture, fixtures and fittings, provision of activities in the home and training issues. The accident log was examined and found to be in order. A fire safety risk assessment has been completed by the local Fire office and recommendation made, paper work indicated that fire safety equipment had been checked in accordance with current guidelines. Records demonstrated that electrical wiring had also been surveyed in accordance with the appropriate regulations. Conversely, regular maintenance and safety checks of the passenger lift; bath hoist and other equipment and services could not be confirmed. Oaklands DS0000005513.V264574.R01.S.doc Version 5.1 Page 21 Oaklands DS0000005513.V264574.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 2 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 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 2 3 3 3 x 2 3 1 STAFFING Standard No Score 27 3 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 1 x 3 3 x 2 Oaklands DS0000005513.V264574.R01.S.doc Version 5.1 Page 23 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 OP3 Regulation 14 Requirement The registered person must ensure that the social needs and expectations of service users are fully assessed. The registered person must ensure that all medication in the home is securely stored. The registered person must ensure that privacy screens are provided in all shared bedrooms. The registered person must consult with service users and provide a programme of activities that they want. (Previous timescale 1/11/05 not met) The registered person must ensure staff receives adult protection training. (Previous timescale 1/10/05) The registered person must initiate a programme of refurbishment, maintenance and improved storage provision, a copy of which must be sent to the Commission for Social care Inspection. (Previous timescale 01/10/05) Timescale for action 01/07/06 2 3 4 OP9 OP10 OP12 13(2) 12(4) 16(n) 01/03/06 01/03/06 01/06/06 5 OP18 13(6) 01/03/06 6 OP24OP19 23 01/03/06 Oaklands DS0000005513.V264574.R01.S.doc Version 5.1 Page 24 7 OP26 23 8 OP30 18 9 OP33 24 10 OP38 13 (4) a The registered person must ensure that all areas of the home are clean and fit their intended use. The registered person must ensure that staff receive sufficient training to enable them to meet the needs of service users. The registered person must develop a system for monitoring the quality of the service that incorporates the opinion service users, their representatives, health professionals and others involved in the home. The registered person must ensure that all equipment and services are regularly checked and deemed safe by appropriately qualified individuals. 01/06/06 01/06/06 01/11/06 01/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Oaklands DS0000005513.V264574.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD 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 Oaklands DS0000005513.V264574.R01.S.doc Version 5.1 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!