CARE HOMES FOR OLDER PEOPLE
Oldfield Bank 5 Highgate Road Altrincham Cheshire WA14 4QZ Lead Inspector
Val Bell Unannounced Inspection 12th September 2006 7:30 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 Oldfield Bank DS0000005625.V306184.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. Oldfield Bank DS0000005625.V306184.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Oldfield Bank Address 5 Highgate Road Altrincham Cheshire WA14 4QZ 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 928 0658 Mrs Anne Leavy Mr Lawrence Leavy Mrs Anne Leavy Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability over 65 years of age (0) of places Oldfield Bank DS0000005625.V306184.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. All service users will fall within the category of old age and may additionally have a physical disability. 21st December 2005 Date of last inspection Brief Description of the Service: Oldfield Bank provides accommodation and personal care for up to twentyeight residents within the category of old age. Residents may also have a physical disability. Mr Lawrence and Mrs Anne Leavy own Oldfield Bank with Mrs Leavy being the registered manager. Mrs Leavy is supported by Karen Sykes the deputy manager. The home is a large detached property, which has been extended and is set in pleasant grounds. The enclosed gardens are well maintained and residents can sit or stroll in the grounds. Car parking spaces are provided at the front of the building. The home has 26 single bedrooms, six of which are en-suite. Upper floors are accessed by a passenger lift and stairways. At the time of this inspection the homes charges for care and accommodation ranged from £333 to £470 per week. The home is situated within a residential area of Altrincham and is a short distance from shops, transport links and the motorway network. Oldfield Bank DS0000005625.V306184.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Two inspectors conducted this unannounced inspection over two days, 12th and 13th September. During the inspection various records, including care plans, were assessed, conversations were held with residents, their visitors, management and staff and a tour of the premises was undertaken. What the service does well: What has improved since the last inspection?
There had been considerable progress in the way the home assessed the risks associated with the care of residents. Although there were serious shortfalls in the administration of medication, some progress had been made in this area since the last inspection. Oldfield Bank DS0000005625.V306184.R01.S.doc Version 5.2 Page 6 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.
Oldfield Bank DS0000005625.V306184.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 Oldfield Bank DS0000005625.V306184.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): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. A robust system of assessment ensured that resident’s individual needs would be identified and recorded. EVIDENCE: Residents’ files contained detailed in-house assessments of need and care manager assessments had also been obtained. These assessments contained comprehensive information relating to residents physical and mental health, personal care and social needs. The home did not provide intermediate care. Oldfield Bank DS0000005625.V306184.R01.S.doc Version 5.2 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 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Residents generally received good quality care and staff demonstrated commitment to continuity of care for residents admitted to hospital. However, unsafe practice in the administration of medication placed the health and welfare of residents at serious risk. EVIDENCE: The care plans of four residents were case-tracked and conversations were held with the four residents and one of their relatives, who was visiting the home on the second day of inspection. The progress that had been identified in care planning at the last inspection had been maintained. However, the outstanding requirement that care plans must include detail to show how residents’ specific needs would be met had not been addressed. Daily records needed to record the specific outcomes experienced by residents in relation to the care they received. It was encouraging to note that significant progress had been made in the area of risk assessment, although further progress was needed to ensure that the standard was met. This was particularly evident in
Oldfield Bank DS0000005625.V306184.R01.S.doc Version 5.2 Page 10 the risk assessments of residents that needed their food and drink intake monitoring. Care plans contained evidence that resident’s health concerns had been addressed in a timely manner by prompt referrals to relevant health professionals and the home was efficient at notifying the Commission of any incidents that affected the wellbeing of residents. The inspector had a conversation with a social worker who praised the home for the dedication that staff had shown to residents that needed to be admitted to hospital. The social worker said that staff maintained regular contact with residents and provided valuable support to nursing staff in ensuring that residents needs were met, such as support with feeding. This was identified as an area of best practice and the home received a commendation. The pharmacist inspector looked at how the home handled medication. It was found that the home had made some improvements since the last inspection specifically in the way medicines are supplied to the home. The manager said the new system was easier to use and made medication administration safer for the residents. The policies and procedures for medication were still not detailed enough to ensure safe medicines handling nor did the policies reflect current practice. The standard of record keeping was found to be poor and inaccurate. On the evening of the inspection medication that had not been administered had been signed for. Signing for medication, which has not been given, could put residents’ health at risk because it is unclear as to actually what had been administered. The record keeping in the controlled drugs register was also poor it was noted that medication had been signed out of the register on the evening of the inspection but had not been administered. The home fails to keep an up to date reference of the current medication that is prescribed for each service user. It is essential that the home have these details recorded for each resident in order to protect their health. The pharmacist inspector found concerns regarding the poor administration of medicines. There were serious concerns surrounding the poor administration of antibiotics. It was found that antibiotics were not given as prescribed. There were instances where more antibiotics had been signed as administered than had actually been given. Another example of poor medication administration was evidenced by the failure of the home to administer a once weekly tablet to a resident for the past two weeks. The pharmacist inspector also identified concerns that nighttime medication was given very shortly after teatime medication. This could put the health of service uses at risk, as some medicines must be administered at regular intervals in order to be effective. Oldfield Bank DS0000005625.V306184.R01.S.doc Version 5.2 Page 11 Conversations were held with twenty of the twenty-five people in residence at the home. All residents spoken to confirmed that they receive good quality care and that staff treat them with respect and maintain their privacy and dignity. Several residents said that staff are always helpful and that there is always someone around when they need assistance. Oldfield Bank DS0000005625.V306184.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. There was insufficient evidence to demonstrate that the homes activities programme met the diverse needs of individual residents. This potentially placed their wellbeing at risk. EVIDENCE: This inspection was started at 19:30 on 12th September in order to assess concerns that had been passed to the Commission. It was alleged that the majority of residents go to bed after their evening meal and that lights are turned out apart from selected areas in the home. On arrival at the home it was noted that very few lights were on. Twenty-one of the twenty-five residents were in their bedrooms and some of these were sitting in the dark. The four remaining residents were in the downstairs lounge with staff supervision. From conversations with residents it appeared that going to bed early had become custom and practice. When asked why this happens several residents said, “I prefer to go to bed early because it is a long day just sitting around.” Two residents added that they go to their bedrooms early because they like to read and be quiet and the home’s communal areas are too dark.” Further questioning about what activities are provided by the home revealed
Oldfield Bank DS0000005625.V306184.R01.S.doc Version 5.2 Page 13 that this is an area that would benefit from further development. One resident commented, “I think there is a quiz every month. I would prefer it to be more often as it gets a bit boring. If they were going to have a meeting I would like to go to it to talk about activities.” Another resident was asked if they went out on trips. She said, “My daughter takes me to hospital appointments but no other trips.” A resident who had recently been admitted to the home had been an avid reader prior to suffering a stroke. This resident would benefit from access to talking books and newspapers although this had not been identified in his care plan. The home must take action to recognise and meet the diverse needs of the residents so that they can continue to enjoy their preferred lifestyles. However, residents did feel that in all other areas their right to choice and personal autonomy was being respected. Additionally, there was evidence that activities had been provided, such as a visiting entertainer every two weeks, church services, themed nights, manicures and puzzles. Residents were also able to have a daily newspaper delivered. It was encouraging to note that the provider and deputy manager stated their commitment to making improvements in this area and had formulated an action plan by the second day of inspection to address the issues raised. This would include regular consultation with residents and their relatives to ensure that the right kind of activities would be provided. Residents confirmed that they can receive visitors at any time and visitors were made welcome to the home on the second day of this inspection. Residents praised the standard of catering provided by the home. Special diets were catered for and the chef took care in ensuring that meals were attractively presented. A number of residents were offered soft diets and food was being liquidised separately to make the meals look more appetising. The chef confirmed that the kitchen equipment was repaired or replaced quickly as needed. A minor shortfall in the storage of food was found. Sliced meat and vegetables stored in the fridge had not been date labelled. Oldfield Bank DS0000005625.V306184.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents were listened to and action was taken to address their concerns and policies and procedures in place offered them protection from harm. EVIDENCE: Residents, or their representatives, had been provided with comprehensive information on admission to the home and this included a copy of the homes complaints procedure. Residents knew who to talk to if they had any concerns and they confirmed that staff listened to them and took their views seriously. The relative of a resident said that she had some concerns relating to her husband being woken up by staff in the morning. She stated, “I have spoken to the owner about this and now they leave him to the last to wake. I think this has improved.” The initial focus of this inspection was to investigate anonymous concerns that had been passed to the Commission. Concerns were detailed as follows: 1. That the majority of residents retire to their bedrooms after their teatime meal. 2. That there is poor practice in the control of infection in relation to the disposal of continence wear. 3. That the full range of communal areas, are not accessible to residents at night due to the lights being turned off.
Oldfield Bank DS0000005625.V306184.R01.S.doc Version 5.2 Page 15 On investigation these concerns were upheld and the outcome is detailed in this report under the relevant headings. The home had adopted the local authority policy and procedures on the protection of vulnerable adults from abuse. No adult protection issues had been recorded in the period since the last inspection. Oldfield Bank DS0000005625.V306184.R01.S.doc Version 5.2 Page 16 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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents were provided with a pleasant and comfortable living environment. However, shortfalls in safe working practices relating to the control of infection and disposal of soiled waste potentially placed the health and safety of residents at serious risk. EVIDENCE: Twenty-three bedrooms were visited. Bedrooms had been personalised by residents to reflect their personalities and preferences. The homes general décor and fixtures and fittings were domestic in style and of good quality. A planned programme of redecoration, maintenance and refurbishment was in evidence. The dining room, kitchenette, staircase and a number of bedrooms had been decorated since the last inspection and armchairs in the lounge and conservatory and dining room chairs had been replaced. The home was found to be clean and no offensive odours were present.
Oldfield Bank DS0000005625.V306184.R01.S.doc Version 5.2 Page 17 The Commission had received an expression of concern alleging that a member of staff had been observed to walk through the dining room during a mealtime, carrying a used continence pad. It was noted that the layout of the building meant that soiled linen and used continence pads from the downstairs bedrooms would be transported through the dining room to the laundry. On the evening of the first day of inspection a bin in the laundry was found to contain used continence pads, which had not been placed in sealed bags. A requirement was made for all soiled linen and used continence wear to be placed in sealed bags before being taken to the point of disposal. Furthermore, the home did not have a contract for the disposal of soiled waste. The home had the appropriate policy and procedures for the control of infection, although it was evident that these were not being followed at the time of inspection. The provider had taken steps to address these issues by the second day of inspection. Oldfield Bank DS0000005625.V306184.R01.S.doc Version 5.2 Page 18 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Experienced and trained staff are employed to meet the needs of residents. However, shortfalls in undertaking the required pre-employment checks potentially place the welfare and safety of residents at risk. EVIDENCE: Sufficient staff were on duty to meet resident’s health and personal care needs. However, as detailed earlier in this report the home was not providing a varied and regular activity programme for residents. In view of this it is recommended that the registered person undertake a review of the staffing levels to ensure that sufficient staff are deployed to manage daily activities for residents. The inspector was told that the provider was considering employing an activity co-ordinator for this purpose. Five of the thirteen care staff employed by the home had achieved NVQ level 2 in care and one member of staff was due to start this qualification in September 2006. The home did not employ agency staff. Three staff had been recruited since the last inspection. One of these staff had previously worked at the home and had a gap in service of several months. It was noted that the home had not applied for current references and a Criminal
Oldfield Bank DS0000005625.V306184.R01.S.doc Version 5.2 Page 19 Record Bureau disclosure for this person. A requirement was made accordingly. The progress identified in relation to training in the last report had been maintained. Staff had attended a number of training courses since the last inspection such as the protection of vulnerable adults, fire awareness, care of medicines, moving and handling and basic food hygiene. Further training was planned in dementia awareness and basic food hygiene. The commendation for best practice in training opportunities made at the last inspection has been re-iterated in this report. Oldfield Bank DS0000005625.V306184.R01.S.doc Version 5.2 Page 20 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, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has demonstrated that it takes the views of residents and their representatives seriously and intends to use feedback to make ongoing improvements to the care that residents receive. EVIDENCE: The owner and registered manager had recently returned to work following a period of ill health. During her absence the home had been managed by one of the deputies. Satisfaction surveys provided by the Commission prior to this inspection had been forwarded to the residents relatives by the home. Seven of these were completed by relatives and returned to the Commission. Relatives praised the
Oldfield Bank DS0000005625.V306184.R01.S.doc Version 5.2 Page 21 standard of care received by residents. However, the consensus of opinion was that the home does not provide enough activities. The inspector was told that a letter was being prepared to invite relatives to a meeting to discuss how the home should make improvements to the service it provides. This will form the basis of developing the homes quality assurance programme. Residents’ personal finances are managed either by themselves or their relatives. Records were generally found to be accurate and up-to-date. However, some shortfalls were found in the security of confidential information. Residents’ personal information was found on the notice board and in a diary on a desk in the dining room. The inspector was told that the home’s health and safety records were accurate and up to date. Accidents had been appropriately recorded. There were no further health and safety issues identified during this inspection. Oldfield Bank DS0000005625.V306184.R01.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 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 1 STAFFING Standard No Score 27 3 28 3 29 2 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 3 Oldfield Bank DS0000005625.V306184.R01.S.doc Version 5.2 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Care plans must include detail to show how residents’ specific needs will be met. Previous timescale of 21/03/06 not met. Risk assessments must include detail relating to how residents’ identified risks will be managed. The registered person must make arrangements for the recording, handling, safekeeping and safe administration of medicines within the home. Previous timescale of 06/12/05 not met. The registered person must ensure that all policies and procedures regarding medication are updated to reflect current systems and practice. Previous timescale of 14/01/06 not met. The registered person must ensure that all records regarding medication are clear and accurate. Previous timescale of 06/12/05 not met. Timescale for action 12/10/06 2. 3. OP7 OP9 13 (4) 13 (2) 12/10/06 12/09/06 4. OP9 13 (2) 30/09/06 5. OP9 13 (2) 12/09/06 Oldfield Bank DS0000005625.V306184.R01.S.doc Version 5.2 Page 24 6. OP9 13 (2) 7. OP9 13 (2) The registered person must ensure that all medication is administered in strict accordance with the prescriber’s directions. Previous timescale of 06/12/05 not met. The registered person must ensure that the home keeps current up to date information on prescribed medication for each resident. Previous timescale of 06/12/05 not met. The registered person must ensure that the current method for the storage of controlled drugs is risk assessed. Previous timescale of 06/12/05 not met. The registered person must provide residents with facilities for regular recreation that meets their individual preferences. Cooked food being stored in the must be date labelled. The registered person must make suitable arrangements to prevent infection, toxic conditions and the spread of infection in the care home. Criminal Record Bureau checks and two written references must be obtained prior to confirming staff in post. The registered person must ensure that residents’ personal information is stored confidentially. 12/09/06 19/09/06 8. OP9 13 (2) 12/09/06 9. OP12 16 (2) (n) 12/10/06 10. 11. OP15 OP26 13 (4) (c) 13 (3) 19/09/06 12/09/06 12. OP29 19 (1) 12/10/06 13. OP37 17 (1) (b) 12/10/06 Oldfield Bank DS0000005625.V306184.R01.S.doc Version 5.2 Page 25 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. Refer to Standard OP27 Good Practice Recommendations The registered person should review staffing levels to ensure that enough staff are deployed to maintain a regular programme of activities for residents. Oldfield Bank DS0000005625.V306184.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ 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 Oldfield Bank DS0000005625.V306184.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!
