Inspection on 12/09/07 for Sharea

This inspection was carried out on 12th September 2007.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sharea 22/12/08

Sharea 24/01/08

Sharea 31/08/06

Sharea 20/12/05

Sharea 07/07/05

Sharea 10/11/04

Sharea 18/05/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Sutton Lodge Nursing Home

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

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

CARE HOME ADULTS 18-65 Sharea Sharea 69 Reigate Road Hookwood Surrey RH6 0HL Lead Inspector Kenneth Dunn Unannounced Inspection 12 September 2007 10:00 th Sharea DS0000013783.V342655.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sharea DS0000013783.V342655.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sharea DS0000013783.V342655.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sharea Address Sharea 69 Reigate Road Hookwood Surrey RH6 0HL 01293 776248 F/P 01293 776248 reigate.road@theavenuestrust.co.uk glebe.house@theavenuestrust.co.uk The Avenues Trust Ltd 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) William Smith Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (1), Physical disability (6), of places Physical disability over 65 years of age (1), Sensory impairment (6) Sharea DS0000013783.V342655.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The age/age range of the persons accommodated will be 18-64 years. 1 (one) person within the category LD(E) or PD(E) may be accommodated over the age of 65 years. Persons may be accommodated who have both a learning disability (LD) and a physical disability (PD). 31st August 2006 Date of last inspection Brief Description of the Service: The home is registered as a care home only within the service user category: Learning disability (LD) and Learning disability over 65 years of age with sensory impairment (SI). The home is registered to accommodate a maximum of six Service Users. Avenues Trust Limited manages the home. It is a large detached bungalow with extensive grounds to the front and rear and is situated on a busy main road, south of Reigate town centre. Fees for the service range from £1,111.00 to £1,167.00 per annum. Sharea DS0000013783.V342655.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Mr. Kenneth Dunn, Regulation Inspector, undertook the site visit on behalf of the CSCI. The registered manager was not on duty on the day of the visit. A full tour of the premises took place. An annual quality assurance assessment (AQAA) was supplied to the home by CSCI, and this was completed and returned. Information from the AQAA will be referred to in this report. The AQAA states that the home has policies and procedures to promote equality and diversity and all staff have received training, to increase their knowledge and awareness of these issues. In addition the home has a set of policies and procedures that have been designed to safeguard the rights of the residents in gender and lifestyle choices. The final report takes into account detailed information provided by the registered provider that included an Annual Quality Assurance Assessment (AQAA), returned random surveys (next of kin, medical professionals, care manger and any other interested representatives of the residents) in addition any information that the CSCI has received about the service since the last inspection will also be used to complete this report. The Commission for Social Care Inspection would like to thank the residents, relatives, manager and staff for their hospitality, assistance and co-operation with this inspection. What the service does well: What has improved since the last inspection? Some of the previous requirements have been met. Generally the service is operating for the benefit of the residents. Sharea DS0000013783.V342655.R01.S.doc Version 5.2 Page 6 The internal environment of the home is continuing to improve with the new furniture in the sitting room and the refurbishment of the bath and toilet facilities. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Sharea DS0000013783.V342655.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sharea DS0000013783.V342655.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 was assessed during this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of the people who use the service are fully assessed prior to admission to the home. EVIDENCE: There have been no admissions to the home since the previous visit. Evidence sampled concluded that pre admission assessments are completed prior to any individual moving into the home. The organisation has a set of robust policies and procedures to ensure that a full and appropriate assessment need of any potential resident is completed prior to being offered a place at the home. The policy sampled was in line with the National Minimum Standards for Younger Adults. Sharea DS0000013783.V342655.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7and 9 were assessed during this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use the service are provided with an individual care plan, which records their individual needs and goals. They are supported to make decisions about their lives with the full assistance of staff. As part of an independent lifestyle individuals living at Sharea are supported to take risks. EVIDENCE: The home has person centred plans and care plans which sets out in detail action to be taken by staff with regards to personal care, health needs and the social support of the people who use the service. A review of records confirmed care plans are reviewed at least annually however the majority were reviewed with more regularity depending of the individuals needs. Sharea DS0000013783.V342655.R01.S.doc Version 5.2 Page 10 The homes key worker system in operation promotes consistency and continuity of care. A review of records confirmed risk assessments were reviewed, updated and signed by staff to promote personal safety. The inspector sampled a wide range of comprehensive risk assessments, including personal care such a bathing, health, self help skills and outings. Some individuals have emotional difficulties, which could lead to possible aggression toward others within the home, there are clear plans and management guidelines in place to minimise the risk to others and ways of supporting the person when the need arises. Sharea DS0000013783.V342655.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14, 15, 16 and 17 were assessed during this visit. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The arrangements for the people who use the service to participate in the valued and fulfilling activities on offer are not always in place due to low staff numbers. Community links and social inclusion have been developed to allow the residents with assistance to be part of the limited local community. The systems for relationships are good and promote family links and friendships. Meals at the home are good and offer variety and choice. Sharea DS0000013783.V342655.R01.S.doc Version 5.2 Page 12 EVIDENCE: The service has systems in place to offer appropriate support to the people who use the service to participate in valued and fulfilling activities. A weekly activity programme is individually designed for all of the residents of Sharea. The inspector sampled the activities logs, which is updated by the individual’s key workers daily. The home promotes community links with service users accessing the local community and facilities including, shops, pubs and leisure centres. However the resident’s ability to engage in activities is wholly dependent upon the home being sufficiently staffed in order to support each individual. On the day of the site visit there was only three care workers on duty to undertake all ancillary tasks and engage with the residents in meaningful activities. In addition to the limitation of staff the ability to access the community is restricted because of the geographical location of the home, which is located on a very busy main road and some considerable distance from the heart of the local community. To enable the residents to gain access to the community the home has to rely totally upon in-house transport and staff members who are drivers. The home had a visitor’s policy and the inspector was informed that family and friends are always welcome at the home. A review of records confirmed relatives visited the home. The staff commented the home had a daily routine to promote independence and observations confirmed staff knocked on doors before entering bedrooms and bathrooms. The inspector was informed that the home has a core menu but there was a great deal of spontaneity and flexibility in regard to meal planning. The inspector noted the home catered for the dietary needs of one of the people who use the service in weight management. Sharea DS0000013783.V342655.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19, and 20 were assessed during this visit. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements for personal support are in place ensuring the people who use the service receive personal support in the way they prefer and require. The systems for health care are in place ensuring the physical and emotional needs of the individuals are met. Medication needs strengthening to promote health. EVIDENCE: The home provided flexible personal support and care plans reflected the preferred routines and likes and dislikes of the residents. A review of records indicated guidance regarding personal care with risk assessments to support the residents to promote privacy and dignity. Observations confirmed the residents had good personal hygiene and were appropriately dressed which indicated flexible personal support. The home had arrangements for meeting the health needs of the residents they were all registered with a local GP (General Practitioner) and the home had input from a district nurse and community learning disability nurse. Sharea DS0000013783.V342655.R01.S.doc Version 5.2 Page 14 Further evidence indicated the home had health action plans and accessed the local PCT (Primary Care Trust) for health care services. The home had a policy on medications, a service level agreement with a local chemist and adequate storage of medications. Further evidence indicated medication record sheets were dated, signed by staff. However there was no sample signature of the staff responsible for administrating medication and there was no photograph of the resident attached to the MAR sheet. In addition an audit of the medication stored highlighted a large quantities of Diazepam and Chlorpromazine that was not accounted for on the MAR sheets and the Diazepam was dispensed by the pharmacy 11/02/2005. Requirements have been made in this respect. Sharea DS0000013783.V342655.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 were assessed during this visit. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All required policies, procedures and practices are in place to ensure that residents are safeguarded, as far as reasonably possible, from harm or abuse. EVIDENCE: The home has a set of complaints policies and procedures in place. The completed AQAA states that the complaints procedures are available in various formats, audiotape, CD and pictorial forms. The people who use the service however cannot readily access the procedures for making a complaint; in order to overcome this members of staff can sit and talk to the individuals to impart their rights. The AQAA also refers to regular visit to the home by outside professionals to offer feedback to ensure that the service is meeting the needs of the residents. The home had a policy on safeguarding adults and a copy of the local authority (Surrey County Council) procedures on protection of vulnerable adults. The home had a whistle blowing policy and staff have had training in their rights and responsibilities in safeguarding the people who use the service. Sharea DS0000013783.V342655.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24, 26 and 30 were assessed during this visit. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Internally the home has been improved with the purchase of new furniture and the refurbishment of the bathrooms. The exterior of the service however has not improved; the health and safety of the residents and staff could be compromised because of the poor maintenance and upkeep. EVIDENCE: The home has made progress since the previous visit in improving the internal décor. The home is spacious and one room is converted into a sensory area. New furniture been obtained for the sitting room and dining area, however this only offers seating for 5 people at any one time the home provides care for six residents. Sharea DS0000013783.V342655.R01.S.doc Version 5.2 Page 17 The bathrooms and down stairs toilet suites have been replaced and new flooring has been laid in these areas. Bedrooms were viewed as comfortable with the residents having a varied range of possessions, which meets their interests and preferences. New floor coverings have been laid in one bedroom, which is more suitable for the individuals needs. Externally the service must improve; the front drive area is heavily rutted and overgrown with weeds. The rear garden has been subdivided into two areas; a large terrace area with seats can be accessed directly through patio doors in the dining area. This area could be a great asset to the home but because of the weeds growing up through the paving it could be considered a trip hazard for people with visual impairment. The second section in the rear garden is a greater problem with areas that are overgrown with brambles and nettles and there is an unused summerhouse with broken windowpanes. In addition on the day of the visit the rear garden was very unwelcoming due to the smell coming from the sceptic tank. During a discussion with staff it was apparent that the smell was constantly in the garden and not just on this occasion. Requirements have been made in respect of the environmental issues found; refer to page 22 of this report. Sharea DS0000013783.V342655.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 33, 34 and 35 were assessed during this visit. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A competent, qualified and well-trained staff team supports the people who use the service. The organisations recruitment policy is robust and designed to protect the residents. The effectiveness of the staff group however is compromised by the inability to rota sufficient staff to cover duties during times of staff being absent. EVIDENCE: The people who use the service benefit from the dedication of the organisation and staff for the continual training that is undertaken at Sharea. Each member of staff has their own training record in place and it was evident that staff have received mandatory training in safeguarding adults, fire, food handling, food hygiene manual handling, health and safety, first aid and managing medication. The inspector was informed that staff receive training in epilepsy and other areas appropriate to the specific needs of the residents. Sharea DS0000013783.V342655.R01.S.doc Version 5.2 Page 19 The inspector was provided with copies of duty rotas, which indicated that the home was functioning without adequate staffing levels. When the inspector arrived on site there was only two members of the care staff on duty with five individuals at home, one further carer was out on a one-to-one activity with another resident. A member of staff explained that the manager was off due to a long term illness, the deputy manager only worked part time and was not due in on that day and a fourth member of staff had gone off sick the day before the visit. The three care workers also had not only the responsibility of caring for six residents, assisting them in activities; ancillary duties (cleaning, laundry and food preparation) and they were expected to complete any administration work. As a result the residents ability to engage in any purposeful activity was considerably curtailed. A requirement was made in respect of appropriate staffing, the same requirement was placed during a previous CSCI Inspection visit on the 31st August 2006. “The manager must review the staffing figures within the service to ensure that the service users are safeguarded at all times.” In light of the depleted staffing figure found on this site visit this requirement remains unmet. Sharea DS0000013783.V342655.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 38, 39 and 42 were assessed during this visit. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The arrangements for the day-to-day management of the home are insufficient to ensure the people who use the service are safeguarded. There are systems in place to gauge the quality of the service provided by the home. Health and safety practices do not safeguard the welfare of staff and service users. Sharea DS0000013783.V342655.R01.S.doc Version 5.2 Page 21 EVIDENCE: There are policies in place at Sharea to ensure that the day-to-day management of the home is conducted with the best interests of the people who live at the home. However the inspector was informed by a member of staff that the registered manager has unfortunately not been on duty for some time because of ill health and will not be back on duty for a number of weeks. The home has a duty manager but she only works part time and was not scheduled to be on duty that day. Effectively the structures in place for the day-to-day management of the home were ineffective, no one was available to implement the procedures because the staff had to ensure that the residents were well cared for. The CSCI have not been officially informed by the organisation under regulation 38 of the National Minimum Standards for Younger Adults that the registered manager is not on duty. The service has quality assurance systems in place. The AQAA that the service completed and returned to the CSCI stated that the service “seeks the views of family and other professionals” in addition the organisation undertakes Regulation 26 visit once a month to “perform audits and make action plans on outstanding issues”. However a number of health and safety issues identified in this report should have been picked up during the monthly regulation 26 visits but were not identified to the detriment of the residents and staff. Substances hazardous to health (COSHH) were stored securely and appropriately. Health and safety checks are completed and recorded regularly which were sampled including fire prevention records, fridge and water temperatures. The manager provided information to indicate that records and certificates and identified systems are in place for routine service and maintenance arrangements for the environment. Sharea DS0000013783.V342655.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 Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 1 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 2 12 2 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 2 2 X X 1 X Sharea DS0000013783.V342655.R01.S.doc Version 5.2 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 YA33 Regulation 18(1)(a) Schedules 4.6 & .7 Requirement The manager must review the staffing figures within the service to ensure that the service users are safeguarded at all times. (Previous timescales of 30/10/06 not met) The registered provider must ensure that the people who use the service right to access activities are not impeded due to a lack of staff. The registered provider must ensure that the people who use this service are not at risk by failures in the medications policies and procedures. The registered provider must ensure that the home and the grounds are free from potential hazards. The registered provider must ensure that the home is effectively managed at all times. Timescale for action 30/10/07 2. YA14 16(2)(n) 30/10/07 3. YA20 13(2) schedule 3.3(I&k) 13(3&4) 10/10/07 4. YA42 30/10/07 5. YA37 9(2)(b&I) 30/10/07 Sharea DS0000013783.V342655.R01.S.doc Version 5.2 Page 24 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 Sharea DS0000013783.V342655.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Oxford Office 4630 Kingsgate Oxford Business Park South Cowley Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Sharea DS0000013783.V342655.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!