Inspection on 23/10/08 for St Brendans

This inspection was carried out on 23rd October 2008.

CSCI found this care home to be providing an Adequate service.

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

St Brendans 06/09/07

St Brendans 05/02/07

St Brendans 20/02/06

St Brendans 09/08/05

St Brendans 20/09/04

St Brendans 17/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/12/2008.

CARE HOMES FOR OLDER PEOPLE St Brendans 175 Ashburnham Road Luton LU1 1JW Lead Inspector Katrina Derbyshire Unannounced Inspection 23rd October 2008 12:10 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 St Brendans DS0000014959.V372904.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. St Brendans DS0000014959.V372904.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Brendans Address 175 Ashburnham Road Luton LU1 1JW 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) 01582 728737 01582 726022 jetha@hotmail.com Mr Jethra Kara Mrs Bhavna Kara Manager post vacant Care Home 26 Category(ies) of Dementia - over 65 years of age (26), Old age, registration, with number not falling within any other category (26) of places St Brendans DS0000014959.V372904.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th September 2007 Brief Description of the Service: St Brendans is a three storey period house in a residential area of Luton. It is on a bus route and within a short drive of nearby shops, post office, public houses and places of worship. Accommodation is provided on all three floors of the home, with 20 single bedrooms and 3 double bedrooms. Access to the upper floors is via stairs or usually a lift. There is a small lounge on the fist floor and two further lounges and dining room on the ground floor. The kitchen and laundry facilities are located on the ground floor. However at the time of this visit there was no lift available as building work was being carried out and a new lift was to be fitted in the first week of November 2008. There is a garden with an enclosed patio area at the rear of the home with raised flowerbeds and garden furniture. The fees for this home vary from £418.00 per week, to £459.00 per week, depending on the funding source. Inspection reports are stored in the entrance hall and available to residents and their families. St Brendans DS0000014959.V372904.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key inspection carried out on the 23rd of October 2008. The care of three people was looked at in detail and this is known as case tracking. Tracking people’s care is the methodology we use to assess whether people who use social care services are receiving good quality care that meets their individual needs. Through discussion, observation and reading records, we track the experiences of a sample of people who use a service. During the visit the communal areas of the home were seen alongside some of the individual rooms. Time was spent with many of the people who live at the home in one of the sitting areas. Observations of care practice and communication between the people living at the home and staff was also made at the inspection. The focus of this inspection was to look at the key standards. What the service does well: People living at this home feel that the staff are friendly and kind. One person said,” l came here months ago and they made me feel at home straight away”, another person said, “ the staff are just lovely, they really are”. People feel supported and they feel at ease talking to the staff at the home, with many describing them as providing them with the support that they need in their day to day lives. When staff are recruited to care homes there are safety checks that need to be done, this helps to protect the people living at the home. Management must make sure for example, that they receive at least two references and carry out a check known as a Criminal Records Bureau check, this helps them to decide if the person is going to be suitable to work with vulnerable people. This had been done, all staff before being allowed to work had these checks made about them. St Brendans DS0000014959.V372904.R01.S.doc Version 5.2 Page 6 People at the home spoke of how much they enjoyed the food. Several people commented that the food always tastes nice and they always have plenty to eat. One person said, “I’ve eaten every meal since I’ve been here and let me tell you if it weren’t alright I wouldn’t eat it”. This means people feel that their personal preferences relating to their diet are met. What has improved since the last inspection? What they could do better: Some of the areas that need to be improved upon include: Management need to improve in the way they manage medication. Inconsistent practice amongst staff when administering medication where some staff signing to say that they have administered a medication when they have not. The balances of some medication were not correct, or there were too many signatures on a chart for the amount of tablets for a person. This is unsafe for the people living at the home. There are risks that should be re assessed by staff at least once each month and this should be recorded. These include the risk of falling or developing St Brendans DS0000014959.V372904.R01.S.doc Version 5.2 Page 7 pressure ulcers for example. This is important as it shows any changes in a persons needs very quickly and this means staff can alter the care provided or seek medical attention for the person if needed. This had not been done for everyone in the home. 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. St Brendans DS0000014959.V372904.R01.S.doc Version 5.2 Page 8 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 St Brendans DS0000014959.V372904.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 6 People who use this service experience adequate quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Pre admission assessments are inconsistent so staff do not always ensure that they have the required information to know if they would be able to meet the persons needs. EVIDENCE: The care files examined included pre-admission assessment. Assessments included information from visiting the person wherever he or she was living prior to admission and information from any referring social worker or health professional. The information given was recorded on documents that had varying sections including physical, social, emotional and psychological needs of the people. However there were inconsistencies in the information entered. One person recently admitted to the home under their sensory ability St Brendans DS0000014959.V372904.R01.S.doc Version 5.2 Page 10 oral/verbal only had the word poor written in it for example. No explanation given as to why, was it their speech or a language barrier. There is a need for assessments to be comprehensive and clear, and linked to the care plan. People spoken with confirmed that they had been asked about themselves and they felt that they had been able to part of that process. Copies of the terms and conditions of residency were seen alongside contracts. These gave an outline of fees, responsibilities and notice periods. These had been signed by the person or their representative. The statement of purpose was examined. The document provided information on the staffing, accommodation and services available at the home. People had been offered a copy of this. The people spoken to at this visit all stated that they didn’t want a copy and one person said, “I don’t see the point I’m alright the way I am”. Intermediate care is not provided at the home. St Brendans DS0000014959.V372904.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use this service experience adequate quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Good access to medical support by staff ensures peoples healthcare needs are met. However inconsistencies in the management of care planning and medication place people at risk of not receiving the care that they need. EVIDENCE: The care documentation seen in most instances for the person gave sufficient detail to show some of the individual needs, although they were inconsistent in their standard. Examples included one person who had significant high needs had an out of date plan of care. A supplementary drink that they should have was not mentioned in their care plan for example. When staff were questioned as to what plan they were following they could not answer. However other care plans that had been changed were of a very good standard, they included St Brendans DS0000014959.V372904.R01.S.doc Version 5.2 Page 12 information that made them very personal and provided a comprehensive picture of the person and their needs. Medication storage in the home was noted to be satisfactory as was the ordering of medicines. One person within the current 28-day cycle had a balance of 28 tablets written, 11 signatures had been entered onto the medication record, so the balance should have been 16 tablets but there was actually 17. Another person had a balance of 16 tablets, there were 2 signatures so there should have been14 tablets but there were 14. A requirement has been made. People said that staff treated them with respect and maintained their privacy. Everyone spoken to had positive comments to make about most of the staff, people felt that the manager and seniors were especially friendly and courteous to them. Risk assessments relating to tissue viability and falls for example had not in all instances been reviewed monthly. This was raised with the manager at the time of this inspection. One person with very high needs had been assessed by Social Services and it had been decided that the home could continue to meet the persons needs. A document within their file contained an entry that stated the manager had informed Commission for Social Care Inspection and we agreed that the person could remain. It must be noted that it is not the Commission for Social Care Inspection role to undertake this, by submitting a regulation 19 notification does not result in gaining our consent. It is the homes responsibility to assess and make the decision if they feel they are able to meet a persons needs. People spoken with confirmed that if needed they would receive a visit from a General Practitioner or District Nurse. Records of these visits and assistance given were seen. In addition letters from Luton and Dunstable Hospital were also seen demonstrating people’s attendance at specialist clinics when required. Staff were interviewed and described the need to contact medical professionals if a person became unwell. St Brendans DS0000014959.V372904.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use this service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. People living at this home feel that the choice of meals provided are sufficient to meet their tastes and preferences. EVIDENCE: Several people spoke of the activities available to them in the home and one person commented “ l like it when l get my hair done”. Documents examined showed that activities arranged in the home included walks and visiting entertainers and singers. The Bedfordshire library service also visits the home. At the time of this inspection the manager had just offered a job to a person who had previously worked at the home as the activities co coordinator. People were seen to receive visitors. Everyone spoken to confirmed they were able to receive visitors when they wished and many would chose to see them in the privacy of their own rooms. Entries were also seen within people’s care records that demonstrated that the staff at the home would contact the nominated next of kin if there had been a change in their well being, one St Brendans DS0000014959.V372904.R01.S.doc Version 5.2 Page 14 example of this was following an accident and the contact details had been recorded by the staff member. Options available to people in maintaining control, independence and choices in their lives included, choice of meals, voting, choice of clothing, access to a complaints procedure and access to community healthcare support. People living at the home and records confirmed that the choices associated with people’s daily lives were available to them whilst living there. All the people spoken to stated that they enjoyed their meals. An observation of a meal was undertaken most people had chosen to eat this in the dining area. People had been offered two choices and their selection had been written down on a menu sheet. The most recent environmental health inspection found that there were sufficient standards in this area being maintained. In addition nutritional risk assessments were seen to have been undertaken for the people living at the home, although not all were up to date. St Brendans DS0000014959.V372904.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use this service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Systems in place at this home for receiving and investigating complaints is sufficient to assure people that their concerns will be received, listened to and acted upon. EVIDENCE: Records examined showed that staff had undertaken training in the protection of vulnerable adults. On interviewing staff they demonstrated a sufficient level of knowledge on the types of abuse including physical and psychological. In addition the homes procedure in this area was examined, it’s reflected the local guidance. The management had sought a copy of the local protocols and these were seen. The management and staff at the home did demonstrate through discussion an understanding of the need to refer any allegation or suspected abuse. Complaints received at this service had been kept alongside documents to show the investigation carried out, response and any recommendations made following the investigation. Four people asked the specific question on making a complaint indicated that they knew who to speak to if they were unhappy and would feel comfortable doing so. Within the homes statement of purpose there was details on how you could complain and to whom. Staff when St Brendans DS0000014959.V372904.R01.S.doc Version 5.2 Page 16 interviewed gave satisfactory responses on their responsibilities if they were to receive a complaint and this matched the guidance within the homes own procedure. St Brendans DS0000014959.V372904.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People who use this service experience adequate quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Some areas in the home provide a good standard of accommodation however as refurbishment is still ongoing there are other areas that do not provide a homely environment for people to live in or full facilities at this time. EVIDENCE: People’s rooms that were seen contained personal items for example photographs and pictures. Assisted bathrooms are in place and grab rails were also in place to assist people with their mobility. The large ground floor sitting area had been refurbished. The space had been opened up to provide an St Brendans DS0000014959.V372904.R01.S.doc Version 5.2 Page 18 increase in natural light and ventilation. A new carpet and chairs had been purchased. People spoken to felt very satisfied with the changes. Acknowledgement is given for this work however at the time of the visit there were areas that were not homely. The new lift had not yet been fitted so a chair lift was the only means of moving between floors. The carpet in the front entrance was very raised, it is accepted that this should not be replaced until the lift has been fitted. There was also an odour of stale water as you walked into the home, the owners were going to look at this following the visit. Requirements will not be made at this time as acknowledgement is given that the current work programme has not yet concluded. Cleaning schedules were seen to be in place alongside clinical and domestic type waste contracts. Protective clothing such as gloves and aprons were seen to be used by staff and hand washing facilities were situated throughout the home. St Brendans DS0000014959.V372904.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use this service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. The systems for recruiting staff is sufficient to safeguard the people living at the home as they reduce the risk of someone not suitable to work with vulnerable people being employed. EVIDENCE: The induction and training of staff was recorded in the individual records of all employees. Staff through interviewing confirmed that they had undertaken a variety of courses these included health and safety, moving and handling and national vocational qualifications in care. Several of the people living at the home made positive comments on the skills of the staff team, one person said “they always seem to know what they are doing”. References are taken prior to staffs’ commencement and the relevant Criminal Records Bureau check is also carried out and evidence of this having been undertaken was seen. Certificates of qualifications are present within staff files. St Brendans DS0000014959.V372904.R01.S.doc Version 5.2 Page 20 Senior support workers, care assistants, catering and housekeeping staff are employed at the home . The rotas supplied by the home show that there are sufficient numbers of staff on duty throughout the day and night to meet the needs of the residents at this time. People confirmed that staff were available to help and assist them when they need help. Training records examined that were supplied by the home show that staff had undertaken statutory training, including moving and handling, fire safety and food hygiene. In addition staff confirmed that they had attended a variety of courses including dementia awareness. People living at the home who were spoken with felt that the staff had a satisfactory level of knowledge and felt confident in their abilities to meet their needs. Staff were questioned on the individual needs of some of the people who live at the home, through this they demonstrated a good level of understanding of the needs of the person. One staff member had a very good level of knowledge relating to one person, and was able to describe their individual likes, dislikes, family history and the level of care and support needed. St Brendans DS0000014959.V372904.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People who use this service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Health and safety systems are sufficent to reduce the risks associated with this area for the people living at the home.. EVIDENCE: There had been several changes to the day to day management in the home since the previous inspection. The previous Registered Manager left, then the owner oversaw the service, then another managed was employed for 3 months and then the previous manager returned. This person has just submitted an St Brendans DS0000014959.V372904.R01.S.doc Version 5.2 Page 22 application to be registered again with the Commission for Social Care Inspection. Ever person living at the home and member of staff spoke of how friendly and approachable she was. The owner informed the inspector that she was soon to take a step back from management so that she could carryout audits and the quality assurance role. Resident and relative surveys to influence the running of the home was noted to have been sent out. The home has a policy on how peoples monies managed on their behalf should be administered. Only senior staff have specific responsibility in this area and their practices were seen to follow the guidance within the home policy. All records, receipts and other information seen were of a good standard and provided a clear audit trail. All balances checked were noted to be correct and receipts of any expenditure are kept. The home has a Health and Safety policy. There was evidence within the training records that staff had undertaken fire, manual handling, food hygiene and first aid training. Risk assessments had been undertaken and were seen within care files. Records evidencing that maintenance and checks were undertaken relating to fire prevention and electrical and gas equipment was seen. Staff were observed to follow safe practice in the following areas, moving and handling, risk assessment, first aid, food hygiene, infection control and COSHH. St Brendans DS0000014959.V372904.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 St Brendans DS0000014959.V372904.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement Assessments of peoples needs must be completed in full and linked to the care plans to make sure that their needs are met in full. Care plans must contain sufficient guidance and instructions to staff on the support and care that they should provide for each assessed need. (This requirement had a timescale of 01/11/07 which has not been met in full) 3. OP8 12,14,&15 Risk assessments must be 30/11/08 reviewed regularly and this must be documented. This is to ensure changes to peoples needs are acted upon in a timely manner. 13(2) Medication systems must be changed to allow for medication audits to be carried out to identify any shortage of stock, invalid entries being made on to DS0000014959.V372904.R01.S.doc Timescale for action 30/11/08 2. OP7 12(1)(a) & 15 23/10/08 4. OP9 15/11/08 St Brendans Version 5.2 Page 25 records and checking people have actually received their medication. Then action taken must be recorded and reported by staff. 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 St Brendans DS0000014959.V372904.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 St Brendans DS0000014959.V372904.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!