Inspection on 06/04/06 for St Mungo`s

This inspection was carried out on 6th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Mungo`s 16/04/07

St Mungo`s 12/09/05

St Mungo`s 11/04/05

St Mungo`s 02/11/04

St Mungo`s 20/04/04

Similar services:

Ashlong House

Agar Grove & St Augustine`s Alcohol Treatment & Rehab

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Herbert Street

Stacey Street Nursing Home

Haven (The)

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

CARE HOME ADULTS 18-65 St Mungo`s 2 Hilldrop Road Tufnell Park London N7 0JE Lead Inspector Pearlet Storrod Unannounced Inspection 6th April 2006 10:00 St Mungo`s DS0000020973.V288001.R01.S.doc Version 5.1 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 Mungo`s DS0000020973.V288001.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. St Mungo`s DS0000020973.V288001.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service St Mungo`s Address 2 Hilldrop Road Tufnell Park London N7 0JE 020 7700 6402 020 7607 2235 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) St Mungo Community Association Limited Care Home 29 Category(ies) of Past or present alcohol dependence (29), Mental registration, with number disorder, excluding learning disability or of places dementia (29), Mental Disorder, excluding learning disability or dementia - over 65 years of age (29), Physical disability (29) St Mungo`s DS0000020973.V288001.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Home registered for men and women with needs relating to Alcohol dependency together with mental disorder, physical disability and/or old age. maximum of 29 beds within the above facility Date of last inspection 12th September 2005 Brief Description of the Service: 2 Hilldrop Road is a care home situated off Camden Road. The home provides care and support for 29 men over the age of 45 who have experienced homelessness combined with mental health issues and/or alcohol dependency. The home is owned and managed by the St Mungo Association.2 Hilldrop Road is a listed building, which was converted from a church in 1990. Staff support service users in developing harm minimisation programmes to help them to manage their drinking. The staff team also assist service users to access mental health services in the local community. At the time of this inspection half of the 29 service users were over 65 years of age. Fees range between £385 - £689 including breakfast. An additional charge is made for lunch and evening meals. St Mungo`s DS0000020973.V288001.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 6th April 2006, in a timescale of 8 hours. The time was spent talking with the acting manager, a few staff members, some service users, examination of the records and scrutiny of staff and service users’ files. Four of the requirements in this report are matters that have been outstanding and in the process of being looked into by the provider, and are reiterated. The inspector had the benefit of attending the staff handover session and a visit was made to the organisation’s headquarters to observe staff records and CRB checks on 26th April 2006. What the service does well: What has improved since the last inspection? What they could do better: St Mungo`s DS0000020973.V288001.R01.S.doc Version 5.1 Page 6 They could improve the delivery of care by conducting care reviews with set goals, at agreed timescales with written record of the progress and or outcomes made at the time of the evaluation. Staff need to be more attentive in regard to the management of medication, with particular attention being paid to service users who are on antibiotics, and going out for the day, have arrangement in place for their medication to be administered at regular intervals. Similarly, service users who have been identified to be on a low fat diet should be supported to do so. The caterers must be notified of the names of the individuals, concerned. Increasing the levels of the staff is a necessicity in enhancing the quality of individual care, the suggestion posed that consideration is being given to invest in more care assistants with a reduction of project workers is good; this would prevent the need for out sourcing to domiciliary care agencies to perform duties that the home has indicated that they would provide in their Statement of Purpose. The omissions of staff appraisals need to be addressed. The certificate of registration make reference to provision of services for men and women. Women have not ever been referred to the home and a review of the condition is required in this respect. 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. St Mungo`s DS0000020973.V288001.R01.S.doc Version 5.1 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 St Mungo`s DS0000020973.V288001.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Some needs assessments are inadequate in that pertinent information are missing from the recorded information. A review of the condition of registration needs to be undertaken as presently women are not admitted to the home and the Statement of Purpose and Service User Guide have discrepancies relative to the time-scale for complainants and the age groups for admission. EVIDENCE: The tracing of three service users took place. Of the three files examined, one had the cultural needs omitted from the records. Another had the information relating to his relatives omitted from his admission and personal information sheet, including a niece whom the individual wished to regain and maintain contact with; the other service user had pertinent information about his medication missing from his needs assessments. The manager must ensure that service users files include the personal relevant information and that the needs assessments are amended to include information relating to medication. A potential service user visited the home on the day accompanied by his social worker, stated, “I can’t wait to move in!” This individual s known to the acting deputy manager who asserted the “service user as being a suitable client to live at Hilldrop.” It was stated that an assessment of need and initial care plan would be drawn up by the keyworker upon admission. The Service User Guide and Statement of Purpose need to be reviewed relative to the timescales for dealing with complaints are different in both documents; St Mungo`s DS0000020973.V288001.R01.S.doc Version 5.1 Page 9 similarly the age for admission of service users differs. The Service User Guide make reference to age 50 and Statement of Purpose age 45 as the age for prospective service users to be admitted to Hilldrop. Also, the condition of registration refers to provision of services for men and women but this does not correlate with the aims and objectives outlined in the Statement of Purpose and this also needs to be reviewed. St Mungo`s DS0000020973.V288001.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 A care planning system is in place but there is no evidence to demonstrate that reviews occur, which makes it difficult to measure the progress of achievements of the identified goals. EVIDENCE: Generally, care plans are not evaluated which would enable staff to check the progress being made and this would make it difficult to quantify the progress with regard to the identified set goals. It can also be difficult to manage a home with service users who possess a diversity of needs and require an assortment of activities and support, for which the home presently is not appropriately equipped to provide. A staff member reported that he had consulted service users of different cultural backgrounds to learn of their interests, likes and dislikes but the information had not as yet been included in their individual plans of care. Service users plans of care must be updated to include their individual cultural needs and their individual progress must be evaluated. Risk assessments have been carried out and used alongside the care plans. These assessments appear to be working well and new ones will need to be devised for individual service users following completion of the installation of St Mungo`s DS0000020973.V288001.R01.S.doc Version 5.1 Page 11 the new kitchen, when service users who are capable, would be supported to cook. St Mungo`s DS0000020973.V288001.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Staff are making strong efforts to ensure that service users develop life skills and lead more independent life styles. However, the ability of some service users is compromised by their individual past and present lifestyle of alcohol dependency, age or mental health. EVIDENCE: It was reported to the inspector that they have begun to canvass service users from different cultural and ethnic backgrounds about their needs and requirements with an intention to enhance their interests and activities. Information shared with the inspector related to the use of the computer to view an individual’s country of origin and the area where he lived; the inspector raised the fact that news and other information could be accessed for individuals benefit if they so choose. E-mail is an opportunity for making and maintaining contacts with family members living abroad. Various activities are taking place and it was stated by the acting manager that service users in the home are due shortly to have a pool match against another service. It was also pleasing to note that a number of service users St Mungo`s DS0000020973.V288001.R01.S.doc Version 5.1 Page 13 have been afforded a holiday away from the service as recommended in the previous inspection reports. An individual is reported to have had his family member traced; another service user wishes to have his niece traced, which the acting manager has given a commitment to ensure that this happens. The weekly menu looked nutritious and the acting manager stated that they are currently in the process of reviewing the meal arrangements with the intention of having the main meal at lunchtime, as this is more substantial; there is also an incentive to include the meals in the fees. The home is aware that some service users may not want to substitute their money usually spend on alcohol money for a healthy meal and that this could potentially allure some individuals to resort to being homeless. It should also be said that the caterers must be notified of the names of the service users required to be on a low fat diet. As mentioned earlier service users will be supported to cook when the support kitchen is complete. It was pleasing to hear that staff have consulted the catering consultants about providing one Mediterranean meal per month and that catering for service users with a cultural background is being looked into. The home must ensure that service users are supported to maintain their selfrespect, for example, the shoes worn by a service user were in poor condition and it was further observed that he required his fingernails clipped. St Mungo`s DS0000020973.V288001.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Support relating to personal and healthcare requires improvement in regard to the provision of personal support needs currently undertaken by a domiciliary care agency and the dietary needs of some individuals. EVIDENCE: Some service users self medicate but the majority of others have their medication administered by staff. There was evidence of medication that were out of date and some with no named label held in the cabinet. Staff had recently received training in the administration of medication as seen from the training records but there still remain problems relative to the dispensing of antibiotics for service users who goes out during the day; staff failure to note the instruction/guidance on the labels issued by the pharmacist and lack of understanding regarding medication that prescribed as PRN and the signage “O” for other and “R” refused. The acting manager and his deputy who has had nurse training have agreed to reinforce this and immediately begun to address the issues at the handover session. The inspector was informed that approximately three service users receive personal care from London Care a registered domiciliary care agency. Time keeping was said to be poor which effectively to a complaint being lodged by the home. The home’s aim and objectives statement refer to personal care being provided by the home but there are only two care assistants employed St Mungo`s DS0000020973.V288001.R01.S.doc Version 5.1 Page 15 at Hilldrop to provide this service, at a ratio of one care staff per day. The outsourcing though not cost effective, may also provide inconsistency in the approach to care delivery. The inspector visited a service user to talk about his well being, he was discharged from hospital on the day but was obviously experiencing severe pain and discomfort. Staff were in communication with his GP about the course of action to take prior to referring him back to hospital St Mungo`s DS0000020973.V288001.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Service users’ views are acted upon but the procedure for dealing with complaints made slightly differs in the Statement of Purpose and Service User Guide. EVIDENCE: Since the last inspection two complaints were made by one service user, which were dealt with satisfactorily. Several service users were spoken to on the inspection day and none had any complaints to make. An individual did voice a concern that staff were “preventing him from visiting his family in Watford;” the acting manager confirmed that the service user is free to go where he like’s but that his relations have said, “they do not want him to visit them.” An old version of Islington’s Adult Protection Policy is in place; the latest version needs to be obtained by the home. The use of Tippex is evidenced on the financial records. The practice of using Tippex must be stopped and a line drawn across the mistake made should be used instead. The manager should initialize and consent to the amendments made, to show his approval. St Mungo`s DS0000020973.V288001.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Environmental standards at the home are going through improvements to enhance the living conditions to enable service users a more comfortable home to live in. EVIDENCE: There are seven bathrooms/wc, one bathroom that is satisfactory and two newly refurbished shower/wc rooms. The other four bathing facilities will be refurbished in the short-term. Most of the communal areas have had wooden flooring fairly recently; the area outside the reminiscence room/ “memory lounge” is malodours and needs attention. Some service users’ rooms are also in need of improvement; room 18 in particular was malodour and unkempt and requires attention. A support kitchen is in the process of being installed; the air ventilation fans to the main kitchen needs cleaning. Strong efforts are being made to improve the living standards, which should help to enhance some individual’s self esteem. The provider must continue with developing the internal physical features of the home and also to advance the cleaning regime relative to service users’ rooms to provide an environment that is clean and safe to live in. St Mungo`s DS0000020973.V288001.R01.S.doc Version 5.1 Page 18 St Mungo`s DS0000020973.V288001.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34 and 35 The acting manager and staff appear to know the areas in which the home needs to improve and planning and review is currently being focused upon together with the necessary resource. EVIDENCE: The acting manager reported that a staff member is due to leave the service and another phoned in sick on the day of the inspection. Staffing levels are low in comparison to the number of service users and the type and level of support required. With only two care assistants employed, practical and personal support to care is not adequately managed and an urgent review is required. It was stated by the acting manager that the provider is considering employing more care staff as opposed to project workers to effect the changing needs to enable more staff time to service users. The provider must ensure that staffing levels are reviewed so that more staff time is provided to service users. Three staff are undertaking NVQ3 and the quantity of 50 of staff have achieved the required NVQ qualification. The acting manager accomplished his NVQ 4 qualification in February of this year. From scrutiny of the recruitment policy and operational practice these appears satisfactory, with two references verified on each staff file and the appropriate CRB checks carried out. St Mungo`s DS0000020973.V288001.R01.S.doc Version 5.1 Page 20 There is information to demonstrate that staff receive supervision though no evidence exists to suggest that supervision was carried out prior to the acting manager taking up his temporary post. Staff appraisals do not as yet occur. St Mungo`s DS0000020973.V288001.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 and 43 The acting manager and his staff have reviewed aspects of performance in the home, which has led to a significant change of improvements to various areas throughout the home. EVIDENCE: Relevant safety checks pertaining to gas, electric, water and other services have either been carried out or are have been recorded for actions to be undertaken. A number of policy and procedures are under review including service users files, which needs to be overhauled, and old information archived. The monthly monitoring report demonstrates that the service manager visited the home on 24th March 2006. The certificate of insurance has expired. On arrival to the home the front door was left wide opened and with no staff or service user in sight. In discussion with the acting manager, he confirmed that the door is often left opened by the cleaner to dry the floor previously mopped. St Mungo`s DS0000020973.V288001.R01.S.doc Version 5.1 Page 22 Also, the newly laid laminated floor presented a hazard as the flooring near the staircase was not properly secured and had begun to lift. The acting manager temporaily used taped to prevent tripping. The acting manager and his staff are proactive in his approach to management and demonstrate understanding, commitment and leadership qualities throughout the inspection process. St Mungo`s DS0000020973.V288001.R01.S.doc Version 5.1 Page 23 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 2 2 2 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 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 x 32 X 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 3 X 3 X X 2 2 St Mungo`s DS0000020973.V288001.R01.S.doc Version 5.1 Page 24 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 YA1 Regulation CSA 2000 Requirement Review the Registration Conditions in relation to a service provision for men and women The registered provider must review the Statement of Purpose and Service Users Guide in relation to complaints and age for admission The registered provider must ensure that service users needs must be comprehensively assessed The registered provider must ensure that care plans must be evaluated and progress recorded. The registered person is asked to review the present arrangements with regard to meal provision so that meals are included in the weekly charge ensuring that service users health and wellbeing is promoted. This requirement is restated. The registered person must ensure that an accurate record of medication administered is maintained and that staff receive training in medication recording. DS0000020973.V288001.R01.S.doc Timescale for action 30/06/06 2. YA1 4,5 30/06/06 3. YA2 14 30/06/06 4. YA6 15 30/06/06 5 YA17 16(2)(i) 30/07/06 6 YA20 13(2) 30/05/06 St Mungo`s Version 5.1 Page 25 7 YA33 18 8 9 YA24 YA30 23 23 10 YA42 23 11 YA43 25(2)(e) Also medication with no named label and those that are out of date must be returned to the pharmacist. The registered person is asked to review the present staffing levels to provide more staff time for individual work with service users. This is restated from 30.5.05 The registered provider must continue with the general improvements being made. The registered provider must ensure that cleaning regime relative to service users’ rooms must continue to occur The registered provider must ensure that all parts of the home are free from hazards and must review the process whereby the front door is left opened and unattended when the floor is being mopped The registered provider must ensure that the certificate of insurance is renewed and up to date 30/07/06 30/12/06 30/06/06 30/06/06 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA36 Good Practice Recommendations Staff appraisals must be carried out annually St Mungo`s DS0000020973.V288001.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Camden Local Office Centro 4 20-23 Mandela Street London NW1 0DU 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 St Mungo`s DS0000020973.V288001.R01.S.doc Version 5.1 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!