Inspection on 30/11/05 for The Heathway

This inspection was carried out on 30th November 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Heathway 17/07/06

The Heathway 08/07/05

The Heathway 02/12/04

The Heathway 03/08/04

The Heathway 22/10/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Heathway, The 70 Reddicap Heath Road Sutton Coldfield West Midlands B75 7EN Lead Inspector Kulwant Ghuman Unannounced Inspection 30th November 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Heathway, The DS0000033584.V270161.R01.S.doc Version 5.0 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. Heathway, The DS0000033584.V270161.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Heathway, The Address 70 Reddicap Heath Road Sutton Coldfield West Midlands B75 7EN 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) 0121 329 2222 0121 378 1878 Birmingham City Council (N) Indira L Surju Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Heathway, The DS0000033584.V270161.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. That the home is registered to accommodate 26 adults over the age of 65 who are in need of care for reasons of old age and may include mild dementia That minimum staffing levels are maintained at 4 care assistants plus a senior member of staff throughout the waking day of 14.5 hours Additionally to the above minimum staffing levels, there must be 2 waking night care staff and a senior on waking or sleeping-in duty Care manager hours and ancillary staff should be provided in addition to care staff Registration category will be 26 (OP) Date of last inspection 28th June 2005 Brief Description of the Service: The Heathway is a large, purpose built Local Authority care home for 26 elderly people. The home is located in Sutton Coldfield in a mainly residential area close to the Falcon Lodge estate. Sutton Coldfield centre is approximately one mile away where numerous community facilities are located. Public transport is available from outside the home. The building comprises of three floors but living accommodation for the residents is provided on the first and second floors. The ground floor provides office space for the management of the home together with an age concern coordinator, community psychiatric nurses and a day centre. Also on the ground floor is the main kitchen and laundry. The two upper floors are a mirror image of each other in design and comprise of two lounges, a dining room, bedrooms and small kitchenettes. There are bathing and toilet facilities throughout. The residential accommodation for the residents was generally well decorated and comfortable. A sensitivity garden with ramped access, smooth brick surfaces and raised flowerbeds is at the rear of the home and provides residents with a pleasant, sheltered environment in which they and day centre users can enjoy the warmer weather. There is parking to the front and side of the home. Heathway, The DS0000033584.V270161.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over one day during November 2005. This was the second of the two statutory inspections for 2005/2006. Not all standards were inspected during this inspection. This report should be read in conjunction with the inspection report of June 2005 to get an overview of the home. During this inspection only the communal areas of the home were seen. Three resident files, one staff file and a variety of care and health and safety documents were seen. Nine residents were spoken with. What the service does well: What has improved since the last inspection? Seventeen of the beds had been replaced in the home. There was evidence that residents or their relatives had seen their care planning documents as they had signed these. Residents had also been asked about managing their medicines and the number of times they were checked during the night. The home had made significant improvements in the supervision levels for staff. Heathway, The DS0000033584.V270161.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Heathway, The DS0000033584.V270161.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Heathway, The DS0000033584.V270161.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 The home needed to improve its admission processes to ensure that residents had accurate information available to them on which they could make an informed decision about whether they wanted to move into the home and what the conditions of residence would be. The home needed to ensure that they could meet the residents’ needs before they were admitted and that there would be no negative impact on the residents already in the home. EVIDENCE: The inspector did not examine the statement of purpose or service user guide but was informed that it had not been updated. There was a residential care agreement in place on all the three files sampled but two had not been completed, the third was for a period of six weeks but the resident had been at the home for over 3 months. The three resident files sampled all included an assessment carried out by the placing social worker. For one of the residents there was evidence that a 28day review had taken place and the long term plans decided upon. Another resident had come in for interim care for a period of 6 weeks, as identified in Heathway, The DS0000033584.V270161.R01.S.doc Version 5.0 Page 9 the residential care agreement, but had been at the home for a considerably longer period of time with no clear plans identified in the file. There was no evidence on any of the resident files sampled that a preadmission assessment was carried out by the home either on a pre-admission visit to the home or at the residents’ home prior to admission. Residents admitted for interim care at the home did not have a pre-admission visit to the home. It was recommended that a representative of the home assessed the resident at the place where the resident was currently living to ensure that they would be suitable for the home and that the home could meet their needs. Heathway, The DS0000033584.V270161.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The care planning and risk assessment processes were not individualised or detailed enough to enable care staff to meet the residents’ needs in an informed way. The management of medication and administration was good ensuring that in most cases residents received their medication as prescribed. EVIDENCE: There were individual service statements (ISS) on the files of two of the residents. The ISS’s contained statements such as ‘staff to supervise with personal hygiene’ and ‘to be bathed as and when required by assisting into the Parker bath’. The ISS’s needed to be more detailed regarding the care to be provided and how staff were to provide the support, for example, did the staff supervise with brushing of teeth by handing the resident the toothbrush and toothpaste or did they put the toothpaste on the toothbrush and hand it to the resident. The ISS’s needed to cover all areas of needs. For one of the residents it was noted that from the daily records that spectacles had gone missing and the resident wandered around the building due to a level of confusion. The ISS made no mention of that fact that spectacles were used or that there was any confusion. Heathway, The DS0000033584.V270161.R01.S.doc Version 5.0 Page 11 Individual service statements needed to be regularly reviewed and updated. The ISS’s had been raised as an issue over several inspections and significant improvement was required. There were risk assessments in place however they did not always identify all the risks relating to the residents. For example, there was a risk identified for one resident with regards to a visitor, the risk assessment stated that the visitor should not be left alone with the resident however, staffing levels at the home did not allow for this level of supervision at all times. The home were advised to clarify with the social worker the level of supervision required and what the home could provide so that an accurate risk assessment and plan of action could be arrived at with the social worker. The risk assessments needed to detail how staff were expected to deal with the issues so that all staff dealt with them in a consistent manner reinforcing management strategies with the residents. Manual handling assessments were in place but they were not consistent regarding the actions to be taken by the staff if a resident fell. The assessments needed to detail how a resident would be assisted up if there was no injury and if a hoist was to be used the sling size needed to be identified. In general there was evidence that the residents’ health care needs were being met. There were visits from the chiropodist, district nurses and GP’s. There was an incident in one of the files sampled that did not evidence that emotional needs were being adequately managed. A confused resident who had packed their belongings to leave the home had the bedroom door locked so that this behaviour was not continued and the records indicate that the resident asked a few times for it to be opened. This was not an appropriate way to manage this situation. There were no nutritional and tissue viability assessments in place on the files sampled. The systems for the management of medicines in the home were well managed. Residents were encouraged to self medicate where possible, however, audits of how well they were medicating needed to be carried out on a regular basis. It appeared from the records of the amounts of medicines handed over to one of the residents that the medicine was not being taken at the prescribed levels. Eye drops needed to be dated on opening. Residents stated that they could have keys to their bedrooms if they wanted. The resident’s telephone had not been made any more private than at the last inspection. Heathway, The DS0000033584.V270161.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14,15 Residents were afforded a lifestyle that met their needs, maintained contact with family and friends and provided choices and nutritious food at mealtimes. EVIDENCE: Residents spoken to stated that they were happy with the care that they received. They confirmed that they had keys to their bedrooms, could go to bed and get up at times that suited them. Some of them told the inspectors of going out with relatives, chatting together and watching television. Residents were observed to sit in a variety of lounges whilst others spent the majority of time in their bedrooms. There was a plan of activities identified on a board on each floor. Daily records for the residents indicted that there were some activities such as light exercises and attendance at day centres. The staffing levels limited the number of activities but efforts were made by the staff to undertake activities. There had been two residents meetings since the last inspection. The issue of the provision of a telephone that would enable residents to make telephone calls in private on the floors that was raised by the residents earlier had not been addressed. Heathway, The DS0000033584.V270161.R01.S.doc Version 5.0 Page 13 The kitchen and provision of meals was not inspected during this inspection, however, all residents spoken with indicated that they were happy with the food provided. One resident stated that “there were not many empty plates here” indicating that they received plentiful supplies of food. Heathway, The DS0000033584.V270161.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Complaints were investigated at the home under the home’s procedure but adequate records were not maintained in the home to show that all complaints raised by or on behalf of residents were investigated and any lessons learnt implemented in the home. EVIDENCE: There had been no complaints lodged with the CSCI regarding this home and no complaints had been raised in the home. The complaint under investigation at the time of the last inspection had been completed however there was no record of the complaint or the complaint investigation and its resolution in the home. A record of any complaints about the service and the ensuing investigation must be maintained in the home. Heathway, The DS0000033584.V270161.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Residents lived in a comfortable, homely and safe environment with adaptations in place to meet the needs of the residents. The home was clean and odour free. EVIDENCE: An inspection of the premises was not undertaken during this inspection except the lounges, dining rooms and unit kitchens. Requirements made at previous inspections have been carried forward where the inspector was informed that they had not been met. The home was generally clean and warm and the communal areas were well furnished and homely. Staff had not been recording the temperatures of the unit kitchen fridges on a regular basis. Heathway, The DS0000033584.V270161.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Adequate staffing levels were being maintained at the home enabling the needs of the residents to be met. The home needed to increase the number of staff employed so that continuity of care could be given to the residents. EVIDENCE: The home continued to experience difficulties in recruiting staff hours. There had been an increase in the number of vacant staff hours since the last inspection. The home had a core group of staff (5 permanent care staff members) and was using agency and casual staff to fill the gaps. The home had experienced some difficulties with the reliability of agency staff. On the morning of the inspection the agency member of staff had not arrived for her duty. The staff in the home called in other members of staff to cover the staff shortage. The home had limited admissions to 20 residents due to the shortage of staff and the difficulties in covering shifts. In addition to the manager there were three members of staff on duty (including the senior). The home was able to meet its conditions of registration with the use of agency staff. About two thirds of the staff had achieved NVQ level 2. Staff had had some training including manual handling training, fire training and tissue viability assessment. In order for a full overview of training and skills in the home the manager needed to set up a training matrix. The file of one member of staff was sampled and all the relevant information was available for inspection. Heathway, The DS0000033584.V270161.R01.S.doc Version 5.0 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,36,38 The manager ensured the smooth running of the home in a competent manner. The health and safety of the residents and staff was very well managed. EVIDENCE: The manager had the appropriate qualifications and experience and was knowledgeable about the residents needs. There was an open atmosphere within the home with senior staff being involved in the inspection process. The manager needed to ensure that the care planning and pre-admission activities were improved and better documented. The manager must ensure that at all times the home is run with the interests of the residents in mind, even when staffing is stretched and that bedrooms are not made inaccessible to the residents. There had been only one full staff meeting since the last inspection; however, there had been meetings between staff on each of the two units. Heathway, The DS0000033584.V270161.R01.S.doc Version 5.0 Page 18 Supervision was being undertaken by the senior staff and on target to meet the minimum levels required by regulation. All documentation was appropriately stored and accessible. Notifications required by the CSCI were being appropriately forwarded. Some improvements were needed in the care plans, risk assessments and manual handling assessments. There had been only two documented visits made by the owner’s representative. The last one being undertaken a few days before the inspection when a financial check was undertaken. Health and safety was being well managed with evidence readily available for servicing of gas and electrical equipment, fire fighting equipment and the nurse call system, hoists and lift. The only areas outstanding were the updating of the fire risk assessment and the emergency lighting test that had not been carried out during November. Heathway, The DS0000033584.V270161.R01.S.doc Version 5.0 Page 19 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 2 2 2 2 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 X 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X X 3 2 2 Heathway, The DS0000033584.V270161.R01.S.doc Version 5.0 Page 20 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 OP1 Regulation 4(1)Sch 1 Requirement Timescale for action 01/02/06 2. OP2 5(1) The registered person must ensure that the statement of purpose is accurate and all appendices are available. A copy of the updated statement of purpose must be forwarded to the CSCI. (Previous timescales of 18/01/04 and 01/09/05 not met) 01/01/06 The registered person must ensure that the service users are given a contract reflecting their status in the home. All residents must be given a contract or terms and conditions of residence at the point of entering the home. (Previous timescales of 01/10/04 and 01/08/05 not met) There must be a record of the care homes charges to the resident. (Previous timescale of 01/08/05 not met.) The registered person must ensure that a recorded assessment is carried out at the pre-admission visit. (Previous DS0000033584.V270161.R01.S.doc 3. OP3 17(2) Sch4(8) 14(1) 01/01/06 4. OP5 01/01/06 Heathway, The Version 5.0 Page 21 5. OP7 15(1) 6. OP7 12(1)(a) 7. OP7 15(2)(b) 8. OP7 13(5) 9. OP9 13(2) timescales of 01/03/05 and 01/08/05 not met.) The registered person must ensure that ISSs cover all the identified needs of service users and state how care staff will meet these. (Previous timescales of 01/10/04 and 01/09/05 not met) The registered person must ensure that the service user assessment covers nutritional needs and tissue viability. (Previous timescales of 18/01/04 and 01/09/05 not met) The registered person must ensure that the ISS is reviewed on a monthly basis by care staff and any changes in need must be reflected in the ISS. (Previous timescale of 01/10/04 and 01/09/05 not met) The moving and handling assessments must include all relevant information. (Previous timescale of 01/09/05 partially met.) The manager must ensure compliance checks are carried out for residents who selfadminister medicines. Eye drops must be dated on opening. The home must look at ways in which residents can be enabled to make telephone calls in private. (Previous timescale of 01/10/05 not met.) The registered person must ensure that there is a record of all complaints made to the home and the actions taken in relation to the complaint. (Previous timescales of 01/03/05 and 01/09/05 not met.) Flooring in the corridors should be replaced. (Previous timescale DS0000033584.V270161.R01.S.doc 01/02/06 01/02/06 01/02/06 01/02/06 01/01/06 10. OP10 12(4)(a) 01/04/06 11. OP16 17(2) Sch4(11) 01/01/06 12. OP19 23(2)(b) 01/06/06 Page 22 Heathway, The Version 5.0 13. OP25 23(2)(p) of 18/03/04 and 01/10/05 not met) Lighting throughout the home should be domestic in character. (Previous timescales of 01/05/04 and 01/10/05 not met) The registered person must ensure that service users are able to control the temperature of radiators in their bedrooms. (Previous timescales of 01/10/04 and 01/10/05 not met.) Window openings in all bedrooms must be accessible to residents. (Previous timescales of 01/06/05 and 01/10/05 not met.) Unit fridge temperatures must be recorded on a daily basis. (Previous timescale of 29/06/05 not met.) The manager must set up a training matrix. The manager must ensure that all areas of the home are accessible to residents unless identified in a risk assessment. The registered person must ensure that reports of the monthly team managers visits are available for inspection. (Partially met.) The emergency lighting must be tested on a monthly basis. The fire risk assessment must be updated. 01/06/06 14. OP26 13(3) 01/01/06 17. 18. OP30 OP32 18(1)(a) 12(1)(a) 01/02/06 01/01/06 19. OP37 26(5) 01/01/06 20. 21 OP38 OP38 23(4)(c) (v) 13(4)(a) 01/01/06 01/01/06 Heathway, The DS0000033584.V270161.R01.S.doc Version 5.0 Page 23 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. 2. Refer to Standard OP3 OP16 Good Practice Recommendations A pre-admission assessment should be carried out by the home for all residents admitted to the home. The complaints leaflet should be updated to refer to the CSCI. Heathway, The DS0000033584.V270161.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Heathway, The DS0000033584.V270161.R01.S.doc Version 5.0 Page 25 - 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!