Random inspection report
Care homes for older people
Name: Address: The Regency Torrs Park The Regency Ilfracombe Devon EX34 8AZ two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Louise Delacroix Date: 2 6 0 3 2 0 1 0 Information about the care home
Name of care home: Address: The Regency Torrs Park The Regency Ilfracombe Devon EX34 8AZ 01271862369 01271863012 nmcarehomesltd@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Norma Elfreda Martin Type of registration: Number of places registered: Conditions of registration: Category(ies) : Norma Martin Care Homes Limited care home 20 Number of places (if applicable): Under 65 Over 65 20 20 20 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Conditions of registration: 0 0 0 The Regency is registered as a care home able to provide care accommodation for up to 20 service users in the categories OP Old Age (20), DE (E) Dementia over 65 (20) and MD (E) Mental Disorder over 65 (20). Date of last inspection 1 0 0 7 2 0 0 9 Care Homes for Older People Page 2 of 17 Brief description of the care home The Regency is a care home providing accommodation and personal care for up to 20 people over the age of 65 years, who may have a diagnosis of dementia or mental disorder. The home is situated in the Devon seaside town of Ilfracombe. There is a short, steep walk from the High Street and local amenities. Accommodation is provided on four floors. A ramp provides access to one floor and passenger lift to the remaining three. In April 2010, the range of fees was £320 to £400 per week. Additional charges are made for chiropody, hairdressing, newspapers, personal toiletries. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk Care Homes for Older People Page 3 of 17 What we found:
The inspection was unannounced and took place over approximately six hours. There were two inspectors, Louise Delacroix and Judith McGregor Harper. The inspection was in response to an anonymous written complaint that raised concerns about the temperature of the food, poor bedding and low staffing levels. We have also received other concerns about similar issues. The key inspection took place in July 2008, which focused on all key standards linked to care and the management of the home. There was also a random inspection in July 2009 as a result of concerns highlighted in the Annual Service Review report in June 2009. In July 2009, the inspector looked to see whether care needs were being met by the staffing levels and how the home was being managed. No new requirements were made as a result of this visit and there was positive feedback about the service. The purpose of this inspection was to check on the well-being of the people living at the home and on the management of the home. When we inspected on this occasion, there were nineteen people living at the home, all of whom we saw or met with. The home is registered for twenty people. There were four staff on duty when we arrived, which included a senior. This reduced to three staff in the afternoon. The manager was not working at the home but the duty rotas for previous weeks showed that the manager has been working seven days a week between 8am and 8pm, which staff confirmed. However, we did speak to the manager on the phone, both at the start of the morning and at the end of the inspection. The duty rota also showed that the cleaner and the chef were on annual leave and no additional cover had been arranged. On the day of the inspection, three of the staff members had been recruited very recently, and one told us they had not worked in care before. As a result of this inspection we will bring forward the homes next key inspection and liaise with other health and social care professionals. We have also been in contact with Ms Martin so that she can update us on the progress made to address the concerns detailed in this report. What the care home does well:
During the inspection, people told us that the staff were nice, kind and friendly. We observed these characteristics during our visit. A visiting person told us that the manager was wonderful and that there was perfect care, good food. We saw two people living at the home chatting and joking with two members of staff, and we this type of rapport happening on several occasions.Staff are hard working and have shown their loyalty by working long hours. Despite also working long hours, the manager has completed a further care qualification to help keep their practice update. Most people have care plans. The manager told us that they had worked hard to keep the care plans up to date. We saw that some of the care plans had good information, provided guidance for staff and had been updated recently. For example, we saw a diabetic care plan and guidance for staff to support someone resistant to personal care.
Care Homes for Older People Page 4 of 17 The first floor lounge is clean and attractive, and people are able to personalise their rooms. We saw some people exercising choice regarding their meal and staff ensuring that their request was met. What they could do better:
The following areas require further improvement: Care Planning We also saw that some key information was missing from existing care plans. For example, we were told that one person had pureed food and required thick and easy to be added to their drink because they could not swallow properly. Staff demonstrated how much they used and that it was given on a spoon but this detail was not recorded in the persons care plan. They told us that the person had been on a fluid chart until two months ago after being diagnosed with dehydration and kidney failure but that this was no longer needed on the advice of district nurses because of an improvement in their health. The persons care plan aims to ensure that a daily intake of fluid is sufficient. This helps to reduce confusion by minimising a urinary tract infection. When we spoke with the manager on 30th March 2010, they told us that more guidance for staff had now been added to the persons care plan and that a fluid chart was to be reinstated with a target amount for the person to drink. Records show that the person currently has a urine infection. We asked to see the care plan for someone who had lived at the home for approximately a week. Staff said they could not find it but we were later told by the manager on 30th March 2010 that a staff member had not completed the task but that it had now been written. This person has significant health needs, which need to be considered with regard to their food preparation. Health We looked to see how peoples health and well-being was monitored. For example, we looked to see how peoples weight was monitored. The records for two people showed they had lost weight but the last recording for them was June and September 2009. One persons care plan states that their weight should remain steady and continue to improve. Staff told us this person could not be weighed because of mobility issues but we found no other system had been put in place to monitor their weight loss. We spoke to the manager about this and they agreed to approach the district nurses for advice. While for the second person they said they would encourage them to be weighed; the persons care plan did not record that this step had been taken in the past. When we spoke to the manager on the 30th March 2010, she confirmed that they had started to weigh people over the weekend. During the staff handover, we heard staff mention that one person who is cared for in bed had an area of redness but that there was not a pressure sore. We spoke to the manager on 30th March about this comment, she was not aware of this, and agreed to check with staff and check the persons skin. The person is cared for on a pressure relieving mattress, which we were told had been set by a health professional. During the inspection, we saw someone living at the home trying to explain they were unwell
Care Homes for Older People Page 5 of 17 because of their medical condition, the staff member did not understand them, but went and got another staff member who understood and said they would monitor them. Some people seemed low in mood and when we spoke with people they expressed low expectations about life in general. One person was pleased that they had a clean bed and a roof over their head. The manager told us they were still assessing two people who had recently moved in as they appeared withdrawn. We looked at how peoples moving and handling needs were met. A new member of staff told us this training had been covered in their induction the previous week and that they were now involved in using a hoist to provide care. We saw from the duty rota that another member of staff had received the same training as part of their induction but we saw them demonstrate poor practice when moving a person living at the home, who yelled out during the move. We also saw poor moving and handling practice when someone was moved in their bed, which potentially put the person at risk and the carers. We also observed that people were not spoken to about what was going to happen to them during transfers, despite instructions in one of the peoples care plan for this to happen. This form of poor practice has the potential to leave people being objectified and not treated as individuals. We also saw an incident form that indicated a poor moving and handling move had been attempted leaving a carer injured, although the manager told us on 30th March 2010 that this had been inaccurately recorded. We looked at how the home worked with health professionals. Staff commented that on the day of the inspection, they did not feel supported by two GPs who had not seen two people living at the home when the home had requested it. One of the people told us they were waiting to see the GP because they had a painful ear. The manager told us they are awaiting the outcome for a continuing health care assessment for someone living at the home although support from the district nurses support had increased; she told us she had applied for a continuing care assessment in the past for someone who had died before Christmas but had not received the help she felt she needed. However, she also told us about how the on call GP had been called out at the weekend and prescribed the necessary medication to fight an infection and that antibiotics had been collected by staff within an hour of the visit. Medication We will look at medication when we inspect the care home again. The manager told us that they are training up a new member of staff to administer medication but advised they are still being assessed for this role. We spoke to someone who told us they were regularly in pain and they confirmed that they were regularly provided with prescribed pain killers, which were given while we were talking to them. Some people within the home are also able to maintain their independence by managing their own medication; although we heard staff commenting in the handover that one person who administered their own medication was struggling with this. Privacy and Dignity People seemed generally relaxed with staff. However, one person was agitated and restless throughout the inspection, and did not respond well to the staff, raising their hands and hitting out. Another person became frustrated when a staff member did not understand them and could not assist them in the way they requested. Two people told us that they could not understand all of the staff and they did not think
Care Homes for Older People Page 6 of 17 they always understood what was being said, which we witnessed when someone tried to explain about their health needs to a staff member and was not understood. When we spoke to the manager, they acknowledged that English was some staff members second language and that could be a barrier to clear communication for some staff. For example, they told us that a staff member was more suited to work at night because of the language barrier. However, as the home was running with one waking night staff when we inspected, this is not a safe option. During our inspection, we saw some staff knocked on peoples doors before entering, some staff needed prompting and some staff just walked in without knocking. We also witnessed an incident of poor practice, where a persons incontinence needs were attended to in front of another person sharing the room who was eating their meal. There was a screen but it was not used. We have been informed by other visiting professionals that there have been other examples of poor practice around dignity and privacy. We saw that staff did not always explain what they were going to do when they helped people with their mobility, which undermines their dignity. Generally, people looked clean and cared for. For example, clean finger nails, eyes, glasses and clothes. However, staff told us one person wouldnt support with personal care and we noticed that a second person smelt of urine when we arrived, which increased as the day went on. We heard staff discussing at the handover how this person could be encouraged to change their clothing. Their discussion indicated this would be problematic, which was reflected in the persons care plan. We visited the person in their room whilst a staff member was trying to assist them; they were very resistant to care. Later we saw a clean dress was placed over their thick jumper and soiled dress. However, they did go to the hairdresser, which improved their appearance as their hair had been very dishevelled. The handover took place in the hallway of the basement floor, the door was open to the lounge and people visiting and living at the home were sitting near the lounge door. This means that peoples dignity has the potential to be compromised. We saw in one of the lounges and in a corridor that there were electrical plug in devices that looked like listening devices [baby monitors]. We asked two people living at the home what they were, they told us they thought they were plug in air fresheners, which we also saw around the home. We asked a staff member, they did not answer when we asked if they were listening devices but they said we could switch them off. These devises were switched on when we arrived and compromise peoples dignity. The crockery used at the lunchtime meal was institutional in appearance. For example, people were served squash in a mixture of plastic beakers or white mugs, and their meals were served on plates with divided areas for each part of the meal, regardless of their level of need. Activities We saw staff telling a person living at the home that there would be not activities that day. On the board in the dining area, it stated that the activity was the hairdresser, who arrived when we there. We asked people how they spent their time. Some people said they preferred their own company and kept mainly to their room. Other people were unclear but two said they liked to read and had books to read. We saw that one person had been out on their mobility scooter when we arrived at the home.
Care Homes for Older People Page 7 of 17 We looked at the activity records for one person who was very restless; they showed a lack of activities. During our inspection, staff gave them a magazine to look at which they did briefly. We saw that not only were they restless but they were agitated. For example, we saw them banging on the lift door. Staff told us that a digital lock had been placed on the door to the annexe because the person blocked the toilet in this area. The persons care plan states that a great deal of time needed to be given when communicating with [them]. However, we saw staff were too busy to spend any time in meaningful conversation with people living at the home. There was a general lack of stimulation for people living at the home, although a person told us how much they appreciated being taken to the harbour by a carer on their day off. A wall mounted television was on throughout the day, including during the lunchtime meal, when two people were sat directly in front of it. Choice In the kitchen, we saw a list that provided a rough guide to peoples preferences for their breakfast menu, where they ate it and at what time. However, one person was listed as eating at 6am but their care plan did not say this was their preference. At lunchtime, we heard a man requesting an alternative to the main meal of fish and chips. We saw that this was provided to him, although menu lists that we looked at do not record what alternative is offered to people. People told us they chose where to sit and where they ate their meals. One person was not served with a pudding when the person in their shared room was given ice cream. There was no record to explain why this would be. Meals We checked on the quality of the meals because of the complaint we had received. On the day of the inspection, three meals that were served to people were cold, and two were served in an inappropriate manner. For example, one person had a pureed meal but all the different components i.e. fish, chips and beans were pureed together, which is not best practice. It was also cold. The person was also not sat in an appropriate position, as stated in their care plan, to eat their food in a safe manner. Another person had food that was not suitable because of their medical condition; there was no care plan for them and nothing recorded in the kitchen about their needs. Staff were unaware of their needs. We spoke to the person preparing the meal; they were doing this as part of the carer shift. They told us they had a food hygiene certificate from 2007. The meal was bread crumbed fish, oven chips and beans. Staff told us this was a popular option. Peoples portions appeared fairly small and people were not offered seconds. People in the dining room were offered sponge for pudding. We spoke to people about the quality of the food, someone commented that it was adequate and another said it was not the Savoy. People that we spoke to expressed low expectations about what they could expect at this time in their life. Two people said that the teatime meal was a poor standard, although one felt this had improved recently. We were told by staff and people living at the home that the chefs hours had been cut and that other staff members were filling in. This could account for the variable quality, as in the past people have made positive comments about the standard of food at the home. We saw from timesheets that the chef has worked 12 days out of the last 25 days. The manager told us on 30th March 2010 that she hoped to increase the chefs hours to
Care Homes for Older People Page 8 of 17 cover an extra day. However, the chefs hours do not cover breakfast or teatime, which is currently being covered by the care staff as part of their care shift. Complaints and Safeguarding We will look at how this area of care is managed in more detail during our next visit. However, we were concerned that a substantial amount of money had gone missing from one persons personal account and that another person had their visa card go missing. The Police was involved on both occasions and the manager has arranged to pay a monthly amount back to the person to cover the money that has gone missing. During our inspection, we heard that staff had found another person throwing £60 away. This same person was found burning money and paper towels in December 2009. Environment The maintenance of some areas of the home is poor in places. For example, the decor on the corridor on the first floor is shabby with wallpaper missing. On the ground floor, the bathroom is shabby with exposed plaster. On the basement floor, there are tiles off the bathroom wall exposing a cracked wall. The room leading to the annexe appears unfinished with a rough wooden ramp. However, the lounge on the first floor is an attractive room, and we saw it was used once during the day by a person living at the home. On basement floor, there is a bright lounge with a range of clean armchairs and several dining room tables. The standard of cleanliness in the home is poor. For example, on the top floor the toilet was streaked with a black dried liquid on the toilet bowl and toilet seat. On the first floor bathroom, there is dried black fluid on the bath lever and on the inside of the bath. In the ground floor bathroom, there is mobile style hoist with an extremely dirty cover, which is stained and coated with a brown residue. On the basement floor, the toilet is stained and dirty and the bathroom smells of urine. The stairs leading down to the basement are heavily stained and the carpet in the basement floor lounge is unclean. Surfaces in the kitchen were sticky, as was the floor. A person living at the home told staff that there were too many dirty cups left in the lounge, they joked with them but cleared them away. Dirty dishes were piled up in the sink after lunch and were not washed until a carer was free to do so, an hour and a half later. We checked the fridge and saw that food was covered with cling film but not all of them had a date sticker to indicate when they had been prepared. A staff member appeared confident about when these unlabelled meals had been prepared and threw several away. We spoke with a staff member on the phone, and they also told us when meals had been prepared, and explained that they pre-prepared food for staff to cook in their absence. There are unpleasant odours in different areas of the home. The first floor smells of tobacco smoke, while the basement floor has a strong unpleasant smell, which includes a smell of damp. The manager felt this odour might have been contributed to by one person living at the home being resistant to personal and medical care. On the basement floor, the bathroom smells of urine. We looked at how infection control was maintained and saw that there were poor standards in this area of care. A staff member told us that as part of their induction, they
Care Homes for Older People Page 9 of 17 were taught about infection control, as well as other areas of care within a three hour session. They told us that gloves were readily available, which we saw were available, and they explained how they provided personal care using infection control measures. However, we witnessed an example of poor and unsafe practice when a carer did not use gloves whilst attending to someone who had been incontinent. After this, they requested that a second carer assist them with moving a person in bed. The second carer, who was not wearing gloves, placed their hands on the person upper thighs then went back to assisting a second person with their meals without washing their hands. During our tour of the building, we saw that the sluice rooms have no hand washing facilities, which compromises good hygiene practices. There was no consistency regarding the supply of liquid soap, paper towels and bins in the toilets and bathrooms. There are areas of the home that are potentially unsafe given the needs of some people living at the home due to physical frailty, falls and mental health needs . For example, the radiators in the top floor bathroom and the first floor bathroom are unguarded and hot too touch. A store cupboard on the first floor was unlocked despite a notice saying it should be locked, and contained there was a very hot water pipe. The sluice rooms were unlocked and one contained a bottle of Domestos, which is unsafe given the vulnerability of some of the people living at the home. We asked people if they were warm enough in their rooms and if their bedding was warm enough. This was because of the information we received in a complaint. Four people told us they were happy with the warmth of their room and their bedding, one of these peoples rooms felt cold to us but they assured us they got to uncomfortable if it was warmer. We visited other rooms that were warm. However, we met one person whose room was cold, as shown by the room thermometer, and they told us they were cold, and had been since they moved in. We informed staff about our concerns, and advised that we had switched on the radiator that was off. Staffing We made an immediate requirement to improve staffing levels. This is influenced by the four levels of the building and the annexe which four people live in. We heard from staff and saw from the rota that the home currently has only one waking night staff despite the building layout and the challenging behaviour of some people living at the home. We are also concerned that staff covering the night shift on their own may not have the skills to carry out this task alone, for example, due to a language barrier and a lack of moving and handling skills. As we have mentioned in other parts of the report, staff were busy, and generally lacked time to engage in meaningful conversation with people living at the home. Because people some choose to stay in their room, which is their right, or because they are cared for in bed, plus the layout of the building, staff cover is stretched. On the day of the inspection, two of the five staff had all started their induction three days earlier. And a third person had started a fortnight earlier. This means that there is not a balanced staff group, with a mix of experienced staff who know the people living at the home and new staff. Management The manager told us that she has not advised CQC about some of the difficulties at the
Care Homes for Older People Page 10 of 17 home, which she links to the home reducing to nine people over the Christmas period when it is registered for twenty. However, since the random inspection she has shared some of the problems she faces and said that she would like to work in a transparent way with CQC. Staff told us that budgets have been restricted, and that some staff hours have been cut. However, the manager advised that on 30th March 2010 that the food supplies had been re-stocked, which a staff member had told us would happen when we spoke with them on 26th March 2010. People living at the home told us there had been lots of changes to the staff group. The manager told us that due to falling numbers, five staff had been made redundant, and then further staff had left. As referrals have been made to the home, the manager told us that they have recruited new staff and assured us that the recruitment process was robust. We were unable to look at recruitment records because the manager was not on the premises and they were stored securely. These will be checked as part of the key inspection, as will training records. A staff member told us that the home was in crisis because of the staffing situation. We saw from a rota for the week beginning 8th March that staff are working excessively long hours. One person worked 63 hours and another 48 hours, which has the potential to make staff too tired to be effective. The manager is also working seven days a week and working long hours; she told us that she was exhausted. We asked the manager if she had considered using agency staff but she was reluctant to do this because of past experiences. Therefore the home is running with a small group of staff to cover both day and night shifts, which is likely to be unsustainable. Since the inspection, a newly recruited member of staff has left and two other staff members have advised that their availability is now restricted. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 11 of 17 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 12 of 17 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action 1 15 16 People living at the home must be provided with adequate quantities, suitable, wholesome and nutritional food, which is properly prepared. The meals at the home must meet the needs of all the people living at the home, including those with swallowing difficulties and medical needs. Records of peoples weights must be up to date and action taken where necessary. 28/03/2010 2 27 18 People living at the home 28/03/2010 must be cared for by a staff team who are qualified, competent, experienced. And in such numbers as are appropriate for the health and welfare of people living at the home. Appropriate levels of staffing must be provided given the building layout, needs and mix of people living at the home and staff skills and expertise. This applies to both day and night. Care Homes for Older People Page 13 of 17 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 15 Each person living at the 10/04/2010 home must have a care plan. This relates to providing clear guidance for staff who care for people with swallowing difficulties. 2 8 13 People must be moved in a safe and dignified manner. Staff training and practice must be reviewed to ensure that people are moved safely and in a dignified manner. 30/04/2010 3 10 12 Peoples dignity must be maintained by the staff working at the home. Screens must be used in shared rooms. Time must be taken to ensure that peoples communication needs are met. 10/04/2010 4 12 16 People must be provided with 30/04/2010 activities to suit their individual needs. This is to help people living at the home have a better quality of life. 5 19 16 The home must be kept from 10/04/2010 offensive odours. This is to ensure that people live in a pleasant environment. 6 19 13 Toilets, bathrooms and equipment must be cleaned 10/04/2010 Care Homes for Older People Page 14 of 17 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action throughly This is to maintain peoples dignity and to help keep the safe and well, 7 25 23 All people living at the home 10/04/2010 must have heating provided suitable to their needs. This is to help ensure people are warm and comfortable. 8 26 13 Staff must work in a way which promotes infection control and prevents the spread of infection. This is to help keep people safe and well. 10/04/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 7 The manager should ensure that all staff re-read the care plans to ensure they meet the needs of people living at the home appropriately. The manager should ensure that care plans are in place for all the people living at the home. All people living at the home should be offered meal alternatives, and all meals and drinks should be served in a manner appropriate to each individual to maintain dignity, safety and independence. The staff handover should take place in an area of the home that cannot be overheard. Listening devices should be removed from the home. The manager should review incident and accident forms and take appropriate action to protect people. One example relates to the incident of money being thrown away by a
Page 15 of 17 2 8 3 10 4 16 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations person living at the home. Care Homes for Older People Page 16 of 17 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 17 of 17 - 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!
