Inspection on 08/02/06 for Thomas Edward Mitton House

This inspection was carried out on 8th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Thomas Edward Mitton House 28/02/08

Thomas Edward Mitton House 08/12/06

Thomas Edward Mitton House 04/10/05

Thomas Edward Mitton House 02/02/05

Thomas Edward Mitton House 05/08/04

Thomas Edward Mitton House 15/01/04

Similar services:

Flint House

The Cotswold Home

Fairways

Treloar College

Rush Court

The Maypole Nursing Centre

Fir Tree Lodge

Chilmington House

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

CARE HOME ADULTS 18-65 Thomas Edward Mitton House Belvoir Avenue Emerson Valley Milton Keynes Bucks MK4 2JA Lead Inspector Mrs Rosemarie James Unannounced Inspection 8th February 2006 09:30 Thomas Edward Mitton House DS0000015072.V282309.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 Thomas Edward Mitton House DS0000015072.V282309.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. Thomas Edward Mitton House DS0000015072.V282309.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Thomas Edward Mitton House Address Belvoir Avenue Emerson Valley Milton Keynes Bucks MK4 2JA 01908 504778 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) The Disabilities Trust Miss Jane Hurrell Care Home 16 Category(ies) of Physical disability (16) registration, with number of places Thomas Edward Mitton House DS0000015072.V282309.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for 16 people with a physical disability. Date of last inspection 25th February 2003 Brief Description of the Service: Thomas Edward Mitton House is a 16-bedded residential home for people with a physical disability. The aim of the unit is to provide rehabilitation for people with Brain injury back into more independent living or to move onto specific units more able to meet their needs. The accommodation consists of 16 single rooms all en-suite. The house has a library and a large dining area, as well as therapy rooms and lounges. Thomas Edward Mitton House is well located to take advantage of the facilities in Milton Keynes, with the public transport service running close by. Thomas Edward Mitton House DS0000015072.V282309.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the summary of the inspectors’ findings following the inspection that took place on the 8th February 2006 commencing at 9.30am. The inspector was Mrs Rosemarie James. During this inspection action on the requirements made at the inspection the previous October was assessed. The inspection covered 15 of the key standards and involved interviewing the manager, speaking with staff, looking at some records, attending a Rehab Meeting and meeting with some of the residents. A comprehensive tour of the premises was not undertaken on this occasion. The inspector would like to thank the staff and residents for their time and their warm hospitality for what was a very enjoyable inspection visit. The home received 24 hours notice of this inspection visit. What the service does well: The philosophy of Thomas Edward Mitton House (TEMH) is to encourage and assist the residents to move onto a more independent and satisfying lifestyle and they do this well. The manager reported that in the past 12 months 80 of their residents had in fact been through the homes assessment and rehabilitation programmes and moved on to begin the next stage of their lives. The weekly Rehab Team Meetings chaired by healthcare professionals are the cornerstone of this homes effective communication system. The result is a consistent approach to meeting a variety of, and at times challenging, care needs. The home has comprehensive medication policies and procedures in place. The Medication Administration Record (MAR) sheets examined showed no gaps and appropriate use of codes was evident. Recruitment files were in good order and all appropriate checks on staff are carried out before employment commences. The Brain Injury Rehabilitation Trust (BIRT) has a very positive attitude to training and this was evident in the training records of staff working at the home. Thomas Edward Mitton House DS0000015072.V282309.R01.S.doc Version 5.1 Page 6 The home is to be commended on the thoroughness of their induction programme. Those residents spoken with were clearly happy with their lives at TEMH. What has improved since the last inspection? What they could do better: No specific areas were identified at this inspection where the home could do better. However, the Trust and the staff at TEMH work hard to consistently improve the service they provide and indeed see the inspection process as a way of doing this. Please contact the provider for advice of actions taken in response to this Thomas Edward Mitton House DS0000015072.V282309.R01.S.doc Version 5.1 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Thomas Edward Mitton House DS0000015072.V282309.R01.S.doc Version 5.1 Page 8 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 Thomas Edward Mitton House DS0000015072.V282309.R01.S.doc Version 5.1 Page 9 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&5 Information provided by the Trust, the homes Statement of Purpose, Service User Guide and their admission policy and practice ensure any prospective resident has all the information they need to allow them to make an informed choice as to whether they want to live at TEMH. All residents have a contract that is signed by them and a representative of the home. This ensures they have a clear understanding of the terms and conditions of their residence. EVIDENCE: The manager stated that the Statement of Purpose and Service Users Guide are reviewed every 6 months for content accuracy. Copies of both these documents and the latest inspection report are made available to prospective residents and there are copies in all residents’ bedrooms as part of the TEMH Guide that everyone has. The prospective resident and family members are invited to the house as many times as they want to help them decide whether a move to TEMH is the right one. All residents have a contract that details the terms and conditions of their residency. All contracts contain the detail as specified in the National Minimum Standards (for Adults). Some may have specific clauses such as the need for 1 Thomas Edward Mitton House DS0000015072.V282309.R01.S.doc Version 5.1 Page 10 to 1 care. The manager likes to take on the task herself of going through the contract with a new resident to ensure they are happy with the content of the document, both then sign. A copy of a signed contract was made available for inspection purposes and was in good order. In addition to the contract between TEMH and the resident, most have a funding agreement from the local authority. Thomas Edward Mitton House DS0000015072.V282309.R01.S.doc Version 5.1 Page 11 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): 9 & 10 Risk assessments are in place and form a very important part of the homes programme in moving residents on to more independent living. The staff team work hard to build a trusting relationship between themselves and the residents. This ensures the residents are comfortable in sharing information of a confidential nature. EVIDENCE: The individuals that come to live at TEMH have a range of disabilities that means the move on to more independent living involves a greater element of risk than would perhaps normally be the case. A risk identification checklist is completed at the pre admission stage. A team approach to identifying risks is taken between the resident, their family, care managers and staff at TEMH. They will look at what is an acceptable risk and how it can be reduced. The manager gave the example of a resident who was not able to recognise the dangers crossing the road could be and his wanting to go out alone. She described a staged process whereby he began going to a local shop initially with staff and eventually the support was tapered off until he could go out alone. During the inspection one resident was being observed and helped to Thomas Edward Mitton House DS0000015072.V282309.R01.S.doc Version 5.1 Page 12 make himself a hot meal. This involved one to one care to not only prompt him through the process but to manage and overcome the risks involved in hot meal preparation. The home operates an effective key worker system. This allows staff members to build up a trusting relationship with their resident to make the sharing of confidential information easier. Staff will ask if it is all right to share information should this be necessary. All written records concerning the residents are held in a locked room. ‘At a glance’ care details are on a white board in the staff room. Access to this room is restricted to staff only and the board positioned so that the details the board contains cannot be seen from the door. Thomas Edward Mitton House DS0000015072.V282309.R01.S.doc Version 5.1 Page 13 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 &17 The home employ the services of an activities organiser to ensure a variety of appropriate activities are available to the residents. Residents are encouraged and enabled to make use of local facilities. This helps to ensure they feel very much a part of the community. Residents are encouraged to continue with family and friend relationships making their time at TEMH as ‘normal’ and enjoyable as possible. Good standards of catering and a chef that is fully involved in the operation of the home ensure the residents enjoy a healthy balanced diet. EVIDENCE: The home employs the services of an activities organiser. They together with the staff team and healthcare input as appropriate will look at a residents needs and goals e.g. to go home. A daily and weekly programme of activities will be drawn up. This may include formal clinical sessions, 1 to 1 and group sessions and trips out of the home for shopping and coffee etc. Orientation sessions are held every morning. At these sessions staff will join a group of residents (they are encouraged to attend but this is not compulsory) to discuss Thomas Edward Mitton House DS0000015072.V282309.R01.S.doc Version 5.1 Page 14 news topics and to go through the activities that are programmed for the day. The manager stated that although a wide variety of activities are available on a daily basis, should a resident not wish to do something then this was all right too. On the morning of the inspection 1 to 1 sessions were observed as well as a group film session. The home is fortunate to be situated in the modern city of Milton Keynes and close by to the town of Bletchley. They make full use of the facilities this city and town provide. More locally the shop just up the road is frequently visited. At the time of this inspection visit only one resident attended a local church. A recent objective is to get local schools involved with Halfords to design a cycle helmet for Brain Injury Awareness Week. The home has an open door policy with regard to visitors. Maintaining contact with family and friends forms an important part of the residents’ rehabilitation process and weekends to the family home are arranged as appropriate. Residents can see their visitors in the privacy of their own rooms or in any of the social areas around the home. The residents enjoy a varied and wholesome diet. The chef is very much a part of the homes operation and likes to get to know the residents and their likes and dislikes. Three meals a day are provided as well as hot and cold drinks and snacks in between. Special diets are catered for including those necessary for cultural reasons. Should healthcare concerns warrant it, advice from a dietician would be sought. On the day of the inspection steak pie was the main choice with a lamb alternative for the resident who for religious reasons could not eat beef. Fish and chips on a Friday are a particular favourite. Themed days are also arranged. Recently the residents celebrated the Chinese New Year with the dining room decorated with lanterns and a Chinese meal served up for lunch. Thomas Edward Mitton House DS0000015072.V282309.R01.S.doc Version 5.1 Page 15 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 & 20 Residents are fully involved in the drawing up of their care plans and the review process to ensure personal support is given in the way they prefer and require. Care plans and the weekly multidisciplinary Rehab meetings help to ensure the physical and emotional healthcare needs of the residents are met. The homes medication administration policies, procedures and practice ensure the residents receive their medication in a safe and satisfactory manner. EVIDENCE: Form the pre admission stage the residents are involved in how they are cared for. They have input into the care plans and have a key worker with whom they build up good working relationships. Care plans are reviewed regularly. Weekly Rehab meetings are held with the staff team usually chaired by the homes neuropsychologist. At these meetings all the residents are discussed whether they are at the assessment phase of their care or going through the rehabilitation process. The inspector had the opportunity to join this meeting and what was particularly impressive was the careful detail involved even down to how staff were to respond to particular dialogue from a resident. Thomas Edward Mitton House DS0000015072.V282309.R01.S.doc Version 5.1 Page 16 Effective communication amongst the staff team is essential to provide a consistency of care and it was very evident the TEMH were good at doing this and they are to be commended for it. Medication is stored appropriately in a locked room. At the current time medication is dispensed from cassette boxes. The home is in the advanced stages of negotiating with a national supplier to take over the homes pharmacy requirements. The (MAR) sheets for the current month were looked at and it is pleasing to be able to report that there were no gaps and codes for nonadministration were used appropriately. Entries made by staff for new admissions or changes in medication were double signed. The date and an explanation were recorded for when a medication was finished or stopped. Thomas Edward Mitton House DS0000015072.V282309.R01.S.doc Version 5.1 Page 17 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): EVIDENCE: Not assessed at this inspection. However, key standards 22 & 23 were scored as met at the last inspection. Thomas Edward Mitton House DS0000015072.V282309.R01.S.doc Version 5.1 Page 18 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): EVIDENCE: These standards were not assessed at this inspection. However, it is appropriate to record the progress made following requirements set at the last inspection with regard to the environment. The lounge door has been adjusted to ensure it does close onto its rebate. Latex gloves are now stored more securely. A weekly audit of cleanliness within the home is now carried out and standards have improved as a result. The housekeeping vacancy has now been filled which should help matters still further. An audit of the en suite facilities has been undertaken and a decision made to turn them into ‘wet rooms’. Quotes for the work to be carried out are in the process of being obtained and it is anticipated that half the work will be done this financial year and the remaining half the following year. Following the last inspection an assessment of the mattresses in use at the home was undertaken and 5 new ones provided. Monitoring the condition of the mattresses is now undertaken regularly. Thomas Edward Mitton House DS0000015072.V282309.R01.S.doc Version 5.1 Page 19 Thomas Edward Mitton House DS0000015072.V282309.R01.S.doc Version 5.1 Page 20 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): 34 & 35 The home has employment policies and procedures in place, which are followed by management to ensure residents’ are cared for by staff fit to do so. The Trust and TEMH have a very positive attitude to training, which ensures the staff team are well qualified to meet the varying needs of the residents. EVIDENCE: The recruitment files of the two most recent staff to be recruited were looked at during the inspection. The files were in good order with a recruitment checklist on the front cover to make progress tracking easier. It is pleasing to be able to report that both files contained all the necessary paperwork and checks needed. There was evidence of the checks being in place before the commencement of employment. At the time of the inspection visit one member of staff was going through their induction. These records were made available for inspection purposes. Induction training is divided into three modules: Mandatory training – carried out by accredited trainers BIRT formal training – carried out by training managers Practical work experience training that included such topics as: what is brain injury, paperwork, manual handling, OT, communication and behaviour etc. Induction can last anything up to 2 months. The home is to be congratulated Thomas Edward Mitton House DS0000015072.V282309.R01.S.doc Version 5.1 Page 21 on the thoroughness of their induction training. One recommendation has been made with regard to fire safety training. The training programme for 2006 was shown to the inspector. The programme included: Health & Safety Fire Safety COSHH Manual Handling Food Hygiene Epilepsy Adult Abuse ‘Who Cares’ Words Change Lives The manager has a training budget. In order for the Trust to respond appropriately to training needs the manager completes a Training Needs Alert Form. Monthly training returns are sent to head office. There are very clear ‘at a glance’ training records for all staff on file and these were seen. Thomas Edward Mitton House DS0000015072.V282309.R01.S.doc Version 5.1 Page 22 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 A well-trained staff team effectively led, good record keeping and the homes success stories are evidence that this is a well run home benefiting all who come to live there. Residents are listened to and consulted with ensuring they are fully involved in their care and how the home runs. EVIDENCE: During this inspection there was evidence of effective communication amongst the staff team, good leadership from management, team work, an understanding of and following of policies and procedures, good record keeping and most of all happy residents. The homes success over the past 12 months in being able to move on 80 of their residents are all indicators that this is a well run home. It has already been stated in this report how residents are involved in their care and how the home is run. In addition to the evidence already provided, Thomas Edward Mitton House DS0000015072.V282309.R01.S.doc Version 5.1 Page 23 the home hold weekly client meetings chaired by the deputy manager where ideas for the home and beyond are shared. Recent examples include advising on the questions for a satisfaction questionnaire and decoration choices for the home. Thomas Edward Mitton House DS0000015072.V282309.R01.S.doc Version 5.1 Page 24 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 3 2 X 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 x ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X X x Thomas Edward Mitton House DS0000015072.V282309.R01.S.doc Version 5.1 Page 25 No 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 YA42 Regulation 13.4(a) Requirement The manager is required to ensure that latex gloves are stored safely. The lounge door is to be adjusted to ensure it closes fully onto its stops. Timescale for action 04/01/06 2. YA42 13.4(a) 20/01/06 3. YA30 23.2(d) The manager is required to 01/12/05 review the cleaning schedules, to ensure that service users personal areas are maintained. The provider is required to undertake and audit of the ensuite bathrooms and forward an action plan to refurbish identified areas. Action plan to be forwarded by 1.1.2006. Identified work to be completed by 1.6.2006. The manager is required to undertake an assessment of the standard and quality of the mattresses in use in the home, replacing any identified as old and worn. 01/06/06 4. YA27 23.2(b) 5. YA26 23.2© 01/02/06 Thomas Edward Mitton House DS0000015072.V282309.R01.S.doc Version 5.1 Page 26 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 YA35 Good Practice Recommendations It is recommended that the fire safety training that takes place on the first day of induction is included on the checklist for the first days training. Thomas Edward Mitton House DS0000015072.V282309.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Aylesbury Office Cambridge Office 8 Bell Business Park Smeaton Close Aylesbury Bucks HP19 8JR 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 Thomas Edward Mitton House DS0000015072.V282309.R01.S.doc Version 5.1 Page 28 - 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!