CARE HOMES FOR OLDER PEOPLE
Victoria Lodge 11 Victoria Road Acocks Green Birmingham West Midlands B27 7XZ Lead Inspector
Ashley Fawthrop Key Unannounced Inspection 31st January 2008 09:00 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 Victoria Lodge DS0000017040.V359181.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Victoria Lodge DS0000017040.V359181.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Victoria Lodge Address 11 Victoria Road Acocks Green Birmingham West Midlands B27 7XZ 0121 707 7921 0121 707 7626 care@victoria-lodge.co.uk 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) Ms Susan Howard Ms Gillian Rea Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Victoria Lodge DS0000017040.V359181.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 28th November 2006 Brief Description of the Service: The quality rating for this service is 2 stars. This means that people using the service experience good quality outcomes.
Victoria Lodge is a large, double fronted mid Victorian residence. It stands back from the road within its own grounds. The building has been adapted and extended to provide accommodation for 24 elderly persons. There is off road parking situated at the front of the premises. There is a large lawned area and patio situated to the rear of the building, which is accessible from the main lounge. The home is located within a residential area of Acocks Green and a short walking distance from all local amenities. Public transport is available close by providing access to Birmingham City centre approximately five miles to the north and Solihull six miles south. People’s accommodation is located on two floors. There are 22 single rooms all with en-suite facilities (toilet and wash hand basin); there are also two comfortable shared rooms. The home does provide respite facilities. There are communal toilets and bathing facilities including assisted bathing located throughout the home. The ground floor provides a quiet front lounge and a dining area leading onto the large lounge, which overlooks the pleasant rear garden. There are dedicated kitchen, laundry facilities and a main staff office. The home has just completed an extension to the building and the extra bedrooms are finished to a high standard. The full fees for the home were between £368.00 and £385.00 per week. Victoria Lodge DS0000017040.V359181.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was carried out without prior notification and was conducted by one inspector over the course of one day. The inspector would like to thank everyone who took the time to talk to them and express their views. People who live in the home completed seven survey forms and relatives carers or advocates completed five. Before the visit, accumulated information about the home was reviewed. This included looking at the number of reported accidents and incidents, adult protection issues, reports from other agencies, i.e., the Environmental Health Officer, and correspondence following the last inspection. This information was used to plan this inspection visit. The inspector case tracked three people’s care plans. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. Where appropriate, issues relating to the cultural and diverse needs of residents and staff were considered. Using this method, the inspectors assessed all twenty-one key standards from the Care Homes for Older People National Minimum Standards, plus other standards relevant to the visit. The inspectors spoke with identified people who live at the home and relevant members of the staff team who provide support to them. Documentation relating to these people was looked at. Where possible, contact was also made with external professionals to obtain their opinions about the quality of services provided at the home. What the service does well:
The home has available detailed information for people and their representatives in the Statement of Purpose and Service User Guide, this is reviewed and updated regularly. The Service User Guide is left in people’s rooms for them or their representative to pick up and check at any time. The print size of the service Users Guide can be changed to help residents with sight impairments. Victoria Lodge DS0000017040.V359181.R01.S.doc Version 5.2 Page 6 People have assessments have an assessment before moving into the home to the home and these assessments were detailed and reflected the individual persons needs and preferences in how care is delivered. People said that the home had got to know them before they got admitted and made arrangements for staff they know to be on duty when they came in. The home makes sure that every person has a care plan that tells staff how the care should be given. This information is summarised so staff to remind them of the help needed can use it quickly. The residents Health Care needs were met. The home showed that they were quick to identify the changing needs in health and make sure that appropriate health professionals were informed. District Nurses and GP’s regularly visit the home as part of the care of the people, they have no concerns about the home and have said that the staff are knowledgeable about the needs of the people in their care. They also said that staff were quick to respond in the changing health care needs of people and were happy to ask for advice. People who visit the home said that the staff were very pleasant and happy atmosphere of the home people living in the home said it was ‘better than I thought a care home could be.’ The home provides activities on a daily basis and has the benefit of a minibus, which allows those people that wish the opportunity of visits out. People are encouraged with assistance to go out to the local shops if able and to maintain good contacts with relatives and friends. There was no restriction of residents walking around the building or going to their rooms if they wished. People said that the food was good well prepared and hot.. The home offers a choice of food at each meal time and residents were monitored for changes in appetite as part of overall health monitoring. The homeowner has meeting s with relatives and people who live in the home routinely to talk about concerns, and improvements the home can make and this openness tends to prevent concerns being complaints. The home was clean and fresh, well furnished and decorated. The staff continue to undertake NVQ training and there are good levels of trained staff in the home. Although the homes management changed recently an appropriately qualified and experienced member of staff who has been the deputy for sometime Victoria Lodge DS0000017040.V359181.R01.S.doc Version 5.2 Page 7 manages the home. This has made sure that continuity of care has been maintained The home has an independent quality assurance assessment but also the homeowner checks the home’s performance against the National Minimum Standards and this is commended. The home assists people to manage their finances and assists relatives and residents manage small floats of money for hairdressing and so on. All sampled maintenance and inspection records for services such as gas and electric were in place and in date. What has improved since the last inspection? What they could do better:
The home provides a very good service to the people who live there. However, the manager is new to the post and needs time to make sure that the services provided are constant and remain at a high standard. He is supported by the registered provider and there is good level of supervision and input from her.
Victoria Lodge DS0000017040.V359181.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Victoria Lodge DS0000017040.V359181.R01.S.doc Version 5.2 Page 9 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 Victoria Lodge DS0000017040.V359181.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides sufficient information for people about the service before they move into the home. This gives them the opportunity to assess whether the home can meet their needs or not. People have their needs assessed by the home and the home keeps this under review and staff are able to meet the needs of the residents in the home. EVIDENCE: The home recognise the importance of supplying up to date information to people about what services the home can offer. The home’s Statement of Purpose and Service User Guide are reviewed and updated regularly. Copies of the service users guide are given to each person these were visible in people’s bedrooms.
Victoria Lodge DS0000017040.V359181.R01.S.doc Version 5.2 Page 11 Speaking to visitors they said that they had received information about the home and had had the opportunity to visit before making the decision use the service. Both the Statement of Purpose and the Service User Guide have useful information and gives a clear account of the services, specialist services and the routines of the home and the environment. These can be dated quickly and that the size of the print can be adjusted to the needs of the individual. The Service User Guide contains a list of people’s rights and clearly showed that the home has considered the range of ability, cultural experience, sexuality, religion and so on that may influence what the people can expect from the home. All the care plans case tracked had pre admission assessments and the needs of the individual were clearly shown. People’s health and personal care were clearly assessed enabling the staff to start the care plan as soon as the person moved into the home. Two residents said that the home had got to know them before admission. One resident came to the home for visits, then day care and then respite care before deciding to make a move into the home. People said that a staff member they had got to know helped them when they were admitted to the home. One person that had been admitted recently had good assessments on file. The information for the assessment was collected before admission and involved the care manager sometimes visiting the hospitals to gain the information. The assessments were in plain English and were easy to read and this makes them accessible for residents, their representatives and staff. There are no people admitted into the home for intermediate care. Victoria Lodge DS0000017040.V359181.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care planning was individual to the person it was written for and meets their diverse needs. The health care needs of people were monitored and met. The policies and procedures relating to the ordering, storage, administration and disposal of medications was safe. People who live in the home and relatives were happy that they were treated appropriately and sensitively. EVIDENCE: Three care plans were case tracked these are people centred and were based on meeting the physical and social and emotional needs of people. These included how the dignity, autonomy, and diversity would be met. Victoria Lodge DS0000017040.V359181.R01.S.doc Version 5.2 Page 13 Care plans included good information that explained a persons psychological need or behaviour where this was needed. The care plans included risk assessments where necessary for example on moving and handling and mobility. The care plans are reviewed on a monthly basis for any changes however where changes have been seen care plans are amended quickly. There was evidence that people have access to healthcare services and other health care professionals such as GP’s Dentists, Chiropodists, opticians and specialist NHS services. Concerns or incidents recorded in the daily reports were acted upon quickly and where required other professionals were involved. District Nurses and GP’s regularly visit the home as part of the care of the people, they have no concerns about the home and have said that the staff are knowledgeable about the needs of the people in their care. They also said that staff were quick to respond in the changing health care needs of people and were happy to ask for advice. People said that the staff were very caring and the improvement in their relatives health and well being were very good. Records relating to accidents or injuries to people who live in the home or staff are well recorded. The home has its medication delivered in a monitored dosage system and this has the medication for the people separated out into sections according to the time of day it needed to be given. The medications were seen to be given safety and the recording was accurate. The recording of prescriptions was appropriate and the system is audited regularly to reduce the risk of mistakes. People who self medicate have risk assessments to minimise the risk and theses are reviewed as necessary. People spoken said that they were happy in the home and that the staff were helpful and friendly. Observation and interviews with staff suggest that people are treated with respect. Relatives said ‘Victoria Lodge is very pleasant and happy home.’ ‘ People said We have been very impressed with the whole atmosphere there staff are great and very friendly.
Victoria Lodge DS0000017040.V359181.R01.S.doc Version 5.2 Page 14 Victoria Lodge DS0000017040.V359181.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provided activities for people that are meaningful and individual meeting their diverse needs. The arrangements for food, visits and choice were good with residents and relatives expressing happiness with the service provided. EVIDENCE: The home makes sure that there is a designated activity every day and in addition there is always a singsong at part of the day. People have the opportunity to be involved in making their own lifestyles and organising their days. This includes having the opportunity to go out with friends or family of with the staff in the homes mini bus. People visiting the home said that they were happy with the visiting arrangements. Visiting arrangements were detailed in the Service User Guide and restrictions were only made around meal times.
Victoria Lodge DS0000017040.V359181.R01.S.doc Version 5.2 Page 16 People who live in the home and their visitors were seen to have freedom of movement within the home. Care plans showed residents preferred routines of getting up and going to bed. People were seen enjoying the privacy of their own rooms or entertaining visitors in private. Comment cards suggested that the majority of residents thought that the meals were always good with a number thinking they were usually good. The menus provided showed that people had a choice of food at meal times. Staff were seen asking people what they wanted for a meal. The home had good stocks of food available. The cook was aware of what people were not eating well and had a monitoring system in place to record the amount these residents had eaten and where needed supplements were started. People said that the food was good that there was fruit available and the meals were hot and well cooked. Victoria Lodge DS0000017040.V359181.R01.S.doc Version 5.2 Page 17 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home makes sure that people who live in the home and their relatives could raise their concerns in different ways and be confident that these would be dealt with. The home ensured by good procedures, good communication and training that people were protected. EVIDENCE: There have been no complaints received since the last inspection. The policies and procedures relating to how to complain are easy to understand and are made available to people who live in the home and their relatives. People spoken to said they had a good relationship with the staff at the home but would not have a problem talking to the staff or manager if they had any concerns. The homeowner and manager are available and make themselves known to relatives and check that people are happy with the service they provide. Victoria Lodge DS0000017040.V359181.R01.S.doc Version 5.2 Page 18 The homeowner has meetings with both pe9ople who live in the home and their relatives to discuss the running of the home and concerns are talked about. The service user guide has information about how to complain. Comment cards received stated that people and relatives knew how to complain but had manager if they were unhappy about anything. The home has appropriate adult protection procedures including The Department of Health guide “No Secrets” and staff undertake training in the Protection of Adults from Abuse either as an in house training session or as part of NVQ training. People said they had no concerns about their safety. Victoria Lodge DS0000017040.V359181.R01.S.doc Version 5.2 Page 19 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24 and 26 People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The décor, facilities in the building were to a high standard and met the needs of the people who live there. The home is well maintained and safe. EVIDENCE: The home is decorated and maintained to a good standard. The communal areas are light and spacious they are pleasantly decorated and furnished. On touring the building it was noted the people were able to decorate and furnish their own rooms and have their own personal possessions around them.
Victoria Lodge DS0000017040.V359181.R01.S.doc Version 5.2 Page 20 This gives the rooms a feeling of individuality and ownership. At this inspection the manager’s office was in the treatment room while the manager’s office was being refurbished. There are sufficient bathrooms and toilets in easy reach of communal areas. There is special equipment available including assisted baths, hoists and wheelchairs. The home was clean and fresh at the time of the inspection. The home has domestics and housekeepers available that have undertaken NVQ training in cleaning and this helps to ensure that infections were kept under control. The home had adequate laundry and cooking facilities to meet the needs of the people. Victoria Lodge DS0000017040.V359181.R01.S.doc Version 5.2 Page 21 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, and 30 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home recognises the importance of skilled and trained staff in sufficient numbers to meet the needs of the people who live there. The policies and procedures relating to recruitment and selection have improved since the last inspection and are robust. EVIDENCE: No concerns were raised with the number of staff available to provide care. Rotas showed that the current staffing level was three care staff throughout the 24 hours with additional housekeeping, cooking and management support and this level of staffing is good. The home showed continues to provided NVQ training to staff and levels of trained staff are good. The home undertakes a recruitment process and details of this were kept on the staff files for example the inspector found application forms, references, Criminal Record Bureau checks and checks against the Protection of Vulnerable Adults list. The home was on occasions employing staff for their supervised induction days before these checks were in place. Since the last inspection no
Victoria Lodge DS0000017040.V359181.R01.S.doc Version 5.2 Page 22 people have started work at the home without a check by the Criminal Records Bureau. This is improved practice. The home had an induction procedure and was aware of the Skills For Care organisations recommended training for new staff. The home kept a matrix of training that staff had undertaken this did not have dates of achievement so it was difficult to check that these had been up dated within the timescales. One staff member spoken to needed formal update training on first aid. The home manager trains the staff on moving and handling her Training for Trainers has been updated and this makes sure that moving techniques in the home remain current and safe. The home has some training that it undertakes by videos and must make sure that these remain current as practices change. Victoria Lodge DS0000017040.V359181.R01.S.doc Version 5.2 Page 23 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home was well run and managed with the best interests of people who live in the home and staff. Health and safety being promoted and people are protected. EVIDENCE: The registered manager has left the home since the last inspection. However, the deputy manager has now taken the role. This has made sure that some consistency in care is continued. Victoria Lodge DS0000017040.V359181.R01.S.doc Version 5.2 Page 24 The new manager worked at the home for some years and is appropriately experienced and qualified. People spoken during the course of the inspection said that they knew both the owner and the manager well and said that the home was run very well and that they were always available to speak to. The home has a system where staff have the opportunity to quality audit there procedures to make sure that the people who live in the home receive the best care. The home has had an independent quality assurance where it scored extremely high and both the manager and homeowner are keen to improve. The home has an annual review of its service and the homeowner regularly assesses the home’s performance against the National Minimum Standards. People who live in the home and relatives are invited to meetings to discuss the home. The homeowner is in day-to-day contact with the home. The home assists people that cannot manage their financial affairs in several differing ways. A number of people have small amounts of money kept in the safe to pay for hairdressing and so on. The home had appropriate records of maintenance testing and inspection of the building to ensure the safety of Gas and Electrical installations, Lifting equipment and Fire equipment. Victoria Lodge DS0000017040.V359181.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X NA HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X X 3 X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 X X 3 Victoria Lodge DS0000017040.V359181.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Victoria Lodge DS0000017040.V359181.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Victoria Lodge DS0000017040.V359181.R01.S.doc Version 5.2 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!
