Inspection on 30/04/09 for Walton Lodge

This inspection was carried out on 30th April 2009.

CQC found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Walton Lodge 08/09/09

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Walton Lodge 316 Bawtry Road Doncaster S Yorkshire DN4 7PD     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Sarah Powell     Date: 1 5 0 5 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought 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 The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 24 Information about the care home Name of care home: Address: Walton Lodge 316 Bawtry Road Doncaster S Yorkshire DN4 7PD Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Wendy Lloyd Type of registration: Number of places registered: care home 13 Walton Lodge Ltd Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Walton Lodge is a care home for adults ages 18 - 65 with severe learning disabilities and autism. The home can accommodate up to thirteen clients. The home is a converted large modern bungalow with extensive and secure gardens. It has been extended and separated into two units. One unit is for four clients to practice independence skills. The home is on the bus route into town and close to some local amenities such as shops and pubs. The home also has a minibus. The home provides staff over twenty-four hours. They also employ a handyperson. The current weekly fees vary depending on the persons needs, for further information you should contact the home. Additional charges are made for outings, toiletries and various activities. 13 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been revised or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. This was an unannounced visit, which took place on the 30th April and 6th May 2009. The first day commenced at 09:30 and ended at 16:15 hours. The second day commenced at 09:45 and finished at 17:30 hours. Two inspectors were present on each day the lead Inspector and an Inspector from the regional enforcement team. A pharmacy Inspector also visited the home as part of this key inspection on Friday 8th May 2009 the visit commenced at 8:30 hours and finished at 11:45 hours. This inspection visit included talking with people living at the home, a number of Care Homes for Adults (18-65 years) Page 5 of 24 professionals, the deputy manager, the manager and five staff. During the visit we also walked round the building to gain an overview of the facilities. We also checked a number of records. The manager had not completed an AQAA but this was in agreement with the Inspector, as the home had recently had a fire and the inspection had initially been rescheduled. However a number of safeguarding referrals had been received and following an investigation by other organisations, it was decided the key inspection could not be rescheduled. Full feedback was given during and at the end of the inspection to the deputy manager and registered manager. Care Homes for Adults (18-65 years) Page 6 of 24 What the care home does well: What has improved since the last inspection? What they could do better: 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. No pre-admission assessments were carried out for service users who had been admitted into Walton Lodge Evidence: We looked at care plans and saw there was no evidence that the home had carried out a detailed assessment prior to admission. Therefore they were also not kept under review or revised when there was a change in circumstances. The deputy manager told us she had not seen any assessments but the manager may have these. The manager gave us assessments for the 2 most recently admitted service users. These were on the computer, not in service users care plans. The information on the assessment was limited and did not clearly identify peoples needs. We found detailed assessments for service users from placing authorities. However these were not kept in service users care plans for staff to have access to. This would enable the staff to understand service users assessed needs and how best to meet them. Care Homes for Adults (18-65 years) Page 9 of 24 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care Plans did not fully detail how service users health and welfare needs would be me. Evidence: We looked at the care plans and risk assessments for the service users who are accommodated at Walton Lodge. We saw that care plans in the home at the time of the inspection, and available to staff to inform the delivery of care to service users, were very basic. Care plans contained much information to record for example, whether or not service users had washed, brushed their teeth, their bowel movements etc. but little in the way of more person centred planning and individual service user profiles to record their likes, dislikes and personal preferences. Care plans lacked information to record the actions staff are required to take to meet service users needs. Care Homes for Adults (18-65 years) Page 10 of 24 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported with leisure activities, links with family and friends were maintained and the food we observed was well presented. Evidence: People access activities each day, all service users are staffed one to one so are able to go out at any time with the care worker. Many activities are organised including arts and crafts, trampolining, bowling, swimming, movie nights, meals out, going to the pub, cinema, board games, education centres and days out. There is a mini bus used by all service users and two people share a car. Good family links were maintained, families we spoke to told us they are always made welcome when they visit and their involvement is encouraged. During our visit we observed good Interaction between staff and service users. We observed one meal during the visit it was well presented and appetising. There was a new cook in post and he had attended training, however not all the correct Care Homes for Adults (18-65 years) Page 11 of 24 Evidence: records were being maintained, as the cook was still to receive training on safer food better business, The manager told us she was going to do this as soon as possible. The kitchen being used was not the main kitchen as this was out of action following the fire, therefore facilities were cramped and lacked storage. The building work is due to be completed by 3rd July and then the main kitchen will be recommissioned. It was not clear from the care plans seen if peoples nutritional needs were being assessed or reviewed, one person was seen to have lost considerable weight in a short period yet their had not been followed up to ensure the persons needs were being met. Care Homes for Adults (18-65 years) Page 12 of 24 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users health care needs were not always met, medication practices were generally satisfactory. Evidence: Service users did not always receive support in the way they require. Professional advice was not always obtained and when it was obtained, it was not always followed. This did not ensure people needs were met. Service users were not always given choice or control over there lives as the plans did not reflect their choices. The plans were not person centred. Service users health care needs were not always met, two people we looked at in detail during our visit were identified as at risk of choking, yet no professional advice had been requested. This put people at potential risk of choking as staff did not know the best methods to reduce or eliminate the risks. As part of this inspection process a Pharmacist from CQC carried out an inspection of the medication policies and procedures. During this visit we examined the homes medication procedure documents, nine current medication administration record (MAR) charts, and the temporary medication storage & handling arrangements. We also observed one senior carer give medicines to one person at breakfast time. Medicines are not currently stored securely enough. All medicines must be stored securely at Care Homes for Adults (18-65 years) Page 13 of 24 Evidence: temperatures and conditions recommended by the manufacturer so that staff know they are safe to use when needed. Work undertaken during the homes refurbishment must ensure that a suitably sized and equipped temperature-controlled room is made available for the secure storage of all medicines. The procedures for ordering, receiving, storing, administering and disposing of medicines should be revised to reflect current best practice guidance. The procedure documents we were shown do not provide enough information for staff on current legislation and guidance to make sure that safe practices are followed. The Royal Pharmaceutical Society of Great Britain and Care Quality Commission professional advice documents on handling medicines in social care should be made available. Robust procedures and up to date guidance mean that staff working in the home fully understand what is expected of them when handling and giving medication. There are only a few administration gaps on the MAR charts meaning that people living in the home can expect to receive their prescribed medicines correctly. However, handwritten entries of eleven medicines seen on five MAR charts are not sufficiently clear or detailed enough to be sure that other staff would always follow the prescribers instructions consistently. The quantity of medication brought forward from one monthly cycle to another is usually recorded on the new MAR chart. This means it is possible to produce a complete record of medication within the home and to check if medication is being given correctly. Monthly prescriptions are not currently seen and checked by senior staff before the medicines are supplied. The prescription is the authority for the staff to administer medication to the person. This also provides an opportunity to check if any new medicines or dose changes have been added. Any problems with prescriptions can be addressed at this point rather than after the supply has been made. The checking of prescriptions is an important part of the management of medication. Individual medication care plans should be developed to reflect the personal preferences and lifestyle choices of people living in the home. For example, daily medication giving times should be adjusted for anyone who prefers not to get up and have breakfast until later in the morning. Clear information should be recorded in each persons care plan to guide staff when giving those medicines labelled when required to ensure the prescriberss intentions are carried out correctly. Care Homes for Adults (18-65 years) Page 14 of 24 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good complaints procedure was available, however people were not always safeguarded. Evidence: The home had a good complaints procedure and this is usually displayed in the entrance hall however due to the fire this area is not in use. When the work is completed this will be displayed again in the hall so it is accessible to everyone. During our visit we also looked into a safeguarding referral that had been made. We identified that staff had not been notifying CQC of incidents that required a notification, many of these were safeguarding incidents. Since the visit a large number of referrals have been made to Doncaster safeguarding and are currently being investigated to ensure people are safeguarded. Care Homes for Adults (18-65 years) Page 15 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment was poor due to the fire and ongoing building work. Evidence: Following the fire half of the home was not accessible. Building work is ongoing and is hoped to be completed by 3/7/09. The environment at the time of the visit was poor as the part of the home affected by the fire contained the communal areas, dining room, lounge, activity room and the main kitchen. The current facilities were very cramped and portacabins were being uses as additional space , which was not ideal. The staff were maintaining the cleanliness as best as possible in the circumstances. Care Homes for Adults (18-65 years) Page 16 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff were not appropriately trained and recruitment procedures didnt protect people. Evidence: Not all staff were up to date with required training, which did not ensure staff were appropriately trained. Training specific to the service users was not always carried out, for example there was no record that any of the staff from Walton Lodge have received training specifically related to Challenging Behaviour. Although it is acknowledged that some staff will have received some training in this area indirectly through NVQ Training. NVQ training was good over 50 of staff had acheived a NVQ level 2 or above. We looked at recruitment there was not a robust and effective recruitment and selection procedures at Walton Lodge. Criminal Records Certificates including Protection of children Act (PoCA) list checks were not obtained for staff. Some staff had been appointed before a full Criminal Records Certificate was obtained and only had a PoVA First clearance but were not appropriately supervised supervised during this period to ensure people were protected. Care Homes for Adults (18-65 years) Page 17 of 24 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management procedures need to be improved once the home is fully operational when the building work is completed. Evidence: The manager is registered with CQC and has been the manager for 7 years. Following our visit and issues we found a new management structure has been put in place there is a deputy in post and an assistant deputy, this will help ensure the issues raised will be dealt with as quickly as possible. The manager told us quality monitoring has continued since the fire and all maintenance records are up to date as they were all checked prior to moving back in the home following the fire. These two standards will be looked at in detail at the next key inspection when Walton lodge is fully open once the building work is completed. Care Homes for Adults (18-65 years) Page 18 of 24 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 19 of 24 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 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 2 14 All perspective service users needs must be assessed prior to admission. This will ensure the home is able to meet peoples needs. 06/07/2009 2 6 15 Each service user must have 06/07/2009 a plan of care. The plan must detail all aspects of personal support, social support and healthcare needs to ensure all peoples needs are met. 3 7 12 Service users should be able 06/07/2009 to make decisions about their lives with assistance as needed. This ensures their rights are respected, these should also be documented in the plan of care. 4 17 13 Service users nutritional 01/09/2009 needs must be assessed and reviewed including risk Care Homes for Adults (18-65 years) Page 20 of 24 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 factors associated with low weight, obesity and eating disorders. This will ensure peoples needs are met. 5 18 12 Service users personal support should be provided in the way they prefer and require. To ensure their needs are met. 6 19 12 Service users health care needs should be identified and procedures in place to address them. to ensure peopels needs are met. 7 20 13 Arrangements must be made to ensure that all medication is stored securely at the correct temperature recommended by the manufacturer. Staff will then know that medicines are safe to use when needed. All incidents must be reported and people safeguarded by the homes policies. Ensuring people are protected from abuse. 06/07/2009 06/07/2009 06/07/2009 8 23 12 06/07/2009 Care Homes for Adults (18-65 years) Page 21 of 24 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 9 24 23 provide an action plan with timescales for completion of the building work, including decoration. to ensure people have a well maintained environment and have full use of all the facilities. 06/07/2009 10 34 18 All staff must be appropriately trained. Ensuring they can meet the needs of the service users. 06/07/2009 11 35 19 A robust recruitment procedure must be followed ensuring staff have CRBs and PoCA list checks. This will ensure people are safeguarded. 06/07/2009 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 2 17 20 This will ensure the home is able to meet peoples needs. Regular, monthly prescriptions should be seen before sending to the pharmacy. This makes sure a check can be made that all the medicines requested have been prescribed and prevents people from being without. Handwritten entries on MAR charts should should be accurately recorded and detailed. They should also be signed, dated and checked by a witness. This makes sure that the correct information is recorded so that all staff understand and follow the changes correctly. 3 20 Care Homes for Adults (18-65 years) Page 22 of 24 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 4 20 Individual agreements about how, where, and when to give people their medicines should be put in place which reflect the personal preferences and expressed lifestyle choices of people living in the home. Care plans should include detailed information and instructions to staff in respect of the administration of medicines, including the circumstances for the use of medicines prescribedwhen required. The medicine policy & procedures should be updated in line with current guidance so that staff understand how to handle and administer medicines safely. 5 20 6 20 Care Homes for Adults (18-65 years) Page 23 of 24 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 24 of 24 - 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!