Inspection on 18/04/07 for Waterside Care Centre

This inspection was carried out on 18th April 2007.

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

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

Other inspections for this house

Waterside Care Centre 31/12/09

Waterside Care Centre 20/07/09

Waterside Care Centre 14/07/08

Waterside Care Centre 22/05/06

Waterside Care Centre 18/01/06

Waterside Care Centre 01/06/05

Waterside Care Centre 09/11/04

Waterside Care Centre 06/07/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Waterside Care Centre 60 Dudley Road Tipton West Midlands DY4 8EE Lead Inspector Mrs Amanda Hennessy Key Unannounced Inspection 18th April 2007 10:00 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 Waterside Care Centre DS0000004824.V330680.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. Waterside Care Centre DS0000004824.V330680.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Waterside Care Centre Address 60 Dudley Road Tipton West Midlands DY4 8EE Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0121 520 2428 0121 520 2448 dalwoods@bupa.com BUPA Care Homes (AKW) Ltd Mrs Frances Taylor Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60) of places Waterside Care Centre DS0000004824.V330680.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 22 May 2006 Brief Description of the Service: Waterside Care Centre is a purpose built Home, opened in 1997, which provides 60 beds for frail older people who require nursing care. The Home is located on the main road between Dudley and Tipton, with public transport and local amenities easily accessible. There are pleasant views of the Black Country canal at the rear of the Home and the Black Country Museum is approximately 300 metres away. There is car parking to the front of the Home and gardens and patio areas to the rear. Accommodation is provided on two floors, all bedrooms are single and have en-suite facilities. There are large lounge/dining rooms on both floors and a number of small quiet sitting areas. The Home offers intermediate / rehabilitation care in up to 10 of its beds, with a team of professionals visiting each week to assess and assist this care. The current scale of charges are £456 - £658.35 per week dependent on the needs and dependency of service users. Waterside Care Centre DS0000004824.V330680.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an inspection undertaken without any notice by one Inspector. The inspection was undertaken between 10.00 and 18.45hrs. This visit included a review of records, talking to staff and service users and a review of information sent to the Commission for Social Care by the Manager before the inspection including comment cards from service users and their visitors. Care records were reviewed as part of the “case tracking” of six service users from each floor. Waterside is owned by BUPA Care Homes Ltd. Mrs Frances Taylor is the registered manager. Two of the previous four requirements have been addressed; four new requirements was made as a result of this inspection What the service does well: What has improved since the last inspection? Waterside Care Centre DS0000004824.V330680.R01.S.doc Version 5.2 Page 6 Care records are now more detailed and include required information. Proposals have been agreed to refurbish and update a number of areas within the home, which will further enhance the environment of the home for people who live there. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Waterside Care Centre DS0000004824.V330680.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Waterside Care Centre DS0000004824.V330680.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective service users needs are assessed prior to their admission to the home, this gives assurance their needs will be met. Terms and conditions of residency would provide service users with more comprehensive information about contractual information about the home. Designated staff provide skilled intermediate care maximising the opportunities for rehabilitation. EVIDENCE: Services users have an assessment of their needs by either the Home Manager or a senior member of staff before agreement is made that their needs can be met at Waterside. Hospital staff assess people admitted for intermediate care with their assessment faxed over to the home before they are transferred to Waterside. Residents and their relatives are involved in this assessment of their needs when ever possible. The Home Manager writes to the prospective Waterside Care Centre DS0000004824.V330680.R01.S.doc Version 5.2 Page 9 resident confirming that the home is able to meet their needs should they wish to come and live at Waterside. All service users have either a placing agreement with their funding authority or a contract if they are privately funded. Information about living at the home is included with the service user guide although terms and conditions of residency are not available. Service users admitted under the intermediate care arrangements have their own facilities and dedicated staff team. The team are supported and given training in rehabilitation from the Primary Care Trust rehabilitation staff that include physiotherapists and occupational therapists. Waterside Care Centre DS0000004824.V330680.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The healthcare needs of service user’s are identified and met. Procedures in relation to medicines are generally satisfactory and safeguard service users. Service users are not always treated as people requiring respect. EVIDENCE: Service user’s have a plan of their care and care risk assessments to ensure that staff are aware of their needs and appropriate arrangements are in place to address them. Risk assessments include the risk of pressure sores, moving and lifting of residents, continence, nutrition and falls. Care plans and risk assessments are reviewed at least monthly with the service users whenever possible or their representative involved in their care. The home was about to update all of its care planning records the day after the inspection with all staff having received training in the new care records. Staff were all positive about the new care planning records feeling that they would further enhance care and care planning. Waterside Care Centre DS0000004824.V330680.R01.S.doc Version 5.2 Page 11 Records seen show that service users are able to access specialist medical and nursing services alongside dental, optical and chiropody services. Care records demonstrated, and comment cards returned confirmed, that they were informed that their relative had seen a Doctor or when there were changes to their health needs or treatment. The home has appropriate policies for the safe handling and administration of medicines. Qualified nurses administer medicines to all service users. The Staff have appropriate records of prescriptions that have been ordered, when the prescription has been checked and medicines that have been received. The drugs fridge temperature and treatment room temperature are checked daily which gives assurance that these medicines are stored safely. The storage and administration of controlled drugs was checked and all were found to be appropriate. The medication administration records were checked and were generally appropriately completed although staff do not consistently sign for the administration of creams and lotions. The home has recently changed its supplying pharmacist and concern was highlighted that the new pharmacy use medicine stickers when medicines are added and there is poor printing of the medication records which is both unsafe and not recommended practice. Service users said that staff generally act on what they say although there was frequently a delay in doing so. Observations made during lunch highlighted that service users “were done to”, with meals placed in front of them, drinks poured for them and fed without staff talking to them and explaining what they were doing. Residents had coveralls put on them by staff to protect their clothing without staff speaking or giving any other choice (such as to use a napkin). Waterside Care Centre DS0000004824.V330680.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a range of activities to cater for a range of service users preferences. A choice of meal is always available but there is a need for staff to make meal times more of an occasion for residents to look forward to. EVIDENCE: Records show that staff ascertain service users interests and preferences such as what time they like to get up, go to bed or spend their day. There are monthly trips out with regular trips to the theatre and The Black Country Museum. Other trips have included visits to the Sea Life centre, the Botanical Gardens and a canal trip. One gentleman spoken to said: “ I had a lovely day out at the military display”, with photographs showing him enjoying a day out at RAF Cosford and their new “Cold War” exhibition. The home has an Activity Organiser who also organises day-to-day activities such as bingo, cooking, crafts, cards games, professional entertainment and other social events such as a recent Easter bonnet parade, garden parties and a forthcoming jumble sale. Several residents commented: Waterside Care Centre DS0000004824.V330680.R01.S.doc Version 5.2 Page 13 “I take part when I want to” and “ I do not want to participate in activities”. A record is made of all activities that residents take part in. Families are encouraged to visit and attend social events that the home holds. The home has a four-week menu that is seasonal and is changed winter and summer, a hot choice available at each mealtime. Staff said that they asked service users either before or after lunch for their choice of meals for the following day. Staff explained when asked about the sufficiency of tables and chairs, that only one resident downstairs liked to have their meals at the table with the remaining residents choosing to remain in their armchairs. Dining tables were appropriately laid upstairs with tablecloths, napkins and cutlery although downstairs tables were not laid. Residents did not have trays laid and were handed their soup and dessert with the spoon put into it and their knives and forks were handed to them with their dinner. The home use sachets of sauce and salt and pepper but these were not offered to residents. One resident commented that they felt that the food did not contain enough salt which could easily have been addressed if all residents were offered condiments. A resident said when their meal had been put forward in front of them by the staff member without speaking to him;-“ I didn’t realise it was lunchtime”. Comments about the food were generally mixed: “The food is plentiful and nicely served”. “”Sometimes the food is not always nice.” and “I always like the meals, it’s not very often that I leave any”. Waterside Care Centre DS0000004824.V330680.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has appropriate policies and procedures to highlight concerns and safeguard service users. Further work must be undertaken to ensure that service users know who to make their concerns known to. EVIDENCE: The home has a detailed complaints procedure. The complaints procedure is displayed in the main reception area of the home and is also included in the service user guide. The home has received six complaints within the last twelve months which were appropriately investigated within required timescales. Two complaints were found to be substantiated with the manager undertaking required actions to address the concerns. Fifty percent (10) of service users who completed comment cards said that they “never” know whom to complain to which needs exploration to see if further actions are required. The home also has a comprehensive adult protection policy that identifies required actions to be undertaken when allegations of abuse are made. There have been two adult protection investigations with all required actions undertaken. The majority of care staff have had adult protection training with Sandwell Council Adult Protection Unit. Waterside Care Centre DS0000004824.V330680.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,25,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean pleasantly decorated and furnished with no offensive odours and has a nice garden for service users to enjoy. The home infection control procedures minimise the risk of cross infection to service users. EVIDENCE: The home is clean and homely with no offensive odour and is pleasantly decorated and furnished. There is a large lounge/ dining room on each floor and three smaller lounges, one of which is designated smoking lounge. A decoration plan is ongoing with the upstairs lounge recently redecorated and has had a new carpet, although the need to replace the upstairs corridor carpet has not been undertaken. Lighting in the some areas of the home (but particularly the downstairs lounge) was found to poor but the manager confirmed that this would be addressed by new and more efficient lighting. The Manager is delighted that work has commenced to convert a bathroom into a kitchen that residents can use. The home has a full call system and a variety of Waterside Care Centre DS0000004824.V330680.R01.S.doc Version 5.2 Page 16 aids and adaptations such as grab rails, assisted baths and wheel in showers and there are ten specialist-nursing beds that are fully adjustable for dependent service users. The home has a small well-maintained garden with garden furniture, patio planters and a water feature. There are boards in the lounges that give information about resident’s medical history and dietary needs which breach confidentiality and should be removed. The home has appropriate infection control procedures that minimise the risk of cross infection, which will be further improved by changes that are being undertaken to the laundry. Waterside Care Centre DS0000004824.V330680.R01.S.doc Version 5.2 Page 17 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): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing arrangements need to be reviewed to ensure that service users needs are met. Recruitment and selection procedures at the home are generally robust and safeguard its service users. Staff have required training opportunities. EVIDENCE: The home provides qualified nurses and carers for each floor with ancillary staff available 7 days a week. Residents however consistently identified that they had to wait for staff to assist them particularly going to the toilet will the following being examples of the comments received: “Staff listen but do not always come right away, they could do with more staff”. “Have to wait too long for the toilet” - “They are short staffed and too busy”“I have to wait too long” “They need more staff, I have too wait too long for the toilet” and “ I get the support but it is slow coming when requested i.e. toileting”. It is not clear whether there are sufficient staff or the way that staff work is ineffective and they require additional supervision or that aids and adaptations Waterside Care Centre DS0000004824.V330680.R01.S.doc Version 5.2 Page 18 are insufficient causing the delay. This requires further exploration by the Manager. The manager ensures that all required checks have been undertaken before the new member of staff commences employment, which includes two written references and a criminal record check. New employees however do not always include dates of their previous employment with one member of staff having no previous dates and two others having just the year and not the month that they were employed. The home uses the BUPA induction programme which that meets national training organisation standards, although no records were seen in the staff files see that they have completed their induction. The Manager encourages staff to undertake a care qualification (NVQ). The home currently has 40 of its care staff with a care qualification. As additional staff complete their training in June 2007 this will increase the homes percentage of qualified care staff to 62 which will exceed the national target by 12 . Waterside Care Centre DS0000004824.V330680.R01.S.doc Version 5.2 Page 19 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): 31,33,35,36, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Leadership of this home is good but there remains some ongoing resistance by some staff to good management practice which potentially could undermine care delivery to service users. The sound financial management of the home and arrangements for safekeeping of their money safeguards service users interests. Staff receive formal supervision and direction although records of this were not up to date. The home has a quality plan that enables services users to be listened to. The home has good health and safety specialist support to support safe practice within the home. There are required mandatory training opportunities although records are not up to date to evidence this. EVIDENCE: Waterside Care Centre DS0000004824.V330680.R01.S.doc Version 5.2 Page 20 The home has an experienced and well-qualified nurse manager who has managed the home for the previous two years. The Manager since her appointment at the home has being developing the staff group and feels that each floor has two experienced and committed senior sisters who are continuing to develop their staff. The manager holds frequent staff meetings and maintains a record and actions taken in response to staff inputs. Staff have supervision but records were not available to evidence that they are held at required intervals. A survey of service users views undertaken during December 2006 has been analysed and a report of findings and an action plan has been implemented. The findings from the survey have also been compared to the findings at the previous survey, which was undertaken in December 2005. The area manager undertakes monthly regulation 26 visits providing a report for the Commission. The manager agrees a budget for each year to meet the agreed business plan, which reflects the findings of the auditing undertaken. The home does not act as appointee for service users, arrangements with full accounting practice is in place for personal allowances held for safekeeping. The home is subject to a health and safety audit by the company advisor, which covers all areas of the home with good standards found. Inspection of the health and safety monitoring records show these to be up to date and that very good standards are being maintained consistently. Certification of services and equipment are all in date. Staff receive mandatory training, although records were not available to fully evidence that this training is up to date. Waterside Care Centre DS0000004824.V330680.R01.S.doc Version 5.2 Page 21 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 x 2 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 x x x x x 2 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 4 x 3 2 x 2 Waterside Care Centre DS0000004824.V330680.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP2 OP9 Regulation 5(1)(b) Requirement Timescale for action 30/09/07 31/05/07 3 OP10 4. OP19 All service users must have a copy of their terms and conditions for living at the home. 13(2) There must be no gaps on the medication record with a record made of the administration of creams and lotions. 12(4) The registered person must ensure that the care home is conducted in a manner which respects the privacy and dignity of service users. 13(3) & The first floor corridor carpet 23(2)(c,d) must have the marks removed or carpet replaced. (This requirement was part met with all other elements removed) and should have been addressed by 30/09/06 18 18(1)(a) There must be sufficient staff to meet service users needs. The registered person must ensure that sufficient staff are qualified to NVQ level 2 in care to ensure a minimum of 50 of carers can be achieved at all times. 31/05/07 30/06/07 5 6. OP27 OP28 16/05/07 30/06/07 Waterside Care Centre DS0000004824.V330680.R01.S.doc Version 5.2 Page 23 This requirement was part met and should have been addressed by 30/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 Refer to Standard OP15 OP16 OP27 OP29 OP36 OP38 Good Practice Recommendations A review is undertaken to ensure service users are served their meals in a pleasant and congenial setting. A review is undertaken to determine the reason why service users say that they never know how to complain. A review is undertaken to determine why service users say that they have to wait to go to the toilet. Staff application forms include at least the month and year of employment. Staff receive supervision that is recorded. There is a record of all mandatory training that staff receive. Waterside Care Centre DS0000004824.V330680.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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 Waterside Care Centre DS0000004824.V330680.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!