Care Home: Grasmere House

What the care home does well The manager ensures that she has a good understanding of prospective service users needs. This means that no one would be admitted to Grasmere House unless she is confident that the service can support them properly. Staff communicate effectively with each other, using care plans and handovers to convey any changes in peoples needs that that they have observed. Health care is well monitored and the staff encourage people to remain as mobile as possible . They also ensure that medication is reviewed regularly. One relative commented that their father had "improved mentally and physically" since he moved to Grasmere House. Staff are provided with a good range of training and thorough induction programme so that they are confident that they have the skills and knowledge to do their job well. A lot of the staff have worked at Grasmere House for a considerable time and know the residents well. There is a low staff turnover and no ageny workers are required to cover any shifts. Staff are supported by a capable, experienced manager. Service users and their relatives are asked what they think of the quality of the service. Mrs Ramtohal is responsive to any suggestions made. One person said that Grasmere House was homely and had a good atmosphere. This was found to be the case during the visit. Relatives are happy with the quality of care provided. One said, for example, "I am completely satisfied that she is receiving the care that she needs" another said "I`ve never had a complaint" One resident said "I`m happy here" What has improved since the last inspection? There have been a number of improvements made to the environment. Washing and bathing facilities on both floors have been altered and so are more accessible to people with mobility problems. The dining room has been upgraded, as has garden furniture. The service now employs an activity co ordinator, and so peoples opportunities to pursue their interests has increased. What the care home could do better: The service needs to review its storage arrangements for medicines to ensure that it is in line with the latest guidance and legal requirements. The service should keep a record of food eaten if a person does not choose to have what is on the menu. This will help staff to monitor and ensure that service users are having a nutritious, balanced diet. The manager agreed to ensure that these areas would be addressed. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Grasmere House 33 Cargate Avenue Aldershot Hampshire GU11 3EW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kathryn Kirk     Date: 0 8 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. Copies of the National Minimum Standards – Care Homes for Older People 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Grasmere House 33 Cargate Avenue Aldershot Hampshire GU11 3EW 01252328052 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Ramtohal care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Grasmere House is a large house in a residential area of Aldershot. The home is a short walk from the local shops and close to the main shopping centre of Aldershot. The home is registered to provide care for nine older people including those with dementia. The home provides accommodation on two floors, with one shared and seven single bedrooms. There is a large lounge and separate dining room. There are gardens to the front and back of the home, with paved seating areas for the residents. The current fees range between £415 and £600 per week depending on assessed needs. There are additional charges for hairdressing, chiropody, newspapers/magazines and toiletries. 0 0 0 Over 65 9 9 9 Care Homes for Older People Page 4 of 26 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The purpose of the inspection was to assess how well the home is doing in meeting the key National Minimum Standards (NMS) and Regulations. The findings of this report are based on several different sources of evidence. These included: A visit to the home by a regulatory inspector, this took place on 8 January 2009. During this time two residents and two staff spoke about what it was like to live and Care Homes for Older People Page 5 of 26 work at Grasmere House. One health care professional shared their views about the service. The needs of the majority of residents are such that they are unable to verbally convey their opinions and so time was spent observing interactions between them and staff in the communal areas. Time was also spent looking at some records and in touring parts of the building. The manager was available to assist throughout the visit to the home. Five surveys were returned to us from staff . One health care professional also completed a survey. An Annual Quality Assurance Assessment (AQAA) was returned to us earlier in the year. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We also looked at information gathered during the previous key inspection and the Annual Service Review, as well as other information we have received about the service. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 of 26 Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents have their needs assessed and are given information to help them to decide whether Grasmere House will be able to meet their needs. Grasmere House does not provide intermediate care. Evidence: Quality in this area was rated as good at the last inspection in June 2006. The AQAA says that prospective service users and their families are provided with an information pack and are invited to spend a day at the home before they decide to move in. Grasmere House also have a website that provides information to people about the service offered. The file of one service user, who had been admitted during the last twelve months was viewed during a visit. Records seen showed that the manager had obtained a discharge summary from hospital and a care management assessment. This provided clear information about the persons needs. A specialist appointment had already been Care Homes for Older People Page 10 of 26 Evidence: suggested and the manager ensured that this was followed up after the person concerned had moved in. The manager had also completed their own assessment including information regarding the persons care needs, life history interests and beliefs. The plan of care was drawn up from this initial assessment. Five staff, who completed surveys all said that they were always given up to date information about the people they support. Comments included We have a handover on each shift so information is passed on about our service users as it is important for continuity of care. We always review our care plans on a monthly basis or more if there is any changes in client conditions or needs if required and Were given up to date information regarding the service users needs where we do the handover before we start the shift. I get information from the care plans. I always talk to relatives friends and families and get information. Care Homes for Older People Page 11 of 26 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good care planning and effective exchange of information helps to ensure that peoples care, medical and social needs are met. The service promotes privacy and dignity of service users. Evidence: As stated in the previous section, a care plan is drawn up from the initial information gathered during the assessment. Two care plans seen covered peoples needs during the day and the night. They were detailed and provided staff with good guidance about how to support people effectively, for example, one night care plan said likes two pillows and also provided information about preferred bedtime drink and what time the person generally likes to get up. Risk assessments were completed where a risk had been identified, giving information to staff about how they should assist, for example, in ensuring a person is moving around the home safely. Records showed that care plans are reviewed every month and are changed as necessary. Staff surveyed all said that they got good information from the care plans and the manager confirmed that service users, or where this is not possible, their family, are consulted about care Care Homes for Older People Page 12 of 26 Evidence: needs. Staff agreed, one said we give service user a choice about their care and we involve them in their care. Relatives surveyed in homes own questionnaire were all satisfied with quality of care provided. They had no anxieties about the way in which care is delivered. One health care professional said staff always refer nursing problems promptly to us and are willing to follow any advice given They also said, residents appear to be monitored closely and their needs catered for The manager talked about one person who, since admission had improved in health. This was borne out by records which indicated that the persons continence had improved, they were taking less medication and their mobility had increased. Records seen showed that the service supports service users to access health care professionals in the community and also ensures that they attend any outpatients appointments which have been arranged. The AQAA says that a chiropodist, dentist and optician visit the home. The chiropodist was attending on the day of the visit. The manager said that at present no one in the home is able to manage their own medication. Records and discussions with staff indicated that those who are responsible for administrating medicines are trained to do so. Medication administration sheets were seen for two service users and these had been fully completed, with no unexplained gaps. Medication in the home was seen to be securely stored. The manager said that no one has been prescribed controlled medication. There has been recent guidance on the storage of medicines which is available on the CSCI professional website. The manager agreed that she would ensure that the home was following this and said that she regularly consults with a community pharmacist who provides additional advice and support where necessary. During the visit staff were observed to interact with service users in a friendly and respectful manner. One care plan seen detailed that the person did not like to be checked at all after they had gone to bed and staff were advised to not go into the room before 7am. The care plan also said that this person liked to spend time in their room. The person concerned agreed that this was correct. One health care professional commented that staff were aware of importance of maintaining residents dignity and right to privacy and also felt that the Care service supports individuals to live the life they choose within the constraints of caring for people who are mentally infirm Staff were asked Do you feel you have the right support, experience and knowledge to meet the different needs of people who use services? All answered alwaysOne said for example. I have attended training and I have learned to respect each service user as an individual regardless of their religion ethnic group race disability. another said the home has a very comprehensive equal opportunities policy and every effort is made to meet requirements of individual residents The AQAA says that Residents may have private telephone in their room if they wish. There is a cordless phone and payphone in corridor. Care Homes for Older People Page 13 of 26 Evidence: Care Homes for Older People Page 14 of 26 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. 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. The daily life of the home takes into account and accommodates as far as possible peoples interests and wishes. Evidence: Care plans seen include information about peoples interests and preferred daily routines . Since the last inspection the home has employed an activities coordinator. The AQAA said that this was in response to listening to peoples wishes. The activities co ordinator was working during the afternoon of the visit and was helping people to do some drawing. Other staff also had the time to spend with individual service users, for example looking through photograph albums with them. The AQAA says that most activities take part in the afternoon, and lists bingo, crosswords and reminiscence as activities that happen. It also says that the home is involved with the Alzheimers society for resources and training. Relatives surveyed said that they felt that service users were enjoying their lifestyle. The AQAA says that visiting is encouraged at reasonable hours and all relatives surveyed said that they could visit in private if they wanted to. The manager said that a priest visits the home every week to offer communion. Service users files contained a list of possessions and valuables that they had brought in with them as a safeguard. Part of a mealtime was observed and Care Homes for Older People Page 15 of 26 Evidence: residents appeared to be enjoying their food and were given appropriate assistance by staff. Most chose to eat in the dining room but others had their meal in their room. One service user spoken with said that they liked the food. The AQAA says that there is a four weekly menu which is on display in the lounge. It says that changes have been made to it as a result of listening to peoples views. Staff said that residents can choose an alternative if they do not like what is on offer. It was discussed with the manager that when this happens a record should be kept of the alternative provided. This will help to ensure that service users are receiving a nutritious diet. The manager said that no special diets are required by any service user at present. Fresh fruit was observed to be available in the kitchen. Relatives were asked whether they were happy with the food offered. All but two said yes. Those that did not said that they were unable to comment andwere invited for a meal and shown copies of the menu. Care Homes for Older People Page 16 of 26 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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 know how to complain should they wish to do so and any concerns are followed up by the manager. There are appropriate policies and procedures in place to help to protect service users from abuse. Evidence: The complaints procedure is on display in the hallway of the home. The AQAA says that the home has not received any complaints in the past twelve months. CSCI has not received any either. Although not a complaint, in one of the responses of relatives surveyed, a comment was made about laundry which had gone missing. Records showed that the manager had followed this up and had written to the relative to explain her findings. All Staff said that they would know what to do if any one had a concern about the home and all relatives felt that any complaint would be treated seriously. The AQAA said that all staff have a copy of No Secrets which gives them guidance as to their rights and responsibilities if they suspect anything amiss in the service It also said that all staff receive training in the Protection of Vulnerable Adults. Records of this were seen on staff files. Care Homes for Older People Page 17 of 26 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, 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. 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. Residents live in a clean and pleasant environment. Evidence: Grasmere House has seven single bedrooms and one shared bedroom There is a stairlift for access to the first floor.The environment was judged to be good at the last inspection and since this time the AQAA has informed us that a number of improvements have been made. These include ,loft areas have been fitted with smoke detectors, a toilet and bathroom on the ground floor has been converted to a wet room a shower room has been upgraded, the dining room has been upgraded and garden furniture has been improved. Alcohol gel is now available for staff and visitors to use to minimise the risk of infection. A Food Hygiene report by an Environmental Health officer dated January 2006 gave the service a satisfactory rating. On the day of the visit the home was clean throughout with no adverse odours. One Service user spoken with said that the home is always clean. Relatives were asked Is the room occupied by the resident comfortable and home like? All said yes. Bedrooms were seen and all had been personalised to the residents taste. A number of the floors were covered with lino rather than carpet. The manager said that where this was the case, it had been the residents choice. Two fire doors (dining room and kitchen) were wedged open whilst lunch was being served. They were closed again as soon as the meal had finished. The manager said that this had already been discussed with the fire service. Care Homes for Older People Page 18 of 26 Evidence: When asked how the service could improve? one health care professional commented that the home does not always have access to all appropriate equipment, for example hoists, although the manager explained that no current service user needs any additional equipment and when they do, it has always been simple to loan it. Care Homes for Older People Page 19 of 26 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. 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. The homes recruitment practices ensure the safety of service users. Residents are supported by well trained and supervised staff. Evidence: On the day of the visit there were always a minimum of two care staff present, and the manager and activity coordinator were also on duty. It was observed that staff had time to carry out their duties and also had time to sit and talk with residents after lunch. One health care professional who has visited the service a number of times said that there always appeared to be sufficient staff on duty. Staff surveyed and spoken with all agreed that there were enough staff to meet the individual needs of people who use the service. One commented that they felt there was good teamwork and another said there are always adequate staff on duty and no pressure There are no waking night staff on duty. Staff confirmed that no current service users have this need, although a member of staff sleeps in every night and two members of staff also live on the premises. If residents need help during the night they are able to use their call bell, although staff said this rarely happened. Since the last inspection the manager has appointed an activity co ordinator to work at the home on weekday afternoons. The manager confirmed that she does not need to employ agency staff. Of the eleven staff employed, two are registered nurses, one senior carer has NVQ in care level 3 and three have completed their NVQ level 2 in care. The last inspection report Care Homes for Older People Page 20 of 26 Evidence: concluded that the home had robust recruitment procedures. The AQAA and all staff surveyed confirms that staff employed have had satisfactory pre employment checks . The file of the most recent employee was checked to verify this and it was found to be satisfactory. All staff surveyed felt that their induction programme covered everything they needed to know to do the job when they started I had to do a twelve week induction programme from skills for care and by the time I finished I was issued with a completion certificate and I felt very confident and was able to work without supervision another said the home uses the skills for care induction programme which I found very comprehensive, detailed and informative. Staff were also happy with the training provided, which they felt kept them up to date, was relevant and helped them to meet the needs of residents. Health care professionals agreed that staff have the right skills and experience to meet current needs. One senior member of staff is a trainer in moving and handling and so can keep all staff up to date in this. The manager said she was looking into training regarding the Mental Capacity Act. Two staff records were checked and were found to include evidence that a number of different training courses had been completed, for example one member of staff had, in 2008 completed training in dementia,medication , moving and handling, fire safety awareness, health and safety awareness, abuse challenging behaviour, reminiscence and infection control. Care Homes for Older People Page 21 of 26 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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. The manager provides good leadership, which ensures staff are supported and residents health, safety and welfare are promoted. Evidence: Mrs Ramtohal has managed Grasmere house since 1989 and is suitably qualified to run the home. She is a registered nurse and has completed the Registered Managers award. Staff said they feel well supported by the manager one for example said we can approach her easily, anytime relatives surveyed said that senior staff were always approachable. The service monitors the quality of its service in the following ways. the manager completed an Annual Quality Assurance Assessment. This provided evidence of how the home was continuing to meet National Minimum Standards. The service sends out surveys to relatives every year to ask them for feedback about the service provided. as discussed earlier the manager is acts on comments made. The manager confirmed that service users and,or relatives are encouraged to Care Homes for Older People Page 22 of 26 Evidence: participate in the care planning process. The service has introduced a suggestion box. The AQAA shows that policies and procedures have been reviewed and updated where necessary in 2008. The manager said that she does not act as appointee for any service user. Any small amounts of money managed on behalf of service users is securely and individually stored. Records are kept and one record seen had been witnessed by another staff member to verify that it was accurate. Service users are provided with lockable facilities for money or valuables if this is their wish. At the previous inspection it was concluded that the service promotes the health and safety or service users. The AQAA confirms that all equipment in the home is regularly serviced and maintained. As discussed in previous sections staff are appropriately trained to enable them to work in a safe way . Whilst at the service the accident book was checked and this accurately reflected an incident which was described by one of the service users. Care Homes for Older People Page 23 of 26 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 Older People Page 24 of 26 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 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 Care Homes for Older People Page 25 of 26 Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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!