Inspection on 09/08/06 for 38 Sandgate

This inspection was carried out on 9th August 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

38 Sandgate 30/04/09

38 Sandgate 14/04/08

38 Sandgate 09/08/07

38 Sandgate 09/03/06

38 Sandgate 11/12/05

38 Sandgate 14/02/05

38 Sandgate 05/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 38 Sandgate Kendal Cumbria LA9 6HT Lead Inspector Ray Mowat Unannounced Inspection 9th August 2006 15:45 38 Sandgate DS0000036570.V296698.R01.S.doc Version 5.2 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 38 Sandgate DS0000036570.V296698.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 38 Sandgate DS0000036570.V296698.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 38 Sandgate Address Kendal Cumbria LA9 6HT 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) 01539 733465 www.cumbriacare.org.uk Cumbria Care Vacant Care Home 3 Category(ies) of Learning disability (3), Learning disability over registration, with number 65 years of age (2) of places 38 Sandgate DS0000036570.V296698.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. An application in respect of a registered manager for this home must be received by the Commission for Social Care Inspection within 28 days of the date of this notice. A maximum of three younger adults with a learning disability (LD3) may be accommodated two of whom may be older with a learning disability (LD(E)2). When single rooms of less than 12 sqm usable floor space become available they must not be used to accommodate wheelchair users, and where existing wheelchair users are in bedrooms of less than 12 sqm they must be given the opportunity to move to a larger room when one becomes available. Staffing levels for the home must meet the Residential Forum Care Staffing Formula for younger adults. 9th March 2006 4. Date of last inspection Brief Description of the Service: 38 Sandgate is a registered care home for up to three people with learning disabilities. The home is owned by Impact Housing Association and operated and managed by Cumbria Care, an independent business unit within Cumbria County Council’s contract services group. There were two residents in the home at the time of the inspection. Due to the high level of assessed needs of one of the residents, there is an additional sleep-in staff required, who is using the third bedroom. The home is in a quiet residential area on the outskirts of Kendal town, it is close to a bus route and local amenities. The home is a semi-detached property with a small front garden and a paved patio area to the rear. All the rooms are single occupancy with the bathroom and communal areas of the home being shared. The current fees for the home range from £501.50 to £2,095 per week. Information about the service is supplied to new and prospective residents in the service user guide. Inspection reports are made available to residents and their representatives and are displayed in the home. 38 Sandgate DS0000036570.V296698.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place in the late afternoon as both residents attend a day service and to enable me to see the evening routines of the home. Both residents were present throughout the visit. I met with two care staff who were on duty, in addition I spoke to other professionals involved with the home and some family members. What the service does well: What has improved since the last inspection? What they could do better: The home must agree a programme of repairs and renewals for the environment so that residents are aware of who is responsible for and when work will be completed. The home environment must be improved/adapted to meet the needs of residents. An annual training programme must be developed so that staff receive appropriate training for their role. The hall and lounge carpet must be replaced. The amount of pain relief tablets held in the home should be reduced. 38 Sandgate DS0000036570.V296698.R01.S.doc Version 5.2 Page 6 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. 38 Sandgate DS0000036570.V296698.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 38 Sandgate DS0000036570.V296698.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3. Quality in this outcome area is good. The home has good systems in place to assess the individual needs of residents, with clear records maintained to guide staff. This ensures the staff team maintains a consistent level of care. They also work closely with other agencies to ensure specialist needs are identified and met. This judgement has been made using all available evidence including a site visit. EVIDENCE: There have been no new admissions to the home since the last inspection. Comprehensive assessments are completed as part of the admission procedure including Social work assessments. These provide detailed information from which individual care plans can be developed to guide and support staff and ensure a consistent service. There was evidence of these being kept under review by the home with input from other professionals and representatives. The home works closely with a range of other agencies to ensure specialist needs are assessed and responded to, including the community health team, Occupational Therapy and Speech Therapy. In Liaison with these professionals strategies and programmes have been developed that make sure staff are aware of individual needs and how to respond to them. This ensures a consistent approach across the staff team whilst promoting and encouraging independence. 38 Sandgate DS0000036570.V296698.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10. Quality in this outcome area is good. The home’s records provide staff with sufficient information to support and guide them in providing an appropriate and consistent service based on individuals preferences. Rights and choices are respected in all aspects of their lives, with evidence of residents enjoying an independent and fulfilling lifestyle. This judgement has been made using all available evidence including a site visit. EVIDENCE: Comprehensive care plans are in place for both residents. These contain a lot of valuable information for staff to help them provide a consistent service to meet individual needs. Staff have developed good relationships with residents and have a good awareness of people’s idiosyncrasies, likes and dislikes. One resident in particular has complex and challenging needs that require staff to be able to understand how they communicate their needs and an understanding of commonly used gestures and words. The staff have become skilled at communicating with them and responding to them in a consistent manner. This has resulted in residents enjoying a settled period in their life. There was evidence that the care plans are kept under review with meetings held at least annually with all interested parties. The meetings were used to 38 Sandgate DS0000036570.V296698.R01.S.doc Version 5.2 Page 10 evaluate existing strategies and activities, in addition to reviewing personal and healthcare needs and future aspirations. A good range of individual and personal risk assessments are in place and are also kept under review, this ensures that both residents and staff are safeguarded both in the home environment and in the community. Staff provide varying levels of support to residents, dependent on their skills and abilities, in all aspects of their lives and decision making. The staff are aware of the need to take on an enabling role encouraging residents to be autonomous when making everyday choices in their lives. How residents like to be involved in home life is well documented in care plans, which ensures their independence is promoted and their rights and choices respected. All the information and records examined were up to date and appropriately stored with confidentiality maintained. 38 Sandgate DS0000036570.V296698.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17. Quality in this outcome area is good. Both residents enjoy a full and varied social life and are supported to lead independent and fulfilling lifestyles both in the home and in the local community. This judgement has been made using all available evidence including a site visit. EVIDENCE: Both residents continue to attend the local day service five days each week, Monday to Friday. This provides them with a good range of social and leisure activities and community involvement. One resident talked to me about how much they enjoyed and looked forward to a “weekly sailing session”. There was evidence in the home’s daily records of both residents enjoying a varied social life with them being involved in a number of community activities each week with support from the home’s staff. This included going out for trips in the car, going out for meals or being involved in other leisure activities such as swimming or attending a social club. Based on discussions with staff they have a good awareness of individual likes and dislikes and provide unobtrusive support to residents to pursue their individual interests and hobbies. They also work closely with other agencies 38 Sandgate DS0000036570.V296698.R01.S.doc Version 5.2 Page 12 such as the day service, to ensure information is shared and needs and preferences are known, which provides a good continuity of care. The home has planned a forthcoming holiday for both the residents, which one of them talked to me about. They also showed me some photographs from their recent birthday celebration, which involved a gathering of family and friends for a cruise on a nearby lake, which they had obviously enjoyed. This type of activity and level of involvement is good practice. Due to the small number of residents menus are very flexible and planned around individual preferences. A record of food provided is completed, which confirmed a healthy and balanced diet is being provided, with healthy options encouraged. When I was talking to a resident about food choices they said, ‘their choices were provided’. Based on these records and discussions it was evident dietary needs and individual preferences are being responded to appropriately. 38 Sandgate DS0000036570.V296698.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20. Quality in this outcome area is good. Despite the constraints of the physical environment for one resident, the home responds well to the individual’s personal and healthcare needs. They work closely with a number of other agencies ensuring health and personal care needs are responded to appropriately. Detailed strategies support staff to provide a consistent and reliable service. This judgement has been made using all available evidence including a site visit. EVIDENCE: The home works closely with other agencies and specialist services to ensure both routine and specialist healthcare needs are responded to appropriately. Residents personal and healthcare needs continue to be clearly recorded and they ensure pertinent information is shared with relevant staff. How staff communicate with and carry out personal care needs is particularly important for one resident. Other agencies have been involved in developing a range of detailed strategies to guide and support staff and ensure consistency among the staff team, this has proved very effective in meeting their needs. One family member described the care staff as “magnificent, they work really hard and are very responsive to individual needs”. 38 Sandgate DS0000036570.V296698.R01.S.doc Version 5.2 Page 14 Unfortunately some of the physical aids and adaptations recommended have not been provided, which would improve people’s independence. These issues should be reviewed and the suitability of the current environment assessed and actions agreed to provide the improvements required. Both the residents are very happy in their home and they are enjoying a very settled period in their lives, which is a credit to the staff team. As one of the professionals involved with the home described them “They are a fantastic team who have worked closely with other agencies and professionals and followed advice and guidance ensuring a consistent approach.” This has provided very positive outcomes and an improved quality of life for both residents. For a relatively small capital investment the physical environment of the home could be adapted, which would further improve the health and welfare of residents and safety of staff. The majority of medication administered in the home is managed using the monitored dosage system, the contents of the medication cabinet were checked against the medication record and found to be in order. However there were excessive amounts of pain relief tablets for both residents, which should be reduced. 38 Sandgate DS0000036570.V296698.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is good. The home’s policies and procedures ensure residents are safeguarded from abuse and their concerns are listened to. This judgement has been made using all available evidence including a site visit. EVIDENCE: There were no recorded complaints since the last inspection. The home has a clear complaints policy in line with the requirements of the National Minimum Standards, which is made available to residents and their representatives. Some staff recently attended mistreatment and abuse training and further courses are planned. Based on discussions with staff they were aware of what constitutes abuse and the reporting procedures if they suspect or witness any mistreatment or abuse. 38 Sandgate DS0000036570.V296698.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30. Quality in this outcome area is adequate. It is not clear who is responsible for maintaining the environment and residents have not been involved in choosing new equipment. The home must produce a programme of repairs and renewals, so residents are aware of the maintenance programme and to ensure the environment is maintained to a good standard. The issue of the suitability of the environment for one resident must be resolved in a timely manner. This judgement has been made using all available evidence including a site visit. EVIDENCE: The home is now owned by Impact housing association. At present there appears to be some confusion as to who is responsible for some aspects of the maintenance of the home although emergency repairs are being completed appropriately. The kitchen flooring and cooker have now been replaced as required, however the residents were not given any choice as to the type of replacement cooker. This has resulted in an inappropriate cooker being provided that causes health and safety issues, as the rings stay hot for a long period and residents struggle with the different style of controls, therefore reducing their independence with regard to cooking meals. Staff informed me that the supervisor is liaising with the landlord regarding residents having 38 Sandgate DS0000036570.V296698.R01.S.doc Version 5.2 Page 17 choice in relation to changes to the environment and to clarify a programme of repairs and renewal. The hall and lounge carpet is badly stained and worn and must be replaced as soon as practicable. Also the decoration in the hall and stairs is in need of attention. This is subject to a requirement. Moving one of the residents up and down stairs remains problematical and a potentially hazardous activity, resulting in personal care being provided downstairs. Whilst this resident’s room remains upstairs the home is not an appropriate environment and is placing both the resident and staff at risk. No progress to resolve the issue appears to have been made. This matter must now be given a high priority to ensure it is resolved in a timely manner. 38 Sandgate DS0000036570.V296698.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34, 35, 36. Quality in this outcome area is adequate. The home now has a full compliment of staff who have developed good relationships with the residents and provide a consistent and personalised service based on their needs and preferences. Staff training has been inconsistent therefore the training needs of staff must be reviewed and appropriate training provided to ensure good practice is maintained. This judgement has been made using all available evidence including a site visit. EVIDENCE: In the absence of the manager and supervisor not all staff records were available for inspection. Staff spoken to during the inspection said they “get good support and regular supervision”. The supervisor provides formal supervision in addition to working on shift in the home alongside care staff. Staff also said how much they valued the regular staff meetings, which provides them with an opportunity to share concerns and discuss any pertinent issues to ensure a consistent approach. Staff said when concerns have been raised they felt they “had been listened to and actions agreed”. Staff spoke positively about the recruitment process and all staff completed the Learning Disability Award Framework (LDAF) induction and foundation training as well as a formal induction to the home and the organisation. Staff spoken to were aware of key policies and procedures and were clear about their role and responsibilities. The home has sound recruitment policies and procedures in line with good practice. 38 Sandgate DS0000036570.V296698.R01.S.doc Version 5.2 Page 19 Based on the training records I examined in the home there is a need to review the training needs of staff and produce a training and development programme that will provide suitable training courses. One member of staff I spoke to had recently attended a training course relating to mistreatment and abuse, which they had found to be “really helpful and informative”. 38 Sandgate DS0000036570.V296698.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, 42. Quality in this outcome area is adequate. The management arrangements for the home are not suitable and must now be resolved in line with the requirements of the National Minimum Standards and Care Home Regulations. Resident’s rights, safety and welfare are being promoted and protected by the policy and practice within the home. This judgement has been made using all available evidence including a site visit. EVIDENCE: The manager’s post has not been appointed to with the manager of another nearby Cumbria Care establishment taking overall management responsibility, with a supervisor managing the home on a day-to-day basis. The inappropriateness of these arrangements and the need for a dedicated manager has been made clear to the responsible individual for the organisation. Despite the problems with the suitability of the environment for one of the residents they are both enjoying a good quality of life, with staff ensuring their rights and best interests are safeguarded. The continuity of care provided by 38 Sandgate DS0000036570.V296698.R01.S.doc Version 5.2 Page 21 the staff team has been a fundamental factor in this, which must be taken into consideration with regard to any future planning. Records required by regulation were examined and found to be up to date and accurate. A manager’s monthly checklist is completed, which monitors the health and safety of the environment, recoding any defects or actions. Other routine servicing and maintenance records were in place including the electrical wiring and PAT testing of electrical appliances, gas services landlord certificate, water temperatures and water services treatment record. Suitable risk assessments are in place here hazards have been identified ensuring the safety and welfare of the residents and staff at all times. The home was clean and hygienic throughout, which was confirmed by a relative who said they always found the home “clean and tidy”. 38 Sandgate DS0000036570.V296698.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 1 25 3 26 2 27 2 28 3 29 1 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 2 3 X 3 2 X 38 Sandgate DS0000036570.V296698.R01.S.doc Version 5.2 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA24 Regulation 23 Requirement The home must now produce a programme of repairs and renewal based on the condition of the home. (The original timescale of 1st May 05 was not met) Timescale for action 01/10/06 2 3. YA24 YA35 23(2) a 18 (c) 4 YA24 23(2) The physical design and layout of 01/01/07 the premises must meet the needs of the residents. The home must develop an 01/10/06 annual training programme to ensure all staff are receiving appropriate training for their role. The hall and lounge carpet is 01/12/06 badly stained and worn and must be replaced as soon as practicable. 38 Sandgate DS0000036570.V296698.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA20 Good Practice Recommendations It is recommended the amount of pain relief tablets held for both residents should be reduced. 38 Sandgate DS0000036570.V296698.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 38 Sandgate DS0000036570.V296698.R01.S.doc Version 5.2 Page 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!