Inspection on 06/06/05 for 72a Broad Street House 2

This inspection was carried out on 6th June 2005.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

72a Broad Street House 2 05/05/09

72a Broad Street House 2 25/04/07

72a Broad Street House 2 04/05/06

72a Broad Street House 2 19/01/06

72a Broad Street House 2 08/02/05

72a Broad Street House 2 16/09/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 72a Broad Street, House 2 Cedar & Douglas Units Clifton Shefford Beds, SG17 5RP Lead Inspector Andrea James Announced 6 June 2005 th 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 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 Stationary 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. 72a Broad Street, House 2 I51 S14885 72a Broad St Hse 2 V221772 060605 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service 72a Broad Street, House 2 Address Cedar & Douglas Units, Clifton, Shefford, Beds, SG17 5RP Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01462 813824 01462 813824 Home Farm Trust Mr John Masterton Care Home 8 Category(ies) of LD Learning Disability 8 registration, with number of places 72a Broad Street, House 2 I51 S14885 72a Broad St Hse 2 V221772 060605 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 08/02/05 Brief Description of the Service: Cedar and Douglas was one of two homes run by the Home Farm Trust in the small town of Clifton. The building was divided into two units to support 8 adults with learning disabilities, the units catered for 7 service users with complex needs and autism and was expecting a new admission in the near future.The units were designed to accommodate four service users independently from the other unit. As a result of this, each unit had its own kitchen, lounge and bathing facilities and was linked by the laundry room on the ground floor and the staff room on the top floor. There were separate entrances to each unit and service users communally shared the garden facilities. The home was situated close to local amenities including shops and pubs. The service users were able to access other towns such as Bedford, Biggleswade and Shefford with the use of their local transport or route cars and the home’s own transport facilities. 72a Broad Street, House 2 I51 S14885 72a Broad St Hse 2 V221772 060605 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection carried out over a 4.5 hour period. The registered manager was present for the duration of the inspection. The inspection was carried out 5 months after the last unannounced inspection. The inspection followed a case tracking methodology where a sample of the service users files were viewed and those service users were spoken to. The report reflects the views of service users, staff, and the management of the home. Some information was also gathered from the pre- inspection questionnaire provided by the home prior to the inspection. What the service does well: The home provided satisfactory of care to the service users that promoted their independence and resulted in a positive outcome. The service users had a structured activities timetable that demonstrated the home’s ability to meet their needs and offer choice in a structured and managed way. The timetable had various activities including colleges, day centres and other activities that met with the ability and needs of the service users. Service users were able to have choices in the daily running of the home. There was evidence to suggest service users were able to plan their weekly menu. The service users were also able to participate in the weekly food shopping. The staff were seen to promote the service users independence by encouraging them to set the dinner table, help with their washing and ironing and cleaning of their bedrooms. Service users spoken to said they enjoyed living in the home and they were observed laughing and talking with the care staff. The home also had a computer that had various activities for the service users to partake in. One service user did a drawing and gave to the inspector. Another service user demonstrated how he could turn on his music and play games on the computer. 72a Broad Street, House 2 I51 S14885 72a Broad St Hse 2 V221772 060605 Stage 4.doc Version 1.20 Page 6 Service users were able to visit their relatives on a regular basis. On the day of the inspection one service user arrived home after spending the weekend with his parents. New care staff spoke about their induction package and felt that the induction programme equipped them in meeting the needs of the service users. What has improved since the last inspection? What they could do better: Due to the change of manager several of the requirements from the last inspection remained outstanding. The inspector identified that the recruitments procedures in the home needed to be improved to ensure all documentations to identify employee’s credibility was kept on file in the home. Their was a need to ensure the care plans for all service users were developed to include a current assessment of need and risk assessments to ensure the welfare of the service users were maintained. 72a Broad Street, House 2 I51 S14885 72a Broad St Hse 2 V221772 060605 Stage 4.doc Version 1.20 Page 7 The staffing levels in the home needed improving to ensure service users received a continuous standard of care and the high level of agency staff was minimised. The shortage of staff adversely affects the ability for some service users to access the community and carry out their chosen activities. Their was also a need to ensure staff training was developed to ensure staff received training in abuse, food hygiene and other aspects of training relevant to meeting the needs of the service users. The procedures in dealing with service users finances needed further development to ensure service users welfare was safeguarded. The home should ensure a choice of meals is recorded on the menus on a daily basis so that service users can make a choice of what they wish to eat. The quality assurance systems in the home needed further development to ensure the views of the service users and relatives are sought and actions taken to reflect quality care in the home. The registration certificate should reflect the current position of the home and changes should be made with the commission. The inspector would like to thank the service users, care staff and manager for their co-operation in the inspection process. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 72a Broad Street, House 2 I51 S14885 72a Broad St Hse 2 V221772 060605 Stage 4.doc Version 1.20 Page 8 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 Standards Statutory Requirements Identified During the Inspection 72a Broad Street, House 2 I51 S14885 72a Broad St Hse 2 V221772 060605 Stage 4.doc Version 1.20 Page 9 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 standard(s) 2,3,4 and 5 The service users received sufficient information to be able to make a choice of living in the home. EVIDENCE: There was evidence to suggest service users received a full pre- admission assessment before going to the home. The service users were offered a review meeting shortly after admission to determine if the home could meet their needs. Service users were able to visit the home before admission. One new service user in the home was able to have various weekend stays and tea stays before he moved in. Service users received a contract on admission. A copy was kept on service users file. 72a Broad Street, House 2 I51 S14885 72a Broad St Hse 2 V221772 060605 Stage 4.doc Version 1.20 Page 10 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 standard(s) 6,7,8 and 9 The care planning procedures in the home were poor and as a result service users needs were not assessed as met. There was no recorded evidence to suggest service users were consulted about their care or how they were empowered to take risks. EVIDENCE: The home received an immediate requirement on the last inspection to implement care plan procedures that identified the needs of the service users. On that occasion one service user who had major changes did not have a current care plan. On this inspection only the one care plan identified in the requirement was actioned. The manager informed the inspector that new care planning procedures were implemented and staffs were being trained in how to implement them, as a result the care plans were still in their implementation process. The health care needs of the service users could not be assessed as met although doctor’s letters and the diary suggested that service users were having the input of external professionals, to address their health care needs. 72a Broad Street, House 2 I51 S14885 72a Broad St Hse 2 V221772 060605 Stage 4.doc Version 1.20 Page 11 There was a need for an assessment of need to be carried out on all service users and risk assessments to be implemented to ensure the home maintains the welfare of the service users. The service users were given the opportunity to participate in various aspects of the home. The inspector observed service users setting the table for dinner. Service users spoken to said they were also encouraged to help with the preparation of the evening meal. Staff explained various ways in which service users were encouraged to part in an independent lifestyle. The service users spoken to said they enjoyed going to the gateway club and other places within the community. One service user was due to commence a part time employed which would develop her independence. 72a Broad Street, House 2 I51 S14885 72a Broad St Hse 2 V221772 060605 Stage 4.doc Version 1.20 Page 12 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 standard(s) 13,14,15,16 and 17 The home provided opportunities to enable service users to live a fulfilled and balanced life. The activities and cultural settings were age appropriate and met with the needs of the service users. EVIDENCE: There was evidence to suggest service users were given the opportunity to develop. Service users daily logs reported various aspects of development such as college placements, resource centres and wider opportunities to meet people of similar background. Service users were encouraged to make and form relationships. One service user was able to visit another of the Home Farm Trust homes where his brother lived on a regular basis. The homes policies and procedures showed that service users were enabled if they choose to have relationships. 72a Broad Street, House 2 I51 S14885 72a Broad St Hse 2 V221772 060605 Stage 4.doc Version 1.20 Page 13 The relatives were encouraged to take active part in their relative’s care and the trust offered opportunities for relatives to meet and discuss their concerns. Service users were encouraged to have a balanced and nutritious meal. The menus seen showed that service users had a wide variety of meals but only one choice was offered on a daily basis. The staff informed the inspector that they would prepare another alternative if the service user did not want what was presented but this would be in the form of a snack or something easy to prepare. 72a Broad Street, House 2 I51 S14885 72a Broad St Hse 2 V221772 060605 Stage 4.doc Version 1.20 Page 14 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 standard(s) 18,19,20 and 21 The home was proactive in identifying and addressing the emotional health care needs of the service users and in dealing with illnesses relating to ageing service users. This resulted in one service user receiving satisfactory standards of care as he develops dementia type illnesses. The medication procedures in the home have been improved and service users benefit from a procedure that reduces the risk of human error. EVIDENCE: The home demonstrated several ways in which service users benefited from personal support received. One service user was able to loose weight with the staff support. Another was able to manage his illness with the input from the staff and guidelines were in place for one service user whose behaviours tends to challenge the service. The administration and labelling of medication that was identified in the last inspection was resolved and satisfactory procedures were in place to protect the service users. The home had a policy that dealt with service users who were ageing. The policy also covered how the home would deal with the death of a service user. One service user had developed the early stages of dementia and the home had the input of external professionals, two staff members had recently been 72a Broad Street, House 2 I51 S14885 72a Broad St Hse 2 V221772 060605 Stage 4.doc Version 1.20 Page 15 trained on the symptoms of dementia. The manager said other staff were also trained in aggression and how to deal with service users who challenged the service. 72a Broad Street, House 2 I51 S14885 72a Broad St Hse 2 V221772 060605 Stage 4.doc Version 1.20 Page 16 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 standard(s) 23 The procedures on place to protect service users from abuse were poor. EVIDENCE: The home had satisfactory policies on the Protection of Vulnerable Abuse but the inspector identified that service users monies were at risk of being abused. The systems in place were unsatisfactory as the petty cash vouchers were only signed for by one care staff and in another case no receipt was found for bank transaction made for one service user. 72a Broad Street, House 2 I51 S14885 72a Broad St Hse 2 V221772 060605 Stage 4.doc Version 1.20 Page 17 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 standard(s) 24,25,28 and 30 The home provided a safe and comfortable environment that met the needs of the service users. EVIDENCE: The home was decorated to a satisfactory standards and new furnishings recently placed in the home added to the attraction of the building. Some furnishings were due to be changed but improvements were seen since the last inspection. The home had separate dining and lounge facilities that generated sufficient space for service users. The manager informed the inspector that due top the nature of the service users furniture’s needed to be replaced on a regular basis. The home was clean and free from offensive odours throughout. 72a Broad Street, House 2 I51 S14885 72a Broad St Hse 2 V221772 060605 Stage 4.doc Version 1.20 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35 and 36. The staffing levels in the home were not satisfactory resulting in some service users not being able to fulfil their activities. The high use of agency also resulted in service users receiving inconsistency in their care package. The home ‘s recruitment procedures were poor because all the information was not available on file. This could result in service users being open to poor levels of staffing. Some aspects of training were provided but there was no evidence that sufficient training was being provided for the staff team. EVIDENCE: The home had 11 care staff that formed the core of the staff team. The rotas suggested that a high level of agency staff was being used in the home. The manager said she had recruited two of the vacancies but was waiting for clearances before they would be able to start. The current staff team appeared dedicated but further training was needed to ensure they were all able to meet the needs of the service users. the training programme was not available on the inspection and as a result the inspector was not able to see what the future training plans were. 72a Broad Street, House 2 I51 S14885 72a Broad St Hse 2 V221772 060605 Stage 4.doc Version 1.20 Page 19 The recruitments procedures needed further development as the staff files inspected failed to have application forms, criminal record check and references. The manager said the head office had all the information but had not yet forwarded them to the home. Staff informed the inspector that they were receiving regular supervision and staff meetings and felt the team were more motivated and committed to the job. 72a Broad Street, House 2 I51 S14885 72a Broad St Hse 2 V221772 060605 Stage 4.doc Version 1.20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39 and 42. The management of the home creates and environment where the service users and care staff can feel safeguarded. The home did not have a self-monitoring system in place as a result the service users could not identify how the home was improving its standards. EVIDENCE: The care staff and service users spoke positively about the appointment of the new manager. There was evidence that changes had occurred that reflected positively for both the service users and staff. The care staff said the manager was laid back and demonstrated a great team ethos. They felt that the manager listened and showed that she cared. One staff member informed the inspector that the manager was busy recruiting to relive the pressure placed on the existing staff team. 72a Broad Street, House 2 I51 S14885 72a Broad St Hse 2 V221772 060605 Stage 4.doc Version 1.20 Page 21 The quality assurance systems in the home were not satisfactorily implemented and as a result quality monitoring of the home could not be measured. The home however, had regular staff and residents meetings. The home had satisfactory health and safety policies but there was a need for further risk assessments to ensure the safety of the service users. One identified on the day of the inspection was a need for risk assessments for service users leaving the day centre, as a care staff did not know who collected the service user. There was also a need for manual handling assessments to be implemented on some of the service users care plans. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 3 3 Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 72a Broad Street, House 2 Score 1 Standard No 24 25 26 27 28 Score 3 3 x x x Version 1.20 Page 22 I51 S14885 72a Broad St Hse 2 V221772 060605 Stage 4.doc 7 8 9 10 LIFESTYLES 3 3 3 x Score 29 30 STAFFING x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 2 2 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 3 2 x x 3 x 72a Broad Street, House 2 I51 S14885 72a Broad St Hse 2 V221772 060605 Stage 4.doc Version 1.20 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 YA2 Timescale for action 14 (1) (a) Arrangements must be made for original all service users to recive a full date:30.03 assessment identifying the needs .05 new required to be provided by the date: home. 30.08.05 15 (1) (2) Arrangements must be made to Original (a) (b) (c) implement and improve all care dates: 03.11.03/ plans in the home. These must demonstrate the identified needs 30.10.04/0 of the service users and the 8.03.05. intended plan of care. new date: 30.08.05 15 (2) Consultation must be sought 30.08.05 where possible for all plan of care recorded for the service users 13 (4) (c ) All service users must be 30.08.05 safeguarded using appropriate risk assessments to identify and where possible eleviate harm to service users. 13 (6) Arrangements must be made to 30.07.05 improve the handling of service users finances within the home. 18 (1) (a) Sufficient staff must be Original date: employed in the home in such numbers as to meet the needs of 30.03.05 the service users. new date: 30.08.05 18 (1) Arrangements must be made to Original ensure agency staff working in date30.03. I51 S14885 72a Broad St Hse 2 V221772 060605 Stage 4.doc Version 1.20 Page 24 Regulation Requirement 2. YA6 3. YA6 4. Ya 6 5. 6. YA23 YA33 7. YA33 72a Broad Street, House 2 8. Ya34 9. 10. Ya35 YA39 the home are equipped to meeting the needs of the service users at all times and service users does not miss out of activities due to this. 18 (1) (a) The recruitment procedures in the home must ensure all files detailing staff credability is kept at the home. 18 (1) (c ) All staff must be trained in (i) meeting the needs of the service users. 24(1) Quality assurance system must be implemented in the home in order to monitor the service being provided. 13 (4) ( c) The call point sysytem in the dsiabled toilet must be improved in order that it can be heard in other parts of the building. 05 new date: 30.08.05 30.08.05 30.08.05 Original date:1.12. 04/30.03.0 5.New date:30.08 .05 Original dates:30.1 0.04?30.03 .05 new date:30.08 .05 11. ya42 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. Refer to Standard YA17 YA32 YA32 Good Practice Recommendations Arrangements should be made for menus to have more than one choice of meal for service users to choose. All staff should be trained in Dementia. abuse awareness and challenging behaviour. The home should provide evidence of how 50 of the care staff will obtain their NVQ level 2 in care. 72a Broad Street, House 2 I51 S14885 72a Broad St Hse 2 V221772 060605 Stage 4.doc Version 1.20 Page 25 Commission for Social Care Inspection Clifton House 4a Goldington Road Bedford MK40 3NF 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 72a Broad Street, House 2 I51 S14885 72a Broad St Hse 2 V221772 060605 Stage 4.doc Version 1.20 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!