Inspection on 31/07/07 for Chadwell House

This inspection was carried out on 31st July 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Chadwell House 27/07/06

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Chadwell House 372 Chadwell Heath Lane Chadwell Heath Romford Essex RM6 4YG Lead Inspector Mrs Sandra Parnell-Hopkinson Unannounced Inspection 31st July 2007 08:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chadwell House Address 372 Chadwell Heath Lane Chadwell Heath Romford Essex RM6 4YG 020 8983 8529 020 8599 3224 sueann.balcombe@sanctuary-housing.co.uk www.sanctuary-care.co.uk Sanctuary Care Ltd 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) Miss Sueann Barbara Balcombe Care Home 60 Category(ies) of Dementia (50), Old age, not falling within any registration, with number other category (10) of places Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home shall provide care to service users with Dementia, from the ages of 55 years and over. The home must not reduce staffing levels below the existing 1:8. Date of last inspection 27th July 2006 Brief Description of the Service: Chadwell is a 60 bedded home for older people. This includes 50 beds for people with dementia and 10 beds for frail older people. The home is situated in the London Borough of Redbridge and is near to King George Hospital and close to public transport. There are 60 single rooms all with toilet, washbasin and shower. The home is accessible to wheelchair users. There is an enclosed rear garden that is well maintained. The home has two floors and is divided into six 10 bedded units. Each unit has a kitchenette, dining area, lounge and a communal bathroom and toilet. There is also an activities room located on the first floor. The current statement of purpose and service user guide is available in the home, and a copy can be obtained from the manager. At the time of this inspection the fees ranged from £523.98 to £600 per week and there are additional charges for services such as hairdressing, private chiropody, some outings and newspapers. Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection undertaken by the lead inspector Mrs. Sandra Parnell-Hopkinson, which took place on the 31st July, 2007 and commenced at 08.00 hours over a period of 12 hours. The manager was available at various times during the inspection, but was primarily engaged in undertaking in house training with staff members. She was available for feedback at the end of the inspection. During the visit the inspector able to speak to many residents, visiting relatives and staff members. Although the majority of residents spoken to have varying degrees of dementia, it was possible to engage with some in meaningful conversations. The files of 14 residents’ were viewed and case tracked, together with the viewing of medication administration records (MAR), staff rotas, training schedules, activity programmes, maintenance records, accident records, fire safety records, menus, complaints records, staff recruitment processes and files. Evidence has also been taken from the Annual Quality Assurance Assessment (AQAA) which had been returned to the Commission prior to the site visit. An inspection was also undertaken by the Commission’s Pharmacy Inspector in June, 2007 at the request of the manager. The inspector discussed equality and diversity issues with the manager who was able to demonstrate a good understanding of the many issues relevant to these areas. However, evidence gathered during the inspection demonstrated that there is much work to be done within this service around the implementation of equality and diversity. People using the service were asked how they wished to be referred to in this report, and the majority said residents. In view of this the term resident/s is used in this report. What the service does well: Since the last key inspection there is a new manager, and she has now achieved registration with the Commission. The new manager has an open approach and is keen to improve the service to the residents. The home was free from offensive odours and was clean. Meals were well presented and a choice was offered to residents. Dining tables in some of the units are laid so that they look welcoming to make dining a positive experience. In discussions with the cook the inspector was satisfied that she was aware of any special health related dietary needs. Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 6 Comprehensive pre-admission assessments for prospective permanent residents are undertaken by people who are qualified to do so. Also prospective residents and family members are invited to visit prior to making a decision. One relative told the inspector “Mum has been here for about 3 years and I visited the home before she moved in.” The activities co-ordinator works hard at ensuring that there are large and small group activities organised for the residents. These include some residents being taken to a community group, some shopping, some to church and arrangements are being made for a large group of residents to visit Leighon-Sea where a venue has been selected for lunch. What has improved since the last inspection? What they could do better: There is a condition on the registration that staffing levels must not fall below 1:8. As a result of this inspection it will be proposed that this condition be removed as staffing levels must be sufficient to meet the needs of all of the residents, and this was not apparent at this inspection. Staffing levels must be reviewed as a matter of urgency so that the service is able to demonstrate that the specialist provision offered at Chadwell House for people living with dementia is meeting their needs. Although two units were reasonably well decorated, four units were in a very poor decorative condition. This issue has been raised in previous reports but remains outstanding. The inspector has been given to understand that the remainder of the home will be redecorated within the next few months. The organisation is reminded that it is responsible for ensuring that all parts of the home are kept in a good state of decoration and repair at all times. Whilst staff training is being undertaken this is at the expense of the day to day management of the home as it is the manager who is undertaking the training. Whilst this may be an exception, the manager has been/will be undertaking training for staff on the 23rd July, 25th July, 26th July, 31st July, 1st August, 2nd August and the 3rd August. This has meant in effect that the home has been without a day to day manager for 7 days, and this is in a home where improvements are required. It is essential that the organisation provides support to managers where staff training is necessary. Issues around equality and diversity must be addressed as a matter of urgency as it was evident during the inspection that the needs of some residents from Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 7 ethnic minorities are not being met. For example there are residents who are not being offered the spiritual support that they require, whose dietary needs are not being met and whose personal care needs are not always being met. All care staff employed at the home must undertake comprehensive training in caring for people living with dementia to ensure that they are able to effectively interact with them. Currently the home is registered for 50 dementia beds, and dementia care is a specialist service. The provision of respite care at the home must be reviewed as it was apparent that this provision is having an impact on some of the permanent residents. A recent complaint showed that the needs of one person on respite care were not met by this service. Again the provision of respite care is a specialist service and often requires more staff input for the person on respite to ensure that they are able to settle at the home, and that skills are maintained and retained for the person living with dementia so that they can return home able to cope. Care plans require attention to ensure that the social care needs of residents are being identified and met. Also daily recordings do not always reflect the identified needs/outcomes as currently detailed on the care plans. The social care activities are generally good, but again there must be more focus on enabling residents living with dementia to retain daily living skills. There was very little interaction between residents and staff, and it seems that a television, with the sound turned down, with music playing is considered by staff to be an acceptable form of stimulation for people living with dementia. Innovative use of communal spaces, signage and décor and the environment would mean that the service would be more able to meet the assessed needs of people living with dementia. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5 and 6 (Standard 6 does not apply to this service) People who use this service experience adequate quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. Whilst prospective residents and relatives are given information on the service, the statement of purpose must be reviewed and updated. Prospective permanent residents can be sure that his/her needs will be assessed prior to making a decision to move into the home, but this is not always the case for people needing respect care. Prospective residents and/or their relatives can visit the home prior to a decision being made that this is a suitable service to meet their needs. EVIDENCE: Whilst there is a statement of purpose this is not in accordance with the requirements of the Care Home Regulations 2001. A guidance document was given to the manager as to the required content of this document. There is a service user’s guide and residents do have a written contract with terms and conditions of residency at the home. Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 10 In discussions with the manager it was evident that she has undertaken work for the production of the service user’s guide in audio and CD formats, and these formats will be available shortly. From viewing files it was evident that permanent residents have had a comprehensive assessment of need undertaken prior to them moving into the home. However, on viewing a file of a resident on respite care, it was not evident that a comprehensive assessment had been undertaken. The arrangements for the provision of respite care at the home must be reviewed and improved. It is clear from the AQAA (Annual Quality Assurance Assessment) that the manager acknowledges the need to improve on the respite care. The AQAA states ‘We could improve on the respites that we have as the information is often missed due to their quick entrance and exit into the home. There isn’t sufficient time to prepare information’. It is important that the pre-admission assessment identifies the routines and current skills and abilities of respite residents so that these can be continued during the stay at the home. Information in care plans must be clear so that care staff are able to provide the right level of care and social interaction. More staff time may be necessary to enable the respite residents to get to know people, feel comfortable and settled. Residents being admitted to the home, whether permanent or short term respite care, also want to know that their bedroom is well furnished, decorated and clean. Whilst this may normally be the case, in discussions with a relative the inspector was told “when mum was admitted her room was dreadful, it needed redecorating and the smell was terrible. I have really had to fight for the room to be improved. The carpet has now been cleaned but the room still needs decorating, and the whole experience has not been a pleasant one.” Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 People who use this service experience adequate quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. Generally the health and personal care needs of residents are met, but the care plans must be improved to cover social care needs. Health and personal care needs must be reflective of the ethnic, religious and cultural needs of the residents. However, generally residents can be sure that they will be treated with respect and that their right to privacy is upheld and that at the time of their death, staff will treat them and their family with care, sensitivity and respect. EVIDENCE: The files of 14 residents were viewed during the inspection together with related documentation. Although all had a care plan, it was evident that not all have had a monthly review undertaken and that monitoring as identified in the care plans is not always being undertaken nor recorded. Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 12 Some staff were observed to be ‘leading’ residents by the hand without any interaction at all and some residents experienced this lack of interaction during lunch, tea and at other times observed by the inspector. Generally residents’ health, personal and social care needs are set out in individual plans but not all of the care plans accurately reflect their current needs. There was limited information on meeting the dementia care needs of residents and in some instances the care plans did not include end of life matters. Although there was a lack of detailed information in the care plans, the inspector was satisfied that during discussions with staff, generally they were able to demonstrate a knowledge of the individual needs of residents. The manager informed the inspector that the care plans are being replaced with a new format, and in the process will be updated. The care plans demonstrated little sense of the person, and therefore, they need to be more person-centred. Very few care plans evidenced information on the life history of the resident. The gathering of this information for all residents is essential to the delivery of quality care. It could then be used in a more meaningful way in planning individual social activities, and as a basis for staff to gain more insight and knowledge of the resident. Some care plans that were examined showed that they had been reviewed, but because of the limited information in the care plans it was not possible to determine if they accurately reflected the current needs of the residents. As part of the case tracking the documentation/health records relating to the management of diabetes was looked at, and it was evident that the district nurse is very involved in this, and attends to administer insulin where necessary. Another resident who is taking warfarin medication, attends a local clinic so that his blood can be monitored on a regular basis. However, in discussions with one relative it was evident that the resident had a pressure sore on her foot, but this had not been recorded in the care plan, although in discussions with a member of staff, the inspector was told that the district nurse was aware of this. Many of the residents have problems around continence, and again there was little evidence of continence care programmes being in place. Very few care plans identified the need for oral health care or for skin care. With all residents there is a need to ensure good skin care, but this is certainly true for some residents from ethnic minorities, and again there was little evidence of care plans around skin care. In conversation with the relative of a resident from an ethnic minority the inspector was told “I do bring in the appropriate toiletries for mum’s hair and skin care, and although some staff seem to use them I know that often these are not being used. One time when I visited, mum’s face was in a terrible state, although it is now improving.” All residents are weighed on admission and thereafter monthly, and increases/decreases in weight are monitored. However, there must be Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 13 consistency in the recording of weights in that either metric or imperial measures are used, and not a combination of both because this is confusing when weights are being monitored. Where necessary a referral is made to the GP if the services of a dietician/nutritionist are required. Sometimes these referrals do take a long time to be responded to by the health professionals. The inspector did observe that fluids are being freely offered to residents at regular times throughout the day. Residents’ files have written evidence that there is involvement from other health professionals including dentist, optician and chiropodist, as well as GP and hospital outpatient appointments. This was confirmed in discussions with relatives, who were visiting at the time of the inspection. Risk assessments are routinely undertaken on admission for all residents around nutrition, moving and handling, falls and pressure sore prevention. However, it was also evident in discussions with some staff that they did not completely understand the forms that they were completing, and also that not all risk assessment were routinely reviewed. A sign of well being assessment form is completed on a regular basis, but again when staff were questioned as to the methods used by them in determining well being in a resident there was no consistency. Staff were left to draw their own assumptions to the questions detailed on the form. Staff are also recording when a resident is assisted with a bath or a shower, and at the same time are recording the water temperature. However, staff have no means of determining the temperature of the water at that time as they do not use a thermometer. When questioned several members of staff told the inspector “that is the temperature told to them by the handyman.” The handyman does check the water temperatures on a weekly basis and maintains a record of these. Therefore, unless at the time of the bath/shower given to a resident the member of staff takes the temperature of the water with a thermometer, they do not know what the temperature is and therefore, should not be recording this and verifying it with their signature. It is essential that for any form used for recording purposes, that there are clear and concise guidelines and that staff have received appropriate training in the use and completion of these forms. Forms which need completing ‘for the sake of it’ serve no useful purpose and detract staff time from residents. Evidence from several of the current forms does not appear to be used to influence care plans at the monthly reviews. Most of the staff talked about residents, and were observed to treat residents, in a respectful and sensitive manner. They understood the need to promote dignity through practices such as in the way they addressed residents and when entering bedrooms, bathrooms and toilets. Most staff were observed to be gentle when undertaking moving and handling tasks, but not all staff Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 14 offered explanation and reassurance throughout the activity. Some members of staff were observed to be ‘leading’ residents by the hand without any interaction at all. Relatives that were spoken to had varying opinions on the level of care at the home. One relative stated, “The standard of care varies dramatically, depending on who is on duty”, other relatives were complimentary stating, “the staff look after her really well, I am really happy with the care my mum receives.” A resident told the inspector “most of the staff are very nice and they don’t turn up their noses.” Medication administration records (MAR) were inspected as part of this visit, and were found to be in good order. However, it is essential that when 1 or 2 tables are prescribed then the actual number of tablets administered must be recorded. Also where hand written entries are made, especially with regard to respite residents, then two members of staff should sign to confirm that the written entry is correct. Controlled medications were checked and again were in good order. Following the visit by the pharmacy inspector the policies and procedures have been reviewed, and the manager undertakes periodic audits. During one such audit medication was found to have been administered incorrectly and this has resulted in disciplinary action being taken in respect of several members of staff. Within the next few weeks the home will be moving to a new pharmacist and medication administration system. It was evident from talking to staff that residents would be treated with care, sensitivity and respect at the time of death, and that this would also be extended to family and friends. However, there was little evidence of meaningful end of life care plans in place, and some just stated ‘burial or cremation’. In discussions with the manager it was evident that she is now actively engaged in promoting comprehensive end of life care, and is looking at introducing the Gold Standard Framework and Preferred Place of Care. Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use this service experience adequate quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. Residents do not always find the lifestyle experienced in the home matches their expectations and preferences, nor that it matches their social, cultural, religious and recreational interests and needs. However, residents are encouraged to maintain contact with family/friends and some with the local community. Generally residents are helped to exercise choice and control over their lives and receive a wholesome, appealing balanced diet. EVIDENCE: It was apparent when inspecting all 6 units that the routines of daily living and activities are generally very flexible. Residents can choose when to get up in the mornings, and breakfast is served at times that are suited to meet the needs of individual residents Residents are encouraged to receive visitors at any reasonable time and some residents are able to maintain links with the local community. Some residents attend a centre operated by a local church. Activities are also organised for trips into the community for leisure and shopping and this is extended to all residents within the home. A trip is being organised to Leigh-on-Sea where a Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 16 venue has been selected for lunch. A minibus is usually available on a Monday and this opportunity is used by the activities co-ordinator to take residents to various venues within the community. At the present time the activities co-ordinator is reviewing the transport needs for all of the residents and is making applications for registration with the local alternative to the London taxicard scheme and to Dial-a-Ride. There is one activities co-ordinator who works very hard in organising and delivering activities to suit the needs of a diverse group of residents. There is an activities room on the first floor, which is also used as a training room for staff. Generally, the activities co-ordinator is very aware of the interests of individual residents and records are maintained of the activity and those participating. However, the development of life histories for those residents living with dementia would greatly assist in the provision of appropriate activities to these residents. Staff must be aware that such residents have a very short concentration span and therefore the activities need to be more individual or small group focused. It would be beneficial if some resources were left in the lounges so that residents are able to “dip in and dip out” as necessary. It is also essential that care staff recognise that activities within a care home are not solely the responsibility of the activities co-ordinator. It is important that care staff are also engaged in enabling residents living with dementia to retain daily living skills such as washing, dressing and choosing clothes. Also to support residents to be involved in activities that focus on the individual’s needs, level of functioning and have some relevance to the individual’s likes, preferences and interests, past and present. This may be time consuming for staff but it is an important element in the care of residents. Many of the residents are currently fairly mobile and would benefit from more outings away from the home. It is essential that this area is addressed to provide an improved quality of care to some residents. Instead of staff having to ‘observe’ every 15 minutes the whereabouts of a particular resident, it would be more beneficial if there were sufficient staff on duty to enable more meaningful activities to be undertaken with this resident. Other residents had observation charts, but again these were not always being completed. The need for an observation chart to ensure the whereabouts of a particular resident is questioned, because often these are the more active residents and activities and staffing levels must be appropriate to meet the needs of these residents. On the day of the inspection the majority of residents were sat in the lounges with the television on and the sound turned off, but music was also being played on an audiotape. Residents were not watching the television but care workers were totally oblivious to this fact. It appeared to the inspector that some staff felt that if the television was on residents were being entertained. It would have been more beneficial for residents for the television to be turned Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 17 off, and for appropriate music to be played, or for staff to be interacting with them. Lack of a stimulating environment can have a direct impact on a resident’s behaviour. On a daily basis staff have to complete an activities sheet, but again this does not appear to be a meaningful task. Many staff are just recording that residents enjoy sitting and watching television all day, every day. However, it was apparent from observation that this was not the case, as many of the residents were aimlessly walking about, sat in front of a television, or sat sleeping in chairs in the lounges. When making daily recordings it is essential that staff use appropriate language, and words such as ‘escape from the unit’ are not appropriate words since Chadwell House is not a prison, but is the home of the residents living there. Although there is a monthly church service in the home, and some residents do visit a local church on a monthly basis, the spiritual needs of some of the residents are not being met. This has been discussed with the manager and the activities co-ordinator who must take steps to address this important aspect of the lives of some of the residents. In discussions with a relative the inspector was told “Mum used to read her bible every day, then it went missing from her room. Although the manager did replace this I don’t think that staff read to her from her bible. This was always a very important part of my mum’s life.” Bedrooms generally were personalised, but many were in great need of redecoration. A visit was made to the main kitchen and the inspector was able to discuss the storage and preparation of food and menus with the cook. She demonstrated a good knowledge and understanding of the importance of well balanced and well presented meals, and the special dietary needs of some residents. Although menus were varied and balanced they were not reflective of the needs of residents from ethnic communities. There are several residents who are from the West Indies, but in talking to some of these residents and a relative it was apparent that they are not offered cultural meals. This is totally unacceptable and the manager must ensure that action is taken to address this matter. In talking to another resident at breakfast time, she told the inspector that “I am having shredded wheat for my breakfast because I like it.” However, in discussions with the care staff on duty the inspector was told that she would be having cornflakes or porridge because they did not have shredded wheat. This was also confirmed during the inspector’s visit to the main kitchen. There is little reliance on processed or frozen foods, and fresh fruit is available. Bowls of fresh fruit were seen on the units, but it may be more beneficial to residents living with dementia, if prepared fruit platters were offered to them Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 18 on a daily basis. In this way residents could choose smaller finger sized portions of fruit. On the day of the inspection braised sausages were one of the choices for lunch. Having case tracked one of the residents it was evident that this resident did not eat pork. The inspector asked several members of staff if the sausages were pork, or beef or a combination of pork and beef. None of the staff could answer the question but were making decisions for residents without proper knowledge. It is essential that staff are aware of the type of diet required by a resident, and also the ingredients of the dishes, if they are to assist residents in making choices. Meals are served in the dining rooms on all 6 units. In some units dining tables were nicely laid with tablecloths, napkins, flowers and cutlery for all three meals, breakfast, lunch and tea. However, this was not true of all units and certainly several units did not lay tables at breakfast time. The taking of any meal should always be a pleasant experience and tables should always be laid accordingly. It is acknowledged that once tables have been laid there may be some residents who then proceed to move things, which makes extra work for staff in re-laying the tables. Staff should discuss this and agree on strategies to distract residents rather than act negatively by not routinely laying tables. Any engagement for a resident living with dementia can be a positive experience, and this may also be in picking up cutlery from the dining table as it helps to maintain their engagement with the world around them. Again staffing levels must be reflective of the needs of residents. The inspector was able to observe meals being served on all 6 units. Some of the residents needed either supervision by staff or assistance with eating. Although there was generally 2 members of staff in each dining room, there were times when residents were just left with little or no assistance. The meals were well presented but it appeared that it was often the staff who decided what somebody would eat. Although each unit does have a folder with some pictorial dishes for use to enable residents living with dementia to choose, these were not reflective of the menu for that day, and the inspector did not observe staff enabling residents to choose the main meal of the day. This may be time consuming but staff should actively be engaging with residents in this activity. The use of finger foods, small nutritious snacks, smaller portions and more flexible eating times to maintain independence and exercise choice around food and eating may be beneficial for some residents. This area does need to be developed through the provision and frequent use of pictorial menus or other methods such as making available to residents before the actual mealtime, small portions of the meals so that they can see, smell or touch the food and thereby make a more informed choice. An actual cooked breakfast is offered once a week, usually on a Wednesday, but if a resident asks for a cooked breakfast such as a boiled egg then this will be provided. Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 19 The taking of meals should be an enjoyable experience for all residents, and the manager’s attention is drawn to the Commission’s report Highlight of the day that is about food and nutrition within care homes. Each unit is equipped with a small kitchen/servery where drinks and snacks are provided for residents. Again the preparation of drinks and snacks was almost always done by a member of staff without engaging residents in these activities. Meals are generally served at the following times: • • • • Breakfast from - 8.30 a.m. Lunch - 1p.m. Tea – 5.30p.m. Supper – from 7.30 p.m. (cake/sandwiches) Currently each unit has two care staff allocated on each shift, but it was apparent during the inspection that at times more staff are required if residents living with dementia are to be actively engaged in the world around them. Evidence from the Annual Quality Assurance Assessment (AQAA) would support the inspector’s findings in that it states “staff could encourage and remind the service users more often when there are activities being held in the home. Staff could pay more attention to record keeping and a more person centred approach to activities.” Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use this service experience good quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. Residents and their relatives and friends can be confident that their complaints will be listened to, taken seriously and acted upon by the manager. Residents are also protected from abuse. EVIDENCE: The home has a written complaints policy and procedure and the complaints log inspected indicated the number of complaints received and included details of investigation, action taken to resolve them and the outcome for the complainant. The manager also maintains a register of issues and concerns, which enables her to address any expressions of concern or dissatisfaction with any element of the service without delay. Complaints and concerns made to the manager are always taken seriously and she actively addresses all concerns and aims to resolve to the satisfaction of the complainant. However, she is still working with many of the staff to ensure that they understand that a ‘verbal niggle’ or expression of concern is treated seriously and addressed in a timely manner. Each unit now maintains a log of complaints and concerns made by residents or relatives on the respective unit, and these are audited by the manager to ensure that the procedures are being followed. Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 21 There is an in house training programme for staff in safeguarding adults and recognising and reporting abuse. This must be extended to all staff including administrative and ancillary staff. Those staff spoken to during the inspection were aware of the action to be taken if they had concerns about the safety and welfare of residents. Staff were also aware of the organisation’s whistle blowing policy. It was under this policy that an alleged safeguarding adults incident was reported. Whilst such alleged incidents may be distressing for the staff involved, especially when they may be unsubstantiated, it is essential that staff who suspect possible abuse continue to be supported to report such concerns. However, the organisation must be clear as to the support given to all parties when the suspended member of staff returns to work. There have been several safeguarding adult investigations at the home, and currently two are still to be satisfactorily resolved by the London Borough of Redbridge’s safeguarding adults team. Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24, 25 and 26 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to the service. Residents live in a safe, clean and hygienic environment. However, the décor of the home is currently poorly maintained and this is not beneficial to residents living there. Also the signage and décor throughout the home must be more reflective of the needs of people living with dementia. EVIDENCE: A tour of the whole home was undertaken at the start of the inspection, and all areas were visited again later during the day. Some bedrooms were seen either by invitation of the resident, or with permission, whilst others were seen because the doors were open or being cleaned. There were no offensive odours in the home and the home was clean and tidy. The standard of the furnishings and fittings is generally being maintained to a good standard. However, with the exception of Christie unit and part of Austen unit the home is in need of a Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 23 complete redecoration. This has been a requirement made at previous inspections, and the inspector has been given to understand that this work will now be completed within the next few months. In discussions with one resident and relative the inspector was told “when mum moved into this room it was awful, the carpet smelt and the room was in desperate need of decorating. The carpet smell has been sorted out but the room still needs decorating.” It was also noted that some of the window handles were missing or lose and this must be rectified by the organisation so that windows are safe and able to be used by residents. The organisation must realise that Chadwell House is the home of the residents living there, and it is totally unacceptable that they should be expected to live in a home that is poorly maintained. They are spending all day, every day in the home and should be assured that the home will be decorated to a good standard, and maintained to that standard at all times. Any new resident moving into the home should not be expected to move into a room that smells and has not been redecorated to a good standard. Again the inspector has been given to understand that the redecoration of bedrooms will be completed by the handyman prior to a new resident moving in, and will also ensure that bedrooms in current use will be maintained to a good standard at all times. The laundry area was visited and this was found to be clean, with soiled articles, clothing and infected linen being appropriately stored. Laundry staff were aware of health and safety regulations with regard to handling and storage of chemicals. Personal Protective Equipment (PPE) such as clothing, gloves, masks and goggles were available. Some residents have commented that clothing often takes sometime to be returned to them, and this was discussed with the manager who will be looking at this aspect. Hand washing facilities are prominently sited and staff were observed to be practising an adequate standard of hand hygiene. Some bedrooms were seen to be very personalised but this was in contrast to other bedrooms visited, which gave no indication, nor were they representative of the occupant’s culture, religious or personal interests. Relatives should be encouraged to bring in items that are familiar to the person living with dementia, as this will make their environment more personal and meaningful. Christie unit had appropriate signage on the bedroom doors to aid identification by the resident, but this was not apparent on the other units. It is essential that appropriate signage is used throughout the home, as the ability of people living with dementia to communicate with words decreases, the use of non-verbal cues and the environment are important in enabling them to cope better with daily life and aids to orientation. The general Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 24 environment on the units must reflect good practice guidance on dementia care within care homes. Consideration must be given to utilising the existing design and layout of the units to meet the specialist needs of people living with dementia. For example, through the use of visual cues such as colour and signage. Containers with suitable materials could be located around the units so that those residents who can walk can touch and feel things. The use of calming equipment such as lighting or a small aquarium could be used. Staff must be aware of the factors such as noise. There were few appropriate pictures in the corridors, lounges or dining rooms. The manager must give consideration to ensuring that there are items of interest for residents throughout the home. Pictures of the East End of London can be obtained from the local library and these can also be used as points of discussion with residents living with dementia. Boards with different materials stuck to them can be displayed on the walls, and this will aid to the enjoyment of residents who are walking along the corridors as they can touch different types of material. The placing of magazines and ornaments at a level that can be reached by residents will also aid in activities for residents. The physical environment has an enormous impact on how the strengths and skills of people living with dementia are supported or not. Changes mentioned above if implemented can help to support people living with dementia, and help to maximise independence and minimise confusion. Therefore, since the service is registered for the provision of care to people living with dementia, and this is viewed as a specialist service the organisation must consider improvements to the environment as follows: Using changes in colour in different areas to help with orientation Having toilet seats that are a different colour to the rest of the room to help with identification, and this includes the en suites. Using pictorial signs as well as written signs and ensuring these are at the right height to help with identifying different rooms and areas Providing freedom to walk about in areas that are interesting and that have pictures and sitting areas, together with times when staff will take residents, especially those who are prone to “walking” into a garden that is safe and is planted with plants and flowers that have colour and smells. Garden mobiles can also be beneficial to residents as these will provide points of interest and movement. Improved lighting to all units as older people often have failing eyesight. The rear garden was well maintained and there were seating areas for residents. On the day of the inspection some residents were seen enjoying the Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 25 garden area but these were mainly residents whose rooms were on the ground floor. It is essential that all residents are given the opportunity to enjoy the garden on a pleasant day, but again this will have implications for staffing levels. There are currently some residents living at Chadwell House who smoke, and under the new smoke free regulations the organisation must make suitable arrangements for these people. It is not acceptable that vulnerable people should be smoking in the open air in inclement weather conditions. Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use this service experience adequate quality outcomes in this area. We have made this judgement using available evidence including a visit to the service. The needs of people using this service are not currently met by the numbers and skill mix of staff, although they are generally in safe hands. Residents are supported and protected by the home’s recruitment policy and practices and staff are receiving training to ensure that they are competent to do their jobs. EVIDENCE: Staffing levels were discussed with the manager and staff, and also staff rotas were viewed. Generally each unit has two care workers, or 1 senior and 1 care worker and there is a duty officer who can act as a ‘floater’ between the units. It was apparent on the day of the inspection that these staffing levels are not sufficient to provide a good quality of care to people living with dementia. In order to provide a good quality of care it is essential that staff have sufficient time to give 1:1 attention at certain times, that staff have time to be with residents and participate in daily living activities or to take residents out of the home for walks or other communal activities. Sometimes between the finishing of the morning shift and the commencement of the afternoon shift, there is only 1 member of staff for approximately 1 Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 27 hour. Also during staff breaks there is only 1 member of staff on each unit. This is totally unacceptable in a specialist dementia service where residents are more demanding of staff time. In discussions with some staff it would seem that the organisation is wanting to reduce staffing levels. This would not be acceptable and the organisation is required to review staffing levels with a view to increasing them. There are no ratios required by the Commission as staffing levels must always be sufficient to meet the current assessed needs of all of the residents. There are many residents who are quite mobile and would benefit from visits to facilities outside of the home, and there are many residents who would benefit from more staff interaction. During the inspection it was apparent that the needs of 1 resident, whose whereabouts required monitoring every 15 minutes, were not being met because there were no staff members on that unit for more than 15 minutes. This is supported by the Annual Quality Assurance Assessment (AQAA) which states “we could increase the ratio of staff to residents to cater for dementia care needs.” At all times there must be enough staff available to meet the needs of people using the service, with more staff being available at peak times of activity. The staffing structure must be based around delivering outcomes for people using the service, and not led by staff or organisational requirements. Some staff told the inspector that the completion of paper work was very time consuming, and it was not evidenced that much of the information recorded on the paper work is used to inform care plans reviews and the changing care needs of residents. The organisation will need to review the current forms being used to ensure that these are necessary, and used to inform future practice. On the day of the inspection the manager was undertaking in house training with staff, and therefore was not effectively managing the home. It would seem that the training of staff has now moved very much to in-house and is the responsibility of the manager. This does reduce the effective time of the manager to ensure that the home is being managed appropriately. Whilst generally staff are undertaking training, the inspector spoke to a fairly new member of staff who had not had training in moving and handling, and some staff had not had training in caring for people with dementia. Although the organisation is undertaking some training, it was apparent from the inspection that staff require training in ensuring that equality and diversity needs of residents are identified and met. Some staff have undertaken training and achieved NVQ level 2 and/or 3 and this continues with staff who have yet to achieve this qualification. The manager was aware of the recently introduced Mental Capacity Act 2005 and is organising training for the staff at Chadwell House. This should be completed by the end of September, 2007 as the major part of the above Act Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 28 comes into effect on the 1st October, 2007 and this will impact on the delivery of care to vulnerable people. Residents and relative spoke highly of many of the staff, and one resident told the inspector “staff are very nice and they don’t turn up their noses.” A relative told the inspector “Most of the staff are very nice, always smiling and treat the residents with kindness.” Staff recruitment processes are robust, and the manager has spent much time regularising the hours worked by students who are on visa restrictions. The home now has a system in place for identifying when visas are due for renewal so that resulting issues can be addressed in good time. Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 29 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 People who use the service experience adequate 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 home which is managed on a day to day basis by a person who is fit to be in charge and able to discharge her responsibilities as fully as the organisation will allow. To be more effective the organisation does need to have a greater understanding of the role of the manager, and to ensure that she is given the information and resources required to manage the home more effectively. This would be to the benefit of residents and staff. Residents can feel sure that their financial interests are safeguarded, that staff are appropriately supervised and that the health, safety and welfare of residents and staff will be promoted. Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 30 EVIDENCE: The manager is newly appointed since the previous key inspection in 2006, and has now gained registration with the Commission. The manager is qualified and has previous experience of managing a care home. During the inspection the manager was able to demonstrate a clear understanding of the key principles and focus of the service and is working continuously to improve services for the residents. However, there does need to be a much more focused approach to equality and diversity issues both with residents and staff. The manager evidenced a person centred approach to care and has identified gaps in staff training which is currently being addressed. However, the manager must also identify external trainers which can also be used to enable her to spend more effective time in managing the home on a day to day basis, as the current system of in-house training detracts from this. Also on the day of the inspection facilities used by residents were being used for staff training. This effectively prevented residents from using the facilities in the activities room. Again this is not acceptable since Chadwell House is the home of the residents, and as such they should not be inconvenienced for the sake of the staff or the organisation. Residents’ finances were inspected and found to be in good order, and the organisation does not act as an appointee for any of the residents. Staff are now receiving regular supervision which is being recorded, and this is being done through 1:1 sessions, direct observation of care practices and group supervision. This was confirmed by viewing records and talking to staff members. Regular staff meetings are also being held. Residents’ meetings are being held by the activities co-ordinator and the records viewed confirmed this, but also it confirmed that there was much repetition in the recording of the minutes. Although there are policies and procedures in place, the manager is currently reviewing these to ensure that they comply with updated legislation such as equality and diversity, mental capacity and the smoking regulations. Currently each resident has a health and safety risk assessment on file around the overriding of window restrictors. The risk assessments are not practical and generally the actions could not be implemented. This was discussed with the manager during the inspection when it was agreed that she would develop and implement a policy for staff to ensure that they did not override window restrictors. Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 31 Maintenance records were viewed around water, gas, electric, lift, fire safety and all were found to be in good order. The insurance policy was for employer’s liability £10million and public liability £5million, and also included professional indemnity cover. The fire systems are checked regularly by the handyman and a fire risk assessment is in place. Visits required under regulation 26 of the Care Home Regulations 2001 are being undertaken by the organisation, and regulation 37 notifications are being sent to the Commission as necessary. Where necessary risk assessments are in place and generally staff work to the health and safety policy. There is a corporate business plan which details the business arrangements for monitoring the performance and practice of the home. However, it is essential that this plan identifies the specialist services provided by the organisation, such as dementia care, and ensures that staffing levels are such that these services can be delivered effectively and in a person centred way. The plan must also ensure that the maintenance of the building is always kept to a high standard, as it is the home of the residents who should not be expected to live in poorly decorated/maintained premises. Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X 2 2 2 STAFFING Standard No Score 27 1 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 2 Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? NO 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 OP1 Regulation 4 and 6. Requirement Timescale for action 30/09/07 2. OP3 14 3. OP7 15 4. OP8 12 The registered persons must provide an up to date Statement of Purpose. This is to ensure that all prospective, current residents and other people are given accurate information of the services and how these are to be delivered at the home. The registered persons must 15/08/07 ensure that all respite residents are only admitted following a comprehensive assessment of need. This is to ensure that the home can meet the identified needs of the individual. The registered persons must 31/10/07 ensure that care plans are comprehensive and that these are reviewed monthly. This is to ensure that the needs of residents are identified, that these can be met and that changes are identified and recorded in the revised care plan. The registered person must 30/09/07 ensure that the health needs, including skin, oral and hair care, for all residents (including those DS0000067411.V347579.R01.S.doc Version 5.2 Chadwell House Page 34 5. OP12OP13 16 (2)(m)(n) (3) 6. OP14 12(2)(3) 7. OP15 16(2)(i) 8. OP19 OP24 OP25 23(2)(b)( d) from ethnic minorities with specialist needs) are identified in the care plan and met. This is to ensure that all needs of residents are identified and met. The registered persons must ensure that all residents are enabled to engage in individual, small group and large group activities, including community involvement, which will be meaningful for people living with dementia and from differing ethnic backgrounds. Also all residents must be enabled to attend religious services of their choice. This is to ensure that residents living with dementia are enable to retain skills for as long as is possible and that their spiritual needs are met. The registered persons must ensure that residents are enabled to maximise choice over their daily lives. This is to enable residents to exercise choice and know that their ‘voice’ will be heard and listened to. The registered persons must ensure that residents receive meals according to their needs, and these must take account of religious, cultural and personal preferences. Also that meals are served in pleasant and congenial surroundings with appropriately laid tables to enhance the ambience. This is to ensure that the taking of meals is a pleasurable and important part of a resident’s day. The registered persons must ensure that all parts of the home are kept in a good state of repair externally and internally, and that all part of the home are reasonably decorated. Also that DS0000067411.V347579.R01.S.doc 30/09/07 30/09/07 31/08/07 31/10/07 Chadwell House Version 5.2 Page 35 OP26 9. OP27 OP30 OP33 18(1)(a) 10. OP38 13 (4) 23(2)(p) the signage and décor is suited to the needs of people living with dementia. This is so that residents can be sure that the home in which they live is safe, comfortable and pleasant, and that they can find their way around for as long as is possible. The registered persons must 31/08/07 review the staffing levels to ensure that at all times suitably qualified, competent and experienced persons are working at the care in such numbers as are appropriate for the health and welfare of residents. This is to ensure that the home operates in line with the statement of purpose, vision and values of the organisation, and meets the identified and assessed needs of all of the residents at all times, and that staff are aware of equality and diversity issues. The registered persons must 30/10/07 ensure that corridor lighting is suitable for the needs of residents, and that missing/broken window handles are replaced/repaired. This is to ensure the health and safety of residents and staff. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Chadwell House DS0000067411.V347579.R01.S.doc Version 5.2 Page 37 - 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!