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Inspection on 15/07/05 for Duncan House

Also see our care home review for Duncan House for more information

This inspection was carried out on 15th July 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 but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The organisation has an effective and thorough assessment procedure in place, and provides a good training programme for staff. The purpose-built unit is spacious and airy and provides a good environment for service users. The level of homeliness has developed naturally as service users have settled in. Service users are enabled to take part in a good range of activities, both onsite and within the local community. There is also a culture of open visiting between the various units on site and a real sense of community within the campus, though units can decline to have visitors if desired. Contact with service users families is positively encouraged and supported.

What has improved since the last inspection?

Care planning and risk assessment systems have improved though there is still some room for further development. Improvements have been made to the medication management system. The preferences of service users (or their next of kin), with regard to funeral arrangements, have been obtained and recorded. A unit complaints log has been instigated. (See below).

What the care home could do better:

Some of the service user contracts remain unsigned by the service user or their representative. There is a need to set up a system of regular review of risk assessments and for a risk assessment to be compiled for the swimming activity. It would be good practice for all staff to sign to confirm they have read the risk assessments. The existence of a number of gaps in medication recording is of some concern given the improvements made to the medication system. There is a need for further improvements in complaints recording and for the unit complaints record to be regularly monitored. The regularity of house meetings, in-house fire alarm testing, staff supervision and team meetings should be increased. The testing of portable electrical appliances remains outstanding and need to be addressed as a priority.

CARE HOME ADULTS 18-65 DUNCAN HOUSE 18 Hucklebury Close Purley-on-Thames Berkshire RG8 8EH Lead Inspector Steve Webb Unannounced 15 July 2005 @ 10:15 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. DUNCAN HOUSE H52-H01 S57646 Duncan House V235283 180705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Duncan House Address 18 Hucklebury Close Purley-on-Thames Berkshire RG8 8EH 0118 942 7608 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) Purley Park Trust Limited Bernadetta Johnson Care Home 8 Category(ies) of Learning Disability registration, with number of places DUNCAN HOUSE H52-H01 S57646 Duncan House V235283 180705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Two service users may be over 65 years of age. Date of last inspection 16/06/04 Brief Description of the Service: Duncan House is one of five recently built units to replace the old main house on the Purley Park site. It is now one of eight smaller, purpose-built units on the attractively landscaped site, together with a separate club-house. The house opened in May 2004 and accommodates eight adult service users with a learning disability in a two-storey unit. Like all of the units on site, it now has a designated manager and staff team, who meet the needs of the service user on a day-to-day basis. The site is enclosed apart from at its entrance, and provides a community within which service users can circulate freely, without the need for direct staff support. Service users are able to visit friends in the other houses. When off-site, all of the service users are supported by a staff member to varying degrees. DUNCAN HOUSE H52-H01 S57646 Duncan House V235283 180705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, carried out between 10.15am and 2.45pm on 15/7/05. The manager was not on duty. The inspector was assisted by the head of care and the team leader. The inspection included conversations with unit staff, observation of care practice and interactions, examination of records and files, and discussion with service users. The inspector also had lunch with service users, and was shown round the building. This was a positive inspection overall, though the high level of staff turnover was of some concern. Some safety issues emerged which are detailed below and in the body of the report. What the service does well: What has improved since the last inspection? Care planning and risk assessment systems have improved though there is still some room for further development. Improvements have been made to the medication management system. The preferences of service users (or their next of kin), with regard to funeral arrangements, have been obtained and recorded. A unit complaints log has been instigated. (See below). DUNCAN HOUSE H52-H01 S57646 Duncan House V235283 180705 Stage 4.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DUNCAN HOUSE H52-H01 S57646 Duncan House V235283 180705 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection DUNCAN HOUSE H52-H01 S57646 Duncan House V235283 180705 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 4, 5 Prospective service users are fully assessed prior to moving into the service and an appropriate transition takes place including visits to the unit. Each service user has an individual contract with the home, though some remain in need of signing by the service user or their representative. EVIDENCE: Systems of risk assessment and care planning have improved. Following an initial referral the unit will obtain the local authority assessment, then the head of care carries out the organisations own assessment through visiting the prospective service user where they are living. The service user’s is invited for a series of visits to the unit, including an overnight stay, and their family are also invited to visit. From the information obtained, a prospective care plan is drawn up and copied to the care manager, service user and their family, together with photos of the unit. Decision making and transition can be set up over whatever period is felt necessary in order to enable the service user to make the move smoothly. Relevant information is summarised for the care staff and a risk assessment is carried out. The service user is registered with a local GP ahead of the move. DUNCAN HOUSE H52-H01 S57646 Duncan House V235283 180705 Stage 4.doc Version 1.40 Page 9 The care plan is reviewed after six weeks, three months and then six-monthly, and a schedule of reviews was available in the unit. Examples of those elements of the above, which had taken place to date, were examined. An Essential Lifestyle Plan is also drawn up for each service user, which identifies specific likes and dislikes around food, and any preferences around personal care, activities, etc. A previous requirement to get all contracts/compacts signed by the service user (if able), or their next of kin/advocate, had been partially addressed, but one document was unsigned and two were not within the file. Outstanding contracts should be signed by the service user or their representative. DUNCAN HOUSE H52-H01 S57646 Duncan House V235283 180705 Stage 4.doc Version 1.40 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) 9 Service users are supported to take risks within the context of an appropriate risk assessment strategy, to maximise their independence. However, some of the risk assessments needed reviewing to ensure they remained relevant, and staff should countersign these documents to confirm they have read them. EVIDENCE: There is a risk assessment process in place which has been improved and covers generic issues and also individual assessments around such things as epilepsy, level of supervision whilst bathing, helping prepare food in the kitchen, travel, and activities. All staff are informed about the resulting risk assessments but not all have signed to confirm they have read them. It is best practice to ensure that all staff countersign risk assessments to confirm they have read them. Staff in other units on site are also told about relevant risk assessments as service users may spend significant periods in other units. It was noted that some risk assessments on file had not been recently reviewed. It is essential to review risk assessments regularly to ensure they remain relevant. DUNCAN HOUSE H52-H01 S57646 Duncan House V235283 180705 Stage 4.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 Service users take part in a wide range of appropriate activities on and off-site and are actively involved, within both the on-site and local communities. A risk assessment is required for the swimming activity. Appropriate relationships are encouraged, and staff work to maintain family contact and support visits where necessary. EVIDENCE: Service users take part in a wide range of activities, on and off-site as well as within the unit. These include swimming, bowling cooking, art sessions, use of local cafes and garden centres, golf, men’s and women’s sessions, meals out and various half and full day trips. A variety of activity sessions are run by a local college in the on-site clubhouse, including drama, maths and art. No risk assessment for the swimming activity could be located. This should be compiled and a copy provided to the inspector. Two service users attend supported work placements. DUNCAN HOUSE H52-H01 S57646 Duncan House V235283 180705 Stage 4.doc Version 1.40 Page 12 Service users have regular holidays, or equivalent short breaks or day trips if this suits them better. Individuals will also have one to one time with their keyworker engaged in shopping and other tasks, and may have supported visits to family. Whilst the issue of local authority funding for annual holidays has been addressed for all new service users, long-standing service users are not usually funded for holidays, though the organisation has worked to try to secure funding from local authorities for this. A service user recently married another from one of the other units on-site, at a ceremony in the local church, attended by family and all their friends within Purley Park. The service user proudly showed the inspector his collection of photographs of the event and talked about the day, and others also commented about their participation, and about having bought new outfits for the occasion. Most of the service users have regular contact with family, either through visits, telephone calls or letters. Two have little family contact though keyworkers help to maintain contact by supporting letter writing. DUNCAN HOUSE H52-H01 S57646 Duncan House V235283 180705 Stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 20, 21 Service users receive personal support in the way they would prefer it, as far as possible. Their views on this are sought and recorded. Though none is able to manage their own medication, an appropriate system is in place. However, despite this a number of gaps were noted in the medication administration records, which should be addressed. In the context of the ageing of the service user group, the views of service users regarding their preferred funeral arrangements have been obtained. EVIDENCE: Wherever possible service users receive any personal care support from staff of the same gender, and on occasions a staff member known to the service user will be borrowed from another unit to enable this. The individual likes and dislikes of service users are established through completion of the essential lifestyle plan with each person. This would include aspects of care, activities, hobbies and interests and dietary preferences. None of the current service users is able to manage their own medication. The home’s medication management system has been improved since the previous inspection, and now includes double signatories for each dosage DUNCAN HOUSE H52-H01 S57646 Duncan House V235283 180705 Stage 4.doc Version 1.40 Page 14 administered; a photo of the service user with their medication administration record (MAR), sheet; and individual medication profiles. The quantities of medication coming into the unit are recorded and a returns record is kept. Additional staff have also received medication training, though newer staff do not administer medication. The high level of staff turnover in this unit has meant that at times, staff have to be borrowed from other units to administer or witness medication, which is not an ideal situation. It was noted, however, that there were a number of gaps in the medication records on MAR sheets, and staff need to be reminded of the importance of proper completion of these records. The preferences of service users or their next of kin, with regard to funeral arrangements, have been sought and recorded in order to respect these wishes when the time comes. This is good practice. DUNCAN HOUSE H52-H01 S57646 Duncan House V235283 180705 Stage 4.doc Version 1.40 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 The views of service users are listened to via the complaints system, but also through the house meetings, though these should take place more regularly. It is important to log all complaints within the unit complaints log to enable their existence to be noted by inspectors and Regulation 26 visitors. Additional records were recommended to be included in the central record of complaints. EVIDENCE: An individual complaints log had been established in the unit since the previous inspection. Although the log was empty, it was established that one complaint had been raised directly with senior management, which had been logged within the central complaints record, but not in the unit. This should also have been noted within the unit log in appropriate terms to respect confidentiality, to enable its existence to be noted from the unit record, by inspectors and Regulation 26 visitors. The unit complaints log should be countersigned by the manager and Regulation 26 visitor on a regular basis. The central record of this complaint was examined. It is recommended that written records of any statements taken as part of the investigation are included herein. It was reported that regular house meetings should be taking place on a monthly basis, but it was noted that there were some extended gaps in the minutes of these. DUNCAN HOUSE H52-H01 S57646 Duncan House V235283 180705 Stage 4.doc Version 1.40 Page 16 The minutes indicate that these meetings provide a good opportunity for discussion of issues within the unit, for any concerns to be raised and for holiday and outing planning. They are also a good way to engage service users, and improve their communication skills and participation. These meetings should therefore, be held more regularly. DUNCAN HOUSE H52-H01 S57646 Duncan House V235283 180705 Stage 4.doc Version 1.40 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 Service users live in a homely, comfortable and safe environment, which reflects their needs and individual personalities. EVIDENCE: The unit remains attractively decorated for the most part, though some minor repairs as the result of plaster shrinkage and damage around hinges, will need to be addressed. Previous bathroom floor drainage issues had been addressed. The level of homeliness has developed naturally as service users have become more settled into their new home. The unit has a light, airy and spacious feeling, and electromagnetic door holdbacks enable service users to move about the home freely. Service users were enables to choose their preferred colour scheme for their bedrooms at admission, and the bedrooms have now developed individuality, reflecting the personality and interests of their occupant. The bath hoist in one bathroom was out of commission awaiting repair, but had been reported. DUNCAN HOUSE H52-H01 S57646 Duncan House V235283 180705 Stage 4.doc Version 1.40 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) 35, 36 Service user needs will be met by an appropriately trained staff team once all of the new staff have completed their induction and foundation and commenced their NVQ. At present the level of training is affected by the amount of staff turnover in the past year. The frequency of supervision and team meetings should be improved to provide more regular support for the new staff team. EVIDENCE: The organisation has a dedicated training manager who is responsible for planning the training schedule. Upcoming courses are advertised within the unit, in addition to those planned as part of induction and foundation training. Given the large turnover of staff in this unit over the past year, (only the manager and team leader remain), most staff are still to complete their core training but this is in hand through the induction and foundation training package provided. A spreadsheet showing training attended was available in the unit. DUNCAN HOUSE H52-H01 S57646 Duncan House V235283 180705 Stage 4.doc Version 1.40 Page 19 The manager had completed her NVQ level 4 and Registered Manager’s Award, and the newly promoted team leader has NVQ level 3. Other staff were still undertaking induction and foundation training and will then go on to NVQ. Supervision was not taking place as frequently as the organisational policy states, (every 2-4 weeks) and team meetings did not appear to be taking place monthly. However, there are weekly management meetings and monthly staff meetings across the organisation. Regular team meetings and supervision are an essential part of building and maintaining effective teamwork and communication, and these should be provided regularly to support the staff. DUNCAN HOUSE H52-H01 S57646 Duncan House V235283 180705 Stage 4.doc Version 1.40 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) 42 For the most part, the health and safety of service users is promoted, and protected, but the identified medication errors, absence of electrical appliance testing, and irregular fire alarm tests could expose service users to potential harm, and should be addressed. EVIDENCE: Some of the required safety and servicing certification was available in the unit, but a number of items could not be located. These were copied to the inspector straight after the inspection, with the exception of records of electrical appliance annual testing which remains outstanding despite a previous requirement. This must be addressed as a priority and annually thereafter. It was also noted that in-house fire alarm testing was not taking place weekly, and the gaps between tests were increasing. It is important to maintain weekly testing of the alarm testing each of the alarm call points in rotation. DUNCAN HOUSE H52-H01 S57646 Duncan House V235283 180705 Stage 4.doc Version 1.40 Page 21 As already noted, a bath hoist was out of commission awaiting repair, but this was in hand. Alternative options were available to service users. The previously noted medication recording errors could expose service users to risk through either repeat administration or missed dosages, and the seriousness of this issue should be pointed out to staff. DUNCAN HOUSE H52-H01 S57646 Duncan House V235283 180705 Stage 4.doc Version 1.40 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x 3 2 Standard No 22 23 ENVIRONMENT Score 2 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score x x x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x x Standard No 11 12 13 14 15 16 17 x 2 3 3 3 x x Standard No 31 32 33 34 35 36 Score x x x x 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 DUNCAN HOUSE Score 3 x 2 3 Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x H52-H01 S57646 Duncan House V235283 180705 Stage 4.doc Version 1.40 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 5 Regulation 5 Requirement Outstanding contracts should be signed by the service user (if able), or their representative. This requirement remains outstanding from the previous inspection. Ensure that all risk assessments are reviewed regularly. A risk assessment for the swimming activity should be compiled and copied to the CSCI. Staff must be reminded of the importance of accurate medication recording. Appropriate details of any complaint made, must be entered in the complaints log. The unit complaints log should be countersigned by the manager and Regulation 26 visitor regularly. Increase the frequency of inhouse fire alarm testing. The testing of all portable electrical appliances must be addressed as a priority. This requirement remains outstanding from the previous inspection. DUNCAN HOUSE H52-H01 S57646 Duncan House V235283 180705 Stage 4.doc Version 1.40 Page 24 Timescale for action 15/9/05 2. 3. 4. 5. 6. 9 12 20 22 22 13 13 13 22 22 15/9/05 15/9/05 15/9/05 15/9/05 15/9/05 7. 8. 42 42 23 13 15/9/05 15/10/05 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 9 22 36 Good Practice Recommendations It would be best practice for all staff to sign to confirm they had read all of the risk assessments. It is recommended that copies of any statements taken in the course of investigating the identified complaint, are held within the central complaints record. The frequency of supervision and team meetings should be increased to organisational expectations, to provide improved support to the new team. DUNCAN HOUSE H52-H01 S57646 Duncan House V235283 180705 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection 2nd Floor, 1015 Arlington Business Park Theale Berks RG7 4SA 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 DUNCAN HOUSE H52-H01 S57646 Duncan House V235283 180705 Stage 4.doc Version 1.40 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!