Inspection on 21/09/06 for Elmhurst Residential Home

This inspection was carried out on 21st September 2006.

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.

Other inspections for this house

Elmhurst Residential Home 27/06/07

Elmhurst Residential Home 27/09/05

Elmhurst Residential Home 24/05/05

Elmhurst Residential Home 21/10/04

Elmhurst Residential Home 15/06/04

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 Elmhurst Residential Home 81-83 Holden Road North Finchley London N12 7DP Lead Inspector Tom McKervey Key Unannounced Inspection 09:30 21 September 2006 st 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 Elmhurst Residential Home DS0000010404.V303524.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. Elmhurst Residential Home DS0000010404.V303524.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elmhurst Residential Home Address 81-83 Holden Road North Finchley London N12 7DP 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) 020 8445 6501 020 8446 5419 Mrs Bernadette Tisdall Miss Elaine Margaret Tisdall Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (30) of places Elmhurst Residential Home DS0000010404.V303524.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th September 2005 Brief Description of the Service: Elmhurst is a privately run care home, first registered in 1967 for 30 older people, some of whom may have dementia. The stated aim of the home is to promote the dignity and privacy of service users who are frail and have dementia, thus ensuring their maximum quality of life. The home is a large two storey, detached building. The bedrooms, which are located on both floors, comprise twelve single and nine double bedrooms. Three bedrooms have en-suite facilities. A passenger lift provides access to the first floor. The communal lounge, dining area, office, laundry and kitchen are all on the ground floor. At the front of the building there is a large car park, and there is an attractive garden at the rear of the building, which is partly paved with a ramp for and access by wheelchair users. The home is located in an attractive residential area of North Finchley and close to Woodside Park tube station. It is well served by a variety of shops, restaurants, transport and other community facilities located along Ballards Lane and High Road in North Finchley. The weekly fees range from £411.00 - £600.00. Elmhurst Residential Home DS0000010404.V303524.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted over a period of seven hours. The inspection was carried out as part of the Commission’s inspection programme and to check compliance with the key standards. The registered manager and deputy were present during the inspection and fully cooperated in the process. The inspection process included a tour of the premises, reading residents’ case files, and discussing with them about their experiences of living and in the home. Visitors to the home were also spoken to during the inspection. The staff were observed interacting with the residents and providing care and support. Several staff were interviewed about their knowledge and experience, and their records were also examined. What the service does well: What has improved since the last inspection? The exterior of the home has been redecorated and the driveway resurfaced. Some bedrooms have also been redecorated and a patio door has been replaced. Several maintenance and repair issues identified at the last inspection have been addressed. Elmhurst Residential Home DS0000010404.V303524.R01.S.doc Version 5.2 Page 6 The records of administration of medicines has improved 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. Elmhurst Residential Home DS0000010404.V303524.R01.S.doc Version 5.2 Page 7 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 Elmhurst Residential Home DS0000010404.V303524.R01.S.doc Version 5.2 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4 & 5. Standard 6 does not apply. The quality in this outcome group is good. This judgement has been made from evidence gathered both during and before the visit to this service. Potential service users are thoroughly needs assessed before admission to the home. The home is equipped to meet the needs of the residents and they or their representatives are able to visit the home to assess its suitability. EVIDENCE: At the time of the inspection, there were twenty-nine residents in the home and there was one vacancy. The case files of four of the last residents to be admitted were examined. All four people were funded by a local authority block contract. Elmhurst Residential Home DS0000010404.V303524.R01.S.doc Version 5.2 Page 9 Full needs assessments had been carried out by the placing care managers or Community Mental Health Team, prior to admission. Assessments by the senior staff in the home were also provided for these residents on admission. Risk assessments were documented, particularly about risk of falls, danger of wandering, moving and handling. Follow-up reviews by the placing officers were carried out after a six-week trial period to determine that the placement was appropriate. The home is registered to care for people with varying needs, including dementia. Two residents who were spoken to during the inspection said that their relatives had assessed the home’s suitability on their behalf. Both residents stated that the home met their needs. One said; “My son found this home for me. I’m very happy here and don’t want to leave”. The home has a lift and there is a ramp to the garden area to assist residents with mobility problems. There is a spacious garden and patio for the residents to enjoy in the good weather. The home is equipped with hoists and adaptations in toilets and bathrooms to assist people with mobility problems. Pressure-relieving equipment, eg air mattresses and cushions are available for residents who are at risk of pressure ulcers. Elmhurst Residential Home DS0000010404.V303524.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 The quality in this outcome group is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The rights and privacy of some residents are being infringed by their rooms being used for administrative and storage purposes. Care plans are generally well constructed, but care plans were not available for two residents, which could lead to staff being unaware of their needs and goals of care. Medication is administered safely and the healthcare needs of the residents are being met by a range of healthcare professionals. The care staff treat residents with dignity and respect. EVIDENCE: Of the four last residents to be admitted, only two had written care plans available for inspection. The deputy manager said she was working on these on Elmhurst Residential Home DS0000010404.V303524.R01.S.doc Version 5.2 Page 11 her computer at home. However, care plans should always be available for care staff to guide them in meeting residents’ needs. Concern about this issue was identified at the last inspection, and a requirement about this issue is restated. The care plans of the other two recent residents were examined. They were comprehensive and covered all areas of care. There was evidence that the care plans were reviewed monthly. The inspector spoke to the District Nurse who was visiting two residents. From her observation when visiting the home, she was appreciative of the care provided by the staff. Two residents currently had pressure ulcers. They had special mattresses to relieve pressure, and the nurse said that one had now healed and the other was on the mend. Residents’ files contained records of healthcare appointments, including visits by the G.P, and district nurse, optician, chiropodist and dentist. A written comment from the G.P was sent to the inspector stated; “The patients are looked after very well. The staff understand patients and families’ needs.” Where appropriate, advice from a dietician had been sought for a resident who was having difficulty in eating. The weights of the residents were monitored monthly. Many written comments were sent to the inspector from residents, relatives and healthcare professionals, which were very complimentary about the home. However, the inspector was concerned to see a double bedroom that was currently occupied by two residents, being used for administrative purposes by the deputy manager. In addition, a relative complained to the inspector that several Zimmer frames were being stored in a resident’s room. Although this was not the case on the day of the inspection, a requirement had been made at the last inspection about this issue. This requirement is therefore restated in this report. Both of these matters are infringements of those residents’ rights and a requirement is made for this practice to cease. The accident book was appropriately completed and was up to date. Elmhurst Residential Home DS0000010404.V303524.R01.S.doc Version 5.2 Page 12 At the time of the inspection, no residents were able to self-medicate. On inspection, medication stocks were being properly stored and accounted for, including controlled drugs. There were no gaps in the administration of medicines records. The inspector observed the staff interacting with residents in a caring, courteous manner. Staff were also observed supporting some residents to eat. This was carried out appropriately in an unhurried manner. Elmhurst Residential Home DS0000010404.V303524.R01.S.doc Version 5.2 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 15 The quality in this outcome group is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. There is a good range of stimulating activities provided for the residents, the majority of whom are able to exercise choice about their lives in the home. Relatives are welcomed to the home and are able to visit at any time. Meals are nutritious and varied, but a record needs to be kept as evidence of choice being exercised when alternatives to the menu are provided. The manager must ensure that eggs supplied to the home are safe for residents to eat. EVIDENCE: Elmhurst Residential Home DS0000010404.V303524.R01.S.doc Version 5.2 Page 14 Residents have a personal activity chart for recording the activities each person has taken part in. The general programme includes, music, exercise and art and craft sessions. A session on keep-fit and reminiscence is also held twice a week by an occupational therapist. There is and open visiting policy, with relatives able to visit whenever they wish, and the visitors book indicated frequent visits to the home. Residents who were spoken to stated that they were able to rise and go to bed when they preferred, and that they could choose their meals. Some residents preferred not to participate in organised activities and would rather stay in their rooms, reading or watching television. Evidence of these choices and decisions was seen in residents’ daily records. The inspector discussed with the manager and deputy manager, the subject of how service users’ sexual and diversity needs were being met. The manager stated that married couples had often been accommodated in the home, and arrangements for people who had diverse sexual needs would be made in accordance with their policy and procedures on sexuality. The majority of residents are currently white, with two residents who are Asian. The menus offer a good variety of wholesome food. Staff were observed supporting some residents to eat their lunchtime meals. This was dome in a caring and unhurried manner, with sufficient time being taken. The residents said they were satisfied with their meals and could choose alternatives to the planned menu. However, where residents did choose an alternative, this was not being recorded and a requirement is made to address this. Elmhurst Residential Home DS0000010404.V303524.R01.S.doc Version 5.2 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The quality in this outcome group is good. This judgement has been made from evidence gathered both during and before the visit to this service. Complaints are properly recorded and there is an appropriate procedure for responding to concerns. Residents’ interests and welfare are safeguarded by training staff in the subject of protecting vulnerable adults from abuse. EVIDENCE: There is an appropriate complaints procedure in place and residents said that they were aware of how to make a complaint. All residents spoken to, said they were satisfied with the service they received. There is a record of all complaints made to the home. A complaint had recently been made by relatives of a resident about their care, which had also been copied to the Commission for Social Care Inspection. During the inspection, the inspector discussed this matter with the manager who was in the process of investigating this complaint. The complaint had also been sent to the local authority, which convened a “strategy meeting” under the adult protection procedures to examine the facts and determine any actions to be taken. Elmhurst Residential Home DS0000010404.V303524.R01.S.doc Version 5.2 Page 16 Following the manager’s investigation, a copy of her response to the complainant was sent to the Commission. This had been completed within the required timescale and was an appropriate procedure for dealing with the complaint. The outcome of the strategy meeting was for a care review to be held by the resident’s social worker, to include their relatives. . At the time of writing this report, the complainant had not yet replied whether or not they are satisfied with the outcome. Staff records showed that they had attended training in adult protection procedures, and those who were spoken to, were knowledgeable about abuse issues and how to report any concerns. Elmhurst Residential Home DS0000010404.V303524.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 & 26 The quality in this outcome group is good. This judgement has been made from evidence gathered both during and before the visit to this service. The residents live in a home that is clean, attractive and comfortable. The home is generally well maintained, however the hot water system needs to be regularly monitored to avoid the risk of scalding. EVIDENCE: A tour of the premises was carried out. There is a good standard of internal and external décor. The exterior of the building had been repainted recently and there were attractive hanging flower baskets and a bench at the front of the home. Elmhurst Residential Home DS0000010404.V303524.R01.S.doc Version 5.2 Page 18 The garden was particularly attractive and there was ample garden furniture in place. At the time of the inspection, contractors were re-surfacing the front and side of driveways. New wall lights had been fitted in the dining room. The manager said that the old carpets and rugs in the dining room will be replaced soon with hard flooring. A new hoist had been purchased and new patio doors had been installed. At the time of the inspection, the home was clean and tidy and there were no offensive odours. Elmhurst Residential Home DS0000010404.V303524.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 The quality in this outcome group is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. There are sufficient numbers of staff on duty at all times to meet the residents’ needs. The practice of recruiting staff is generally satisfactory. However, employing staff without references could put residents’ welfare at risk. Staff are provided with training appropriate to the needs of the residents. EVIDENCE: The staff rota was examined. There is a deputy manager and a senior carer in post. The rota showed that six care staff are normally on duty during the daytime, and three waking night staff. The care staff are supported by cooks, cleaners a laundry worker and a maintenance person. This level of staffing meets the standard. Staff who were spoken to, said they were satisfied with the level of staffing available to support the residents. At the time of the inspection, there were no staff vacancies. Elmhurst Residential Home DS0000010404.V303524.R01.S.doc Version 5.2 Page 20 Three staff have attained National Vocational Qualification level 2 and there is an ongoing programme for all staff to attain this qualification. The records of two recently recruited staff were examined. Criminal Records Bureau checks had been made, however, references had not been obtained for one person. An immediate requirement was made to obtain a reference from this person’s last employer, and by the time of writing this report, had been done. A requirement is made that staff are not permitted to start work in the home until references have been obtained. There were records of staff attending training on health and safety subjects, for example; food hygiene and first aid and moving and handling. Training in fire safety was scheduled to take place and refresher training in mandatory subjects. Elmhurst Residential Home DS0000010404.V303524.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36 & 38 The quality in this outcome group is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The manager has relevant experience and qualifications to manage the service. Residents have indicated in a quality assurance questionnaire that they are satisfied with the service, and there is good a good team spirit among the staff group. The manager must ensure that eggs supplied to the home are safe for residents to eat, and the hot water system must be regularly monitored to protect staff and residents from scalds. EVIDENCE: Elmhurst Residential Home DS0000010404.V303524.R01.S.doc Version 5.2 Page 22 The manager is a qualified nurse and has been managing the home for many years. The deputy manager has also been in post for several years. Both the manager and deputy are currently studying to attain the Registered Manager Award. In a discussion with a group of staff, they described their morale as very good and they worked well together. They were appreciative of having regular supervision with their line manager, when they could discuss their work and any personal issues. The inspector saw evidence of a recent satisfaction survey of residents’ views about the service. There was a good level of satisfaction expressed. A recommendation is made for a summary of the outcome of the audit to be included in the Service User Guide. The Health and Safety Standards were examined. The temperatures of fridges and freezers were recorded daily, but there was no date on the eggs supplied to the home. A requirement is made about this issue to ensure that eggs are safe to eat. The fire log showed that the alarms were tested weekly and the fire extinguishers had been serviced in the last year. Staff were scheduled to attend refresher training on fire safety. Current certificates of safety for fire, gas, electric and water installations were seen, and the lift and hoists were serviced by appropriate engineers. The water in some bedrooms was too hot, which was immediately rectified by the maintenance person during the inspection. However, a requirement is made for regular monitoring of the hot water outlets to avoid the risk of scalding. There was a current employers liability insurance certificate on display. Elmhurst Residential Home DS0000010404.V303524.R01.S.doc Version 5.2 Page 23 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 X 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 X 2 Elmhurst Residential Home DS0000010404.V303524.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15(2)(1) Timescale for action The registered person must 31/10/06 ensure that residents’ care plans are available for staff at all times in the home. This requirement is restated from the last inspection. The previous timescale was 31/10/05. The registered person must 31/10/06 ensure that residents’ bedrooms are not used for administration purposes. The registered person must not 31/10/06 use residents’ bedrooms to store other residents’ Zimmer frames. The registered person must 31/10/06 ensure that eggs supplied to the home are dated appropriately. The registered person must 30/09/06 obtain references for new staff from their last employer, before permitting them to start work. The registered person must 30/11/06 ensure that hot water is monitored regularly to prevent scalding. Requirement 2. OP10 12(4)(a) 3. OP10 12(4)(a) 4. 5. OP15 OP29 13(4)(c) 7, 9, 19 6. OP38 13(4)(a) Elmhurst Residential Home DS0000010404.V303524.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP33 Good Practice Recommendations The registered person should summarise the service users’ satisfaction survey and include it in the Service User Guide. Elmhurst Residential Home DS0000010404.V303524.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 Elmhurst Residential Home DS0000010404.V303524.R01.S.doc Version 5.2 Page 27 - 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!