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Inspection on 05/05/05 for Elsenham House Nursing Home

Also see our care home review for Elsenham House Nursing Home for more information

This inspection was carried out on 5th May 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 no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

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 home has a group of carers that have worked at the home for a long time. They are very keen to raise standards and are very eager for clear direction. The residents spoken to felt that they were treated with respect. The home has a very comprehensive assessment process in place with prospective residents being involved with the whole process; other health care professionals are also involved with this process.

What has improved since the last inspection?

The care planning system has much improved with clear evidence of evaluation and review of care having taken place.

What the care home could do better:

The staff are very willing to do things that need to be improved, but have been inhibited in this regard due to the lack of clear leadership in the home. This arises from the fact that in addition to the manager, the provider is present most of the time. The provider is not qualified as a mental health practitioner and this adds to the confusion over autonomy and accountability and actually who has the authority to make decisions about the health and welfare of the residents who need very specialised care. Recruitment of more qualified staff is essential so that the staffing levels can be improved in the home especially at the weekends and overnight, to ensure appropriate care to the particular type of people accepted into the home. Concerns from all levels of staff must be looked at properly so that they feel that they are being listened to and thus ensuring that the staff and the residents are protected. Residents spoken with would like to take part in more regular activities, outings and holidays. More choice could be offered at meal times. Administration of medication could be handled more expeditiously as residents feel that they are often kept waiting for their medication, which makes them very agitated and stressed. The home could ensure that all members of staff have a job description.

CARE HOME ADULTS 18-65 Elsenham House Nursing Home 49-53, 57 Station Road Cromer Norfolk NR27 ODX Lead Inspector Marilyn Fellingham Announced 5 May 2005 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. Elsenham House Nursing Home I55 S53608 Elsenham House V216512 050505 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Elsenham House Nursing Home Address 49-53, 57 Station Road Cromer Norfolk NR27 ODX 01263 513564 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) jdupuis@elsenhamhouse.freeserve.co.uk Elsenham House Ltd. Anthony Lee Care Home 31 Category(ies) of Mental disorder (31) registration, with number of places Elsenham House Nursing Home I55 S53608 Elsenham House V216512 050505 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: One named service user over the age of 65 may be accommodated. Date of last inspection 27 January 2005 Brief Description of the Service: Elsenham House is situated in an urban location, on the outskirts of Cromer and comprises of four properties, divided by one house in between. The first three properties were built in approximately 1890, they have small rear gardens where there are lawned areas and patios for Service Users use. Public transport services include a bus service every 15 minutes and a train service from Cromer every 20 minutes. Fifty-seven Station Road, Cromer, the fourth property, is intended as a unit where Service Users are encouraged to develop their skills and become more independent, prior to moving back into the community. Many of the Service Users are encouraged to promote as much independence as is possible and are facilitated to continue to engage in outside the Home activities and work experience. Elsenham House Nursing Home I55 S53608 Elsenham House V216512 050505 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was announced and took place over seven hours. A brief tour of the premises took place and staff and care records were inspected. The manager, staff and residents were involved in part, with the inspection process; ten residents, three relatives, five members of staff were spoken with. What the service does well: What has improved since the last inspection? The care planning system has much improved with clear evidence of evaluation and review of care having taken place. Elsenham House Nursing Home I55 S53608 Elsenham House V216512 050505 Stage 4.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Elsenham House Nursing Home I55 S53608 Elsenham House V216512 050505 Stage 4.doc Version 1.20 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 Elsenham House Nursing Home I55 S53608 Elsenham House V216512 050505 Stage 4.doc Version 1.20 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) 1, 3 Every effort is made to ensure that all prospective residents have enough information to make an informed choice about admission to the home. EVIDENCE: The admission process is most robust; it involves not only the prospective residents but also members from all other professional agencies. Individual records are kept for each of the residents and inspection of these records revealed that full assessments had taken place for the most recent admissions. Discussion with relatives confirmed that they were also involved with the admission process and said that they were given enough information prior to their relative’s admission to the home. Elsenham House Nursing Home I55 S53608 Elsenham House V216512 050505 Stage 4.doc Version 1.20 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9,10 Great progress has been made on improving arrangements to ensure that the resident’s needs are identified and that their needs are reviewed on a regular basis. Residents are involved in making decisions about their daily activities and are supported in taking steps to lead independent lives. EVIDENCE: Individual care plans are available and show that progress has been made to ensure all aspects of health and social care needs have been identified and planned for; these plans also confirm that the individuals are supported to take risks in their daily activities to enable them to move forward and lead independent lifestyles. In discussion with the residents they confirmed that they were very much involved in making decisions about their daily lives. Elsenham House Nursing Home I55 S53608 Elsenham House V216512 050505 Stage 4.doc Version 1.20 Page 10 Records show that the needs are reviewed at timely intervals and more when individual’s needs change. Significant events are recorded on a daily basis and care planned accordingly if necessary. Residents are invited to comment on various aspects about the home, for example they were asked if they would like to change the times of the mid day meal and this has been adjusted to suit the desires of the residents. Meetings are held with the residents, although the residents commented that they had not had one for sometime. Everyone contributes to the meetings and notes are kept. All the residents are risked assessed before admission and this process continues whilst on visits until admission. Records indicate that action is taken to minimise risks and there is also evidence that review of the risks also takes place; risks are then identified on care plans, which, revealed the action necessary to reduce those risks. Staff confirmed that all information about the residents is handled appropriately and that their confidences are kept: the home obviously handles some information on a need to know basis especially if it has a significant effect on meeting needs and safety of the residents. Training records indicated that all areas of confidentiality are covered in induction. Elsenham House Nursing Home I55 S53608 Elsenham House V216512 050505 Stage 4.doc Version 1.20 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) 11,12,13,14,15,16,17 Opportunities are given for personal development. Social activities and meals are not managed well; a daily choice of meals is not always given and social activities do not always take place. Residents are encouraged to meet with their families and friends. EVIDENCE: The residents confirmed with the Inspector that they were given many opportunities for personal development and that they make choices about what therapies they are going to undertake. Many of the residents have links with the community, a number have part time jobs such as cleaning the loos at the local tourist train centre and working at a local bus station. Another resident works part time in a local charity shop. Elsenham House Nursing Home I55 S53608 Elsenham House V216512 050505 Stage 4.doc Version 1.20 Page 12 A number of residents follow part time adult education and some receive outreach education in the home. Two of the residents are engaged, one to another resident and the other to a resident in another home, appropriate education is given to them regarding their relationships. Discussion with the residents revealed that they felt that the activity programme was not always adhered to, they said that this was the result of not sufficient staff being on duty. The residents also mooted that they would like to go on more outings and for small holidays, some of the residents stay with family at week- ends but not anywhere else. The residents must be given stimulation through leisure and recreational activities in and outside the home that suits their needs and preferences. The residents make choices on a daily basis; meal times are quite often slotted around any activities. However inspection of the menus revealed that no choices were available at meal times and the menus even stated how many slices of bread were available. The residents stated that they would like more choice at mealtimes and the menus indicated only one choice available. Elsenham House Nursing Home I55 S53608 Elsenham House V216512 050505 Stage 4.doc Version 1.20 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) 18,19,20, Residents are given the personal support that they need and their emotional needs are met, however more could be done to ensure that their physical needs are met. Progress has been made in relation to the safe handling and administration of medication. The authority for any decision to vary the dosage of medication (within prescribed limits) should rest solely with the senior nurse on duty. EVIDENCE: In discussion with a number of the residents it was established that they felt they were well supported in the home by the staff. Because activities are often a hit and miss procedure the residents do not get sufficient physical exercise and felt that they would like to do more. The manager has enlisted the help of the CSCI pharmacist to improve the system for handling and administration of medication. Although it was only introduced a week previous to the inspection the manager felt it was a success. Elsenham House Nursing Home I55 S53608 Elsenham House V216512 050505 Stage 4.doc Version 1.20 Page 14 The residents expressed to the Inspector that they were concerned that quite often they had to wait long periods for their medication; this was due to insufficient qualified members of staff being on duty at any given time. This was confirmed by inspection of the duty rotas. Elsenham House Nursing Home I55 S53608 Elsenham House V216512 050505 Stage 4.doc Version 1.20 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) 22,23 Residents do not always feel they are listened to. Every effort is made to ensure that the residents are protected from all types of abuse. EVIDENCE: Those residents spoken with on the day of inspection felt that they were not always listened to; in part this was due to not sufficient qualified staff on duty to service their needs. They discussed situations where the only qualified nurse on duty was busy with one other resident and was too busy to deal with them and listen to their concerns. Those staff members spoken to during the day confirmed this. Inspection of the duty rosters also confirmed the lack of qualified staff on duty in relation to the assessed needs of the residents. The home has a very comprehensive policy and procedure for making complaints and there is a book available for all residents and relatives to register their observations and concerns. Those staff spoken with said that they had attended sessions on abuse and were very familiar when questioned about all aspects of abuse and the Whistle Blowing policy of the home. They also shared with the Inspector that they would have no hesitation in ‘blowing the whistle’ on anyone who they thought was abusing the residents. Training records were seen that also confirmed that training in relation to abuse had taken place. Elsenham House Nursing Home I55 S53608 Elsenham House V216512 050505 Stage 4.doc Version 1.20 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 30 The home is clean and tidy. EVIDENCE: The Inspector noted that those areas that she encountered during the inspection were very clean and tidy. Elsenham House Nursing Home I55 S53608 Elsenham House V216512 050505 Stage 4.doc Version 1.20 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36 The deployment and number of qualified staff on duty at any given time is not sufficient to meet the stated purpose of the home and the assessed needs of the people who live in it. EVIDENCE: As already mentioned in evidence for other standards many of the residents have expressed concerns that ultimately are all related to staffing issues. Examination of assessed needs of the residents and the duty rosters reveal that there are not enough qualified members of staff on duty to meet the needs of this particular client type: discussion with trained members of staff suggest that some residents have contractual arrangements for certain one to one care on a daily basis. This was subsequently confirmed from detail supplied on request by the provider with a total of 17.5 hours of additional nurse-time and 33.5 of carer-time being commissioned in 11 of the service contracts. The staff spoken with continually expressed their concern about staffing levels within the home. Elsenham House Nursing Home I55 S53608 Elsenham House V216512 050505 Stage 4.doc Version 1.20 Page 18 Discussion with the residents revealed that they did not always feel that their needs were met by appropriately trained staff and if only one Registered Mental Health nurse was on duty at the weekends especially, did not benefit from proper supervision. Both the residents and staff related a recent incident where a resident was being difficult to manage and quite disruptive and only one suitably qualified nurse on duty, this resulted in the neglect of the other residents that, then, began to react to this particular disruptive resident. There are many issues surrounding the clarity of staff roles and responsibilities. The staff spoken to stated that they were quite often put in a very difficult position when dealing with the residents and being directed by not only the manager, but also by the provider. One incident related was when a prospective client was visiting the home with a qualified mental health nurse, the provider requested a carer to take this client out in the car for awhile, fortunately the carer was not sure about this and checked with a trained member of staff and was told this was not suitable because the prospective client was under a special escort. There are many more incidents that were shared by the staff with the Inspector to demonstrate the lack of clarity of roles and responsibilities. Other incidents identify outings being arranged by non-clinical staff and without consent of the clinical staff leading again to disruptive episodes in the home environment. Some staff members do not have a statement of terms and conditions. Concern was also raised, by the staff, that the one qualified nurse on night duty does what is referred to as a ‘sleeping duty’, this leaves only one awake care assistant on duty in the main house and in a very vulnerable position should the need of a qualified nurse arise. Some procedures for recruitment for new staff are adequate and the home has improved in always ensuring that appropriate checks are made to maintain safe working practices: however it was made known to the Inspector that one qualified member of staff had been employed without a proper induction period within the home and commenced a night duty after only having spent two hours in the home. This is not safe practice and must stop immediately. Elsenham House Nursing Home I55 S53608 Elsenham House V216512 050505 Stage 4.doc Version 1.20 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,42 There is ambiguous and sometimes contradictory leadership within the home which does not always allow the residents to receive consistent quality of care to meet their specialised needs; this results in some areas of care that do not promote and safeguard the health and safety and welfare of the residents. The residents do not always benefit from a well run home. EVIDENCE: As Elsenham House is registered as a Care Home with Nursing, the manager must be a qualified nurse. However, the proprietor (who is not a qualified nurse) is also very actively involved in the day-to-day care provided to service users. This results in the manager feeling his authority is sometimes undermined – a potentially dangerous phenomena where clinical decisions are concerned. Elsenham House Nursing Home I55 S53608 Elsenham House V216512 050505 Stage 4.doc Version 1.20 Page 20 There is also lack of communication between the manager and the provider, particularly on clinical based issues. Although the staff stated that they initially have clear guidelines from the manager they are quite often subsequently revised by the provider. One example given was where the manager had arranged for the home to be covered by appropriate qualified staff only to find that those staff have been cancelled by the owner and thus creating a position where the residents’ health and safety and welfare was placed at risk. Elsenham House Nursing Home I55 S53608 Elsenham House V216512 050505 Stage 4.doc Version 1.20 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 x 3 x x Standard No 22 23 ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x 3 Standard No 11 12 Elsenham House Nursing Home 3 2 Standard No 31 32 33 34 Score 1 1 1 2 Version 1.20 Page 22 I55 S53608 Elsenham House V216512 050505 Stage 4.doc 13 14 15 16 17 3 2 3 3 2 35 36 1 1 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x Standard No 37 38 39 40 41 42 43 Score 2 1 x x x 2 x Elsenham House Nursing Home I55 S53608 Elsenham House V216512 050505 Stage 4.doc Version 1.20 Page 23 No 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. 2. Standard YA20 YA31 Regulation 13(2) 12(5)(a) Timescale for action The registered person shall make Immediate arrangements for the safe and on administration of medication. going The registered provider and Immediate registered manager shall and on maintain good presonal and going professional relationships with each other and with service users and staff. The registered person shall Immediate ensure that at all times suitably and on qualified , competent and going experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. This relates to the need to have two qualified staff on duty over weekends and a waking qualified staff member overnight. The registered person shall Immediate and on ensure that the home is conducted so as to promote and going make proper provision for the health and welfare of the service users. Requirement 3. YA32 and 33 18(1) 4. YA42 12(1) Elsenham House Nursing Home I55 S53608 Elsenham House V216512 050505 Stage 4.doc Version 1.20 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA8 Good Practice Recommendations It is recommended that more meetings are held with the service users so that they feel and are more involved with aspects about the home and that theiir views are listened to. It is recommended that activities are better organised with full support of the qualified staff. It is recommended that more outings are offered for the residents to engage in and also short holidays. It is recommneded that choices are made available at mealtimes It is recommended that more physical activities are offered It is recommended that more qualified staff are made available so that the service users can feel that they are listened to particular with respect to their complex health needs It is recommended that staff are given a full induction before being in charge of a shift It is recommneded that appropriate numbers of qualified staff are on duty to ensure that residents needs can be met safely. Is recommended that sufficient staff are always on duty to ensure that the service users feel well supported It is recommneded that not only the manager but the provider has clear job descriptions and that clear lines of accountability and clinical leadership are introduced It is recommneded that the clinical staff are allowed to manage the clinical aspects of care so that the service users can benefit from the ethos and leadership of the home iand that their needs can be met in safety 2. 3. 4. 5. 6. YA12 YA14 YA17 YA19 YA22 7. 8. 9. 10. 11. YA34 YA35 YA36 YA37 YA38YA42 YA43 Elsenham House Nursing Home I55 S53608 Elsenham House V216512 050505 Stage 4.doc Version 1.20 Page 25 Commission for Social Care Inspection 3rd Floor, Cavell House St. Crispins Road Norwich NR3 1YF 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 Elsenham House Nursing Home I55 S53608 Elsenham House V216512 050505 Stage 4.doc Version 1.20 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!