Inspection on 02/08/05 for Glenwood Nursing Home

This inspection was carried out on 2nd August 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Glenwood Nursing Home 08/01/09

Glenwood Nursing Home 09/01/07

Glenwood Nursing Home 16/11/05

Glenwood Nursing Home 22/12/04

Glenwood Nursing Home 21/06/04

Glenwood Nursing Home 26/02/04

Glenwood Nursing Home 23/12/03

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 Ashwood Nursing Home Liverpool Road Widnes Cheshire CW8 7HJ Lead Inspector Anthony Cliffe Announced 2 August 2005 nd 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. Ashwood Nursing Home F51 F01 S5144 Ashwood V231493 020805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Ashwood Nursing Home Address Liverpool Road Widnes Cheshire WA8 7HJ 0151 420 5945 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) Community Integrated Care Thomas Clarkson (proposed) Care Home 12 Category(ies) of LD Learning Disability (12) registration, with number of places Ashwood Nursing Home F51 F01 S5144 Ashwood V231493 020805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 Service Users to be accommodated as follows:6 Service Users may be accommodated within the Ashwood Unit 6 Service Users may be accommodated within the Glendale Unit Date of last inspection 21st December 2004 Brief Description of the Service: Ashwood is a care home with nursing providing care for 12 people with learning and physical disabilities.Ashwood/Glenale is owned and managed by Community Integrated Care, which is a non-profit making organisation. The home is located in the Ditton area of Widnes, near to shops, pubs, post office, and other local amenities. It has a small parking area and a garden area with patio to the rear of the property.The home comprises of two purpose built dormer bungalows, but only the staff offices, staff toilets and staff sleep in rooms are situated upstairs. All the bedrooms are on the ground floor and all have fitted furniture and a wash hand basin. There are no en-suite facilities, but there are 4 assisted bathrooms and separate toilets on the ground floors.Also on the ground floor are two large lounge / dining rooms, two kitchens and utility rooms. The home isn in a local bus route and close to two local railway stations. Ashwood Nursing Home F51 F01 S5144 Ashwood V231493 020805 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection of Ashwood took place over a period of eight hours. The inspector agreed the format of the inspection with the manager. The inspection was carried out using a process of cross referencing the documentation of identified residents following discussion with them and their representative, and following the delivery of care and support to them. A tour of the building, including all communal areas, the kitchens and a number of bedrooms, was completed. Residents a relative and staff contributed their experience of living, visiting and working in the home. No requirements remain outstanding from the previous inspection. What the service does well: What has improved since the last inspection? Recruitment of staff has improved with more permanent staff recruited to the home. Management of the staff team has improved with leadership and guidance improving staff moral. The home has undergone some refurbishment, including redecoration of the home and replacement of carpets. Adaptations have been made to aid residents’ mobility needs and promote independence. Ashwood Nursing Home F51 F01 S5144 Ashwood V231493 020805 Stage 4.doc Version 1.30 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. Ashwood Nursing Home F51 F01 S5144 Ashwood V231493 020805 Stage 4.doc Version 1.30 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 Ashwood Nursing Home F51 F01 S5144 Ashwood V231493 020805 Stage 4.doc Version 1.30 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 Residents are fully assessed before moving into the home to ensure the home can meet their identified needs. EVIDENCE: The records of one resident who recently moved into the home was examined. A detailed a pre admission assessment and detailed assessment of need regarding the resident’s associated mental health needs and learning disability was completed. This was supported by a comprehensive assessment and care plan from the Primary Care Trust (PCT) in relation to the resident’s physical health needs and long term care support plan. A detailed health action plan identified how other professionals involved in the resident’s care would support the resident’s health care needs. These contained details on how the resident’s mobility needs would be met through provision of equipment. It also detailed that the resident had some swallowing problems and advice from a speech and language therapist was present to guide staff on the resident’s nutritional needs. This documentation was used as a basis for the development of a detailed care plan to meet the resident’s needs and was supported by detailed risk assessments. Detailed information was provided by the home the resident had been accommodated in and this was incorporated into a person centred plan. Ashwood Nursing Home F51 F01 S5144 Ashwood V231493 020805 Stage 4.doc Version 1.30 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) 9 Residents’ health and safety needs do not hinder them leading an independent lifestyle. EVIDENCE: Residents’ care plans contained comprehensive risk assessments and risk management plans to manage residents’ health and social care needs. Risk assessment strategies were in place regarding a residents’ mental health and physical health needs taking account of assessment and information from other professionals involved in the residents’ care. There was evidence that residents had been assessed by a speech and language therapist and dietician and staff were following the plans in place to reduce the risk of choking for one resident and ensure another resident received an adequate diet. Essential lifestyle plans recorded the level of support and supervision that residents needed when accessing leisure and community activities. Where a resident required the supervision of one staff member at all times, there was clear guidance for staff on the level and type of activities the residents could participate in safely, taking account of risks to the resident. An example of this being the resident could take part in domestic chores safely when supervised. One of the residents had been diagnosed with severe cognitive impairment, which affected his ability to perceive and process information. There was a detailed plan on how to communicate effectively with the resident but this needs to be revised Ashwood Nursing Home F51 F01 S5144 Ashwood V231493 020805 Stage 4.doc Version 1.30 Page 10 to include how severe cognitive impairment has affected the resident’s ability to communication and how staff have recognised and responded to this. See recommendation 1. Ashwood Nursing Home F51 F01 S5144 Ashwood V231493 020805 Stage 4.doc Version 1.30 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 and 17 Residents are able to participate in appropriate activities. Residents receive a varied diet in pleasant surroundings. EVIDENCE: Residents were involved in pre-planned activities during the day. There was a local trip out arranged between the activities organiser and staff. Residents have a varied leisure and social life. The activities organise said residents were able to communicate their choice if they wished to participate in activities. Residents were consulted about going out and three chose to do so. On return the activities organiser said that one resident in particular had enjoyed the ’fresh air and walking around, he makes lots of sounds when he enjoys something’. The relative of one resident discussed the choice of activities available and said ‘sometimes if staff have to attend to someone who is not well then activities have to be postponed, I am not saying there is insufficient staff it’s that other peoples health take priority’. The relative said that her relative was able to make choices about his lifestyle. She said ‘staff know him as an individual we have learned from each other how best to communicate with him. I have given them information on how to understand his communication needs. He can say some words and staff know how to interpret these and help him. They have taught me about his health and Ashwood Nursing Home F51 F01 S5144 Ashwood V231493 020805 Stage 4.doc Version 1.30 Page 12 communication. We have been out his morning and he enjoyed himself I am invited to go out. He recognises staff and has his favourites. He goes out to buy the groceries and family visit weekly. He goes home regularly and out to the pub with family. I cannot fault the care they are a great staff team’. The staff plan the menu on each unit based on residents’ choices. Residents can eat their meals at times of their choosing. A staff member due to identified risks supervises some residents. Residents that are supervised eat with other residents and not exclusively with staff. The menu consisted of hot snacks to full meals. When possible residents are encouraged to share a meal. Staff asked residents about their individual meal choice at lunchtime and residents were able to participate in the preparation of it. Meal times were a social occasion with residents and staff sharing conversations. Care staff had received training from the speech and language therapist on how to assist residents identified with swallowing difficulties to eat and drink safely. Staff interviewed said this was positive, as they did not have to wait for the qualified nurses to provide this care for residents and it provided choice for residents as to when they ate their meals. Ashwood Nursing Home F51 F01 S5144 Ashwood V231493 020805 Stage 4.doc Version 1.30 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 and 20 Residents receive individualised care and support. Medication management and administration ensures that residents receive their prescribed medicines. EVIDENCE: Examination of residents’ care plans noted that detailed moving and handling assessment were in place supported by health action plans from the Primary Care Trust professionals involved in residents care. No unnecessary restrictions were noted in care plans, which were clear in promoting independence. The home provides a variety of technical aids, and residents have their own technical aids in the home. Details of individual professional support for technical aids were detailed in the health action plan. A resident had been reassessed for a wheelchair mould and wheelchair to afford the resident support and comfort. Ceiling mounted tracking for a hoist had been provided in the lounge area on one unit to assist residents’ mobility when transferring. Ashwood Nursing Home F51 F01 S5144 Ashwood V231493 020805 Stage 4.doc Version 1.30 Page 14 Each resident had been provided with an individual sling for fixed and portable moving equipment. A student nurse on placement at the home said ‘ Residents and staff are supported to make decisions. The staff team are professional and treat residents with dignity and respect when providing personal care. I see staff offer residents their dressing gowns during personal care no one is ever left exposed. Residents are spoken to in a polite way, staff are friendly and they never overstep the mark. They communicate with residents and understand their needs. I find the care plans very easy to follow, they tell you about the resident and how to meet their needs in their words. If I was reading about someone I could follow the plan of care. They are informative, you also get a good handover, the staff work as a team’. No residents manage or administer their medicines. Examination of medicines receipt, administration and recording identified no errors. The home has a policy on the management and administration of medicines. The two units have controlled drugs facilities and record systems for these and only the qualified nurses are responsible for the management and administration of medicines. The Boots monitored dosage system is used in both units of the home. Ashwood Nursing Home F51 F01 S5144 Ashwood V231493 020805 Stage 4.doc Version 1.30 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 and 23 The views of residents and their representatives are taken seriously and acted upon. Staff awareness and training on the local authority adult protection procedures needs to improve to improve to ensure residents are protected from abuse. EVIDENCE: Two complaints had been made by the relatives of residents and these had been acknowledged, investigated and action taken on behalf of the residents. The staff team had training on the registered providers adult abuse policy and procedure in April 2004. The manager had undertaken the local authority ‘train the trainer’ course in July 2004 and can provide training to staff on the local authority adult protection procedures to staff. Two recently employed care staff confirmed they had attended the registered providers training on adult abuse but had not received training on the local authority procedures. The manager confirmed that he had not provided this training to staff. See recommendation 2. Ashwood Nursing Home F51 F01 S5144 Ashwood V231493 020805 Stage 4.doc Version 1.30 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) 24, 25, 26, 27, 28, 29 and 30. Residents live in a comfortable, clean and safe environment, which is equipped to meet their needs and promote their independence. EVIDENCE: Both units have had some residents’ bedroom areas decorated and new carpets fitted. The manager provided evidence that residents’ relatives chose the décor and carpets on behalf of their relative. In addition the corridor, lounge and stair carpets have been replaced and dining room floor fitted with a non-slip surface. The lounge on Ashwood unit and a resident’s bedroom has had ceiling mounted tracking fitted. Five electric profiling beds have been purchased with overlay mattresses. An air replacement mattress has been purchased for a resident. Bedrooms were personalised to the occupant’s choice and contained personal items of equipment, family mementoes and pictures. The home was clean and free from odours. Ashwood Nursing Home F51 F01 S5144 Ashwood V231493 020805 Stage 4.doc Version 1.30 Page 17 A relative and relatives questionnaire returned as part of the inspection visit highlighted that the home does not have separate private visiting facilities for residents to receive visitors in. a relative said ‘ there is only the lounge and dining area to visit in, other than that we use his bedroom. This is full of his furniture and equipment, so it’s limited as to how many family members can sit in there with him. It’s not very confidential sitting in the dining room to talk, you can hear everything that’s said and your business. When we visited as a family we were able to sit outside as the weather was good’. The relative’s questionnaire said ‘ I feel the only set back at Ashwood is not having a visitors room. My brother only has a small bedroom and he comes from a large family. Although the lounge is available other residents use this so it is not private’. See recommendation 3. Ashwood Nursing Home F51 F01 S5144 Ashwood V231493 020805 Stage 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35and 36. There is leadership guidance and direction in the home to ensure residents receive consistent quality care. A competent and appropriately trained staff team cares for residents. Qualified staffing in the afternoons could be improved so residents have access to competent and appropriately trained staff at all times. EVIDENCE: Staff interviewed were positive about the standard of care that residents receive and the management of the staff team. A qualified staff member said `There have been improvements, the manager’s management style is more inclusive and democratic. You can now challenge the management style. There is more delegation of management responsibilities and awareness of management administration systems. I was never aware of some of the management administration. Staff moral has improved and there is a different culture in the home. New staff use their initiative, they will come and ask to do things and want to create more opportunities for social care. Staffing has improved but this can be inconsistent some days we have more than others, but overall we have more staff and regular agency staff who know the residents. Staff training has meant that care staff take more responsibilities for example in assisting residents to eat and drink. The changes have been positive but there could have been more consultation and support from senior management. It meant the manager took flak from the staff. The only staffing Ashwood Nursing Home F51 F01 S5144 Ashwood V231493 020805 Stage 4.doc Version 1.30 Page 19 issue is that in the afternoon there is only one trained staff between the two units. This is difficult when you have six very physically dependent and several very challenging residents and you are needed on both units. This could be improved. A care staff member had completed her NVQ level two qualification and said she will be financially rewarded for this. She said she had previously been employed in a non caring role as a housekeeper. She said she had then applied for a carer’s job and been successful. ‘I have completed the corporate induction programme and had statutory training in moving and handling, food hygiene, first aid and fire awareness. I have found all my training informative. I enjoyed the training on diversity and culture, it has made me think differently about things you never think about or question everyday especially in caring for adults with disabilities. I have had lots of support during the training, and staff were very helpful. If I ever have a problem I could go to anyone. A relative said to me she could approach the manager about anything, she had been unhappy with changes but is now happy. I have seen lots of changes for the better. Staffing levels have increased and activities for residents have improved. Support workers have more time to spend with residents. The management team has improved they are all doing a good job and are approachable’. Two recently employed care staff talked enthusiastically about their role as key workers to a resident. One said ‘I take the lead on liaising with the speech and language therapist about his diet. When we have a review I write up all the notes and what my responsibilities are. She is giving me ideas on how to obtain more low fat products for his diet. He has dementia and we understand he muddles his words but we have the care plans form his previous home and this guides us on what he means when he muddles his words’. The other staff member talked about completing his induction and said ‘the manager has been supportive he listens to your ideas and encourages you to use you initiative’. See recommendation 4. Ashwood Nursing Home F51 F01 S5144 Ashwood V231493 020805 Stage 4.doc Version 1.30 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 The management routines and maintenance and testing of equipment does not safeguard the health and safety of people living in the home. EVIDENCE: The records maintained within the home relating to the health & safety of residents was examined. These included; Fire Log Book, Accident Book, Risk Assessments, Portable Electrical Appliance Tests, HACCP Records Maintenance Records for Hoists and Records of Discharged Hot Water. The testing of the fire alarm system had not been completed weekly as required. See requirement 1. Ashwood Nursing Home F51 F01 S5144 Ashwood V231493 020805 Stage 4.doc Version 1.30 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. 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 2 x x x Standard No 22 23 ENVIRONMENT Score 3 2 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 3 3 3 2 3 3 Standard No 11 12 13 14 15 16 17 x 3 x x x x 3 Standard No 31 32 33 34 35 36 Score 3 3 2 x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Ashwood Nursing Home Score 3 x 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x F51 F01 S5144 Ashwood V231493 020805 Stage 4.doc Version 1.30 Page 22 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. Standard YA42 Regulation 24 Requirement The registered person must ensure that fire alarms are tested weekly as required. Timescale for action 1.11.04 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. 4. Refer to Standard YA9 YA23 YA28 YA33 Good Practice Recommendations Ensure that changes in residents needs are recorded in their care plans. Provide care staff with training on the local authority adult protection proceedures. Provide additional private visitng facilities for residents to use. Provide qualfied staff in both units throughout the day. Ashwood Nursing Home F51 F01 S5144 Ashwood V231493 020805 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Unit D, off Rudheath Way Gadbrook Park Northwich Cheshire, CW9 7LT 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 Ashwood Nursing Home F51 F01 S5144 Ashwood V231493 020805 Stage 4.doc Version 1.30 Page 24 - 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!