Inspection on 14/05/07 for Isis Care and Retirement Centre

This inspection was carried out on 14th May 2007.

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

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

Other inspections for this house

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Isis Care and Retirement Centre Cornwallis Road Oxford OX4 3NH Lead Inspector Jane Handscombe Unannounced Inspection 14th May 2007 11:30 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 Isis Care and Retirement Centre DS0000068950.V332808.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. Isis Care and Retirement Centre DS0000068950.V332808.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Isis Care and Retirement Centre Address Cornwallis Road Oxford OX4 3NH 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) 01865 397980 01865 399920 manager.isis@osjctoaon.co.uk The Orders of St John Care Trust Mr Nicholas Michael William Hill Care Home 80 Category(ies) of Dementia (30), Old age, not falling within any registration, with number other category (80) of places Isis Care and Retirement Centre DS0000068950.V332808.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Up to 6 service users may be admitted for intermediate care. Up to 40 people accommodated may receive nursing care. Date of last inspection Brief Description of the Service: Isis Care and Retirement Centre opened in December 2006 and is operated by the Orders of St John Care Trust. It is a care home providing personal care and accommodation for eighty older people, six of whom can be provided with help with rehabilitation (intermediate care). The care home is managed by The Orders of St John Care Trust, which is responsible for many care homes in Oxfordshire that were formerly provided by the County Council. Isis Care and Retirement Centre is located near to the centre of Oxford, close to local amenities. The property is divided internally into four wings, all of which have their own lounges and dining areas with quiet areas on each floor. There is a bar/bistro, library, internet café, a shop and a hairdressing salon for residents’ use. All bedrooms are single with en suite facilities and the home has well maintained grounds that are easily accessible. Fees for the service range from £480 - £850 per week Isis Care and Retirement Centre DS0000068950.V332808.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Baseline Inspection’ (first inspection looking at key standards) involving one inspector, which took place on 14th May 2007 and was in the service during the afternoon and evening. It was a thorough look at how well the service is doing and involved case tracking four service users care from their initial assessment to date, speaking with service users, the registered manager, deputy manager, members of staff, looking into policies and procedures and touring the home. It took into account detailed information provided by the service’s manager, and any information that CSCI has received about the service. The inspector asked the views of the people who use the services, and spoke to staff, visitors and other people seen during the inspection The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. Comments received from residents during the inspection included: ‘the food is excellent’ ‘It’s a good home…well run’ ‘my daughter and son in law are made welcome’ ‘I haven’t got any complaints, they are all very kind’ ‘my doctor comes in when needed’ Comments from visitors include: ‘I’m made very welcome by all the staff…….and the carer made me a horlicks’ ‘I wouldn’t mind coming here myself’ The inspector would like to thank the residents, staff and relatives/visitors for their warm welcome and their assistance during the inspection process. Isis Care and Retirement Centre DS0000068950.V332808.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Isis Care and Retirement Centre DS0000068950.V332808.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 Isis Care and Retirement Centre DS0000068950.V332808.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are provided with information they need to make an informed choice about admission to the home. Residents are assessed prior to admission to ensure the home can provide the care that is needed. Residents referred solely for intermediate care are helped to maximise their independence and return home. EVIDENCE: Prospective residents are provided with information they need to make an informed choice about admission to the home. The information can be provided in various formats if required. Isis Care and Retirement Centre DS0000068950.V332808.R01.S.doc Version 5.2 Page 9 A service users guide specific to those admitted for intermediate care is in trial and has been provided to a service user for feedback. Prospective residents are assessed before admission to ensure the home can provide the care that is needed. This is undertaken either in the person’s own home, or in hospital if that is their current situation. The home provides opportunities for trial visits enabling those interested, to gain a ‘feel’ of the life experienced within the home and meet fellow residents and staff, before any decision about moving in is made. From the evidence seen by the inspector and comments received, the inspector considers that this service is able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. Isis Care and Retirement Centre DS0000068950.V332808.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each user of the service has an individual plan of care setting out their health, social and personal care needs and how these are to be addressed. The homes policies and procedures around medication serve to protect the service users. The recording of medication administration is poor. EVIDENCE: Service users health, personal and social care needs are set out in an individualised plan of care, which is drawn up from an assessment of needs detailing how the service users needs are to be met and where any risks associated with delivering the care are to be minimised. Nutritional assessments are undertaken but not for each resident and those seen were not in great detail to show that these have been assessed fully. Isis Care and Retirement Centre DS0000068950.V332808.R01.S.doc Version 5.2 Page 11 Current good practice recommends that care homes have a procedure for dietary assessment and nutritional screening using a nationally validated screening tool, such as MUST (Malnutrition Universal Screening Tool). This should be undertaken on admission and at appropriate intervals thereafter, with a record of nutrition, weight gain or loss and appropriate action taken. The home has good working relationships with the local GP’s and community health services and accesses them when appropriate. Evidence of any healthcare treatment received is contained within the care plans. Chiropody is arranged regularly, with dental, hearing and eyesight checks arranged as needed. Policies around the administration of medication serve to protect those who use the service. Where individuals wish to maintain responsibility for their own medication they are enabled to do so within a risk management process. Lockable facilities are provided for this purpose. As part of case tracking service users, the inspector viewed the medication administration records and found evidence of poor recording taking place. Gaps in records failed to contain any coding system as to why the medication had not been administered, therefore making it impossible to ascertain if the medication had infact been given. A requirement has been made to ensure any gaps in the recording of medication administration are documented appropriately and undertake regular medication audits, to reduce these types of errors. Generally medication, which has a short life, is dated when opened however, one such medication failed to contain this information. Discussions with care staff evidenced that they were knowledgeable on privacy and dignity issues and this was evident throughout the inspection. Staff were observed to respect the residents’ right to privacy, dignity and independence and this was verified by service users. Isis Care and Retirement Centre DS0000068950.V332808.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who use the service are provided with good quality food, which meets their nutritional needs. Residents are enabled to spend their day as they choose and maintain contact with family, friends, representatives and the local community as they wish. EVIDENCE: Users of the service are enabled to spend their day as they choose and are encouraged to maintain contact with family, friends, representatives and the local community as they wish. The home considers that visitors, relatives, family and friends are important to the care provision and always provides a warm welcome at any reasonable time. One resident said ‘visitors are always welcome and they make them a cup of tea if they want one’ whilst one visitor told the inspector that he was always ‘made very welcome by the staff’. Isis Care and Retirement Centre DS0000068950.V332808.R01.S.doc Version 5.2 Page 13 Discussions with service users regarding the meals provided at the home were all very complimentary. Service users informed the inspector that they enjoy the meals provided, which are cooked freshly on the premises, are nutritious of good portion size and offer choice. Specialist diets are catered for where the need arises. Feedback regarding the meals provided is sought from service users via the chef who actively speaks to them and through the homes monthly food monitoring process. A daily programme of activities are provided for those who wish to partake and visits to the theatre, mystery tours around the countryside with a stop for a pub lunch are arranged along with shopping trips for those who wish. The home has an internet café providing users of the service with computer and internet facilities. The activities co-ordinator informed the inspector of a service user who has relatives who live abroad and how she was seeking to link the resident with their relatives via a web cam. The home provides a hairdressing service four days a week where service users are able to book appointments when required. Tariffs for this service are displayed on the hairdressing salon window. The home also has bar facilities where residents are able to enjoy taking a drink with fellow residents and their visitors. In the home’s main entrance is a shop supplying sweets, chocolates, and items for personal hygiene. There is a communion service provided by Church of England ministers on a monthly basis and likewise a Catholic minister visits on the first Friday of each month. The home supports religious practice of all denominations and will do their best to enable service users to access these in the local community and assist with transport or other arrangements as required. Isis Care and Retirement Centre DS0000068950.V332808.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints policy and any complaints are taken seriously. The home has procedures in place to protect residents from abuse. EVIDENCE: Information about the complaints procedure is given to service users on admission. The complaints procedure is displayed within the home and copies are also available on request from the manager. The timescale for dealing with complaints is 28-days, as stated in the homes written procedure. The inspector viewed the complaints log and found the home has received one complaint which was responded to in a timely manner and dealt with appropriately. The Commission has not received any complaints about this home. The safeguarding of vulnerable adults is taken seriously, and staff members receive training at induction and regularly thereafter. Isis Care and Retirement Centre DS0000068950.V332808.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 23, 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Users of the service are provided with a pleasant, well-maintained and safe environment. EVIDENCE: Cleanliness within the home was extremely good and there were no unpleasant smells. All parts of the home are accessible to the service users, with the use of grab rails and a lift to facilitate mobility around the home. The home encourages residents to bring small items of furniture and memorabilia to personalise their rooms to their own liking, which was evident whilst touring the home. Isis Care and Retirement Centre DS0000068950.V332808.R01.S.doc Version 5.2 Page 16 There are 80 single bedrooms, all of which have ensuite facilities. Each bedroom has an alarm near to the bed in order that assistance may be sought when required. Six of these rooms are provided with specialised facilities, equipment and designated staff for people admitted for intermediate care. Occupational and physiotherapists provide a service to meet the needs of those admitted for rehabilitation. Residents spoken to on the day informed the inspector that they were very happy with their rooms and found them to suit their needs. The home’s on-site laundry is spacious and has the necessary equipment to provide a good laundry service. Isis Care and Retirement Centre DS0000068950.V332808.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s staffing levels appeared adequate to meet residents’ care needs. The home has good recruitment procedures, to ensure that suitable staff are employed to look after their vulnerable clients although these could be more robust. Staff are trained to meet the needs of people using the service. EVIDENCE: On the day of inspection there was sufficient staff to meet the residents overall needs. The recruitment procedures at the home were generally good with clear monitoring systems in place to promote the protection of service users including application form; interview notes, references and Criminal Records Bureau (CRB) check being sought. However where references have been received without a company stamp these must be followed up by telephone and verified. Isis Care and Retirement Centre DS0000068950.V332808.R01.S.doc Version 5.2 Page 18 Likewise in situations where a persons employment history evidences previous work in the care sector followed by a change in career to a different field of work it is recommended that the reasoning for leaving the care sector be followed up to ensure their suitability to work with vulnerable adults. Where gaps in employment history are evident it is good practice to establish the reasoning for the gaps. All new members of staff undergo induction training upon appointment to their posts, are provided with mandatory training and are offered ongoing training and support which equips them to meet the assessed needs of the residents within the home. Regular updating of skills is provided to all staff. Staff members are encouraged to undertake the National Vocational Qualification (NVQ) in care. Of the homes 60 care staff, 15 members of staff currently hold NVQ (National Vocational Qualifications) in care with a further 17 working towards them. The inspector was informed that recent training has included first aid, fire awareness and evacuation, fire marshal training, food hygiene, moving and handling and medication. Dates have been arranged over the next 3 months to provide further training in the awareness of abuse, health and safety, dementia and COSSH. Isis Care and Retirement Centre DS0000068950.V332808.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well managed, delivering a consistent service to those who live there and is run in their best interests. Staff are well supported although supervision has lapsed and needs to be addressed. Procedures within the home need to be adhered to, namely that of the recording of the administration of medication and robust recruitment procedures, ensuring that service users health and safety is promoted and protected at all times Isis Care and Retirement Centre DS0000068950.V332808.R01.S.doc Version 5.2 Page 20 EVIDENCE: The registered manager is experienced, knowledgeable and competent to manage the home. He displays a good sound knowledge of matters related to the management and running of the care home for older people. Residents and staff spoke in complimentary terms about his management ability and the support he gives. The management approach of the home creates an open, positive, transparent and inclusive atmosphere. The manager obtains feedback from residents and visitors when talking to them in the home, and has an ‘open door’ policy that encourages people see him without the need to make an appointment. The organisation has a quality assurance programme in place. Service managers visit the home regularly and monitor standards which includes examining care plans, fire log training procedures, the administration and recording of medication and other health and safety issues and speak to residents and care staff alike to gain their views on the standard of care provision. These visits undertaken are in line with Regulation 26 of the Care Home’s Regulations and records are kept of each visit. The organisation aims to gain further feedback from residents, relatives and health professionals through an annual survey which will be analysed and the findings acted upon to improve the provision of service. Since the home has only been in operation since December 2006, this has not yet been undertaken. Likewise the inspector was informed that resident and relative meetings had not yet been undertaken since the home opened, however these are in the process of being drawn up. The registered manager does not act as appointee for handling service users financial affairs, this is undertaken by family members or the service users’ representatives. Where the home holds service users spending money, records are kept of all transactions. The inspector met with the administrator to discuss the procedures that are in place to safeguard users personal allowances. Systems and records were seen to be in place and provide a clear audit trail to safeguard the residents’ financial interests. One recommendation was made during the inspection to provide receipts and gain signatures for any purchases from the home’s shop and this was put into place immediately during the inspection. Isis Care and Retirement Centre DS0000068950.V332808.R01.S.doc Version 5.2 Page 21 The home has a health and safety policy statement and provides training and equipment for staff. Safety checks relating to fire safety and infectious diseases are regularly carried out. The manager is aware that the supervision of staff has lapsed and has assured the inspector that measures will be taken to ensure staff receive formal supervision at least 6 times a year. Procedures within the home need to be adhered to, namely that of the recording of the administration of medication (see section headed health and personal care) and robust recruitment procedures (See section headed staffing), ensuring that service users health and safety is promoted and protected at all times Isis Care and Retirement Centre DS0000068950.V332808.R01.S.doc Version 5.2 Page 22 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 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 3 3 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 Isis Care and Retirement Centre DS0000068950.V332808.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? N/A 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 OP9 Regulation 17(1)a Schedule 3 Requirement *Record the administration of medication appropriately using the coding system where medication is not administered. * Short-lived medication to be dated on opening. *Undertake regular medication audits, to ensure procedures are being adhered to. 2 OP36 18 staff receive formal supervision at least 6 times a year. 31/07/07 Timescale for action 31/07/07 Isis Care and Retirement Centre DS0000068950.V332808.R01.S.doc Version 5.2 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 2 Refer to Standard OP8 Good Practice Recommendations Implement a nationally validated nutritional screening tool that is completed shortly after admission and reviewed at appropriate intervals thereafter. It is recommended in instances where references for prospective members of staff are received without a company stamp or with compliments slip, the reference be verbally verified and documented. Where gaps in employment histories of prospective employees are evident document the reasoning OP28 Isis Care and Retirement Centre DS0000068950.V332808.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Isis Care and Retirement Centre DS0000068950.V332808.R01.S.doc Version 5.2 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!