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Inspection on 14/10/05 for Kara House Residential Care Home

Also see our care home review for Kara House Residential Care Home for more information

This inspection was carried out on 14th October 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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 had a pre and post admission assessments, which documented residents` needs. Some good practice was evident including documenting residents` personal preferences e.g. bubble bath for bathing and numbering each aspect of the care plan for ease of review. Choice of G.P was offered wherever possible and clear records of the visits of health care professionals were maintained. Visiting arrangements were appropriate and residents` recreational interests were documented and accommodated where possible. Local churches visited the home on a weekly basis and the home provided a range of activities. Residents said that the food was good and the cook demonstrated a commitment to providing good food to the residents. A clear complaints procedure was readily available to allow residents to raise concerns. Overall, the home was clean, tidy and comfortable, with a good standard of furnishings and fittings. Staffing levels at the time of inspection were meeting residents` needs and residents were happy with the staff. At the time of inspection, the manager had almost completed her NVQ 4 Management Qualification. She had a good rapport with residents and staff.

What has improved since the last inspection?

Since the previous inspection, the manager had purchased alcohol gel for sanitising staffs` hands, which she was about to provide in staff areas. This is good practice.

CARE HOMES FOR OLDER PEOPLE Kara House Residential Care Home 29 Harboro Road Sale Manchester M33 5AN Lead Inspector Helen Dempster Unannounced Inspection 14th October 2005 11:00 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 Kara House Residential Care Home DS0000005617.V255801.R01.S.doc Version 5.0 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. Kara House Residential Care Home DS0000005617.V255801.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Kara House Residential Care Home Address 29 Harboro Road Sale Manchester M33 5AN 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) 0161 973 0754 0161 969 0223 Trinity Merchants Limited Mrs Carol Richards Care Home 21 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0) of places Kara House Residential Care Home DS0000005617.V255801.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users will be over the age of 65 and may additionally have a physical disability. 22nd February 2005 Date of last inspection Brief Description of the Service: Kara House provides accommodation and personal care for up to twenty-one (21) service users within the category of old age (OP), but any of the service users could have a physical disability (PD/E) or dementia (DE/E). Kara House is a private residential care home that is owned by Trinity Merchants Limited and the home is managed by the registered manager Mrs Carol Richards. The home is a large Victorian property that is set in pleasant and spacious grounds. There are car parking spaces at the front of the grounds. The twostorey building has a newer extension to the rear of the property. There is a stair lift to the first floor. The home has fifteen single bedrooms and three double bedrooms. The home is situated in a residential area of Sale within easy reach of the motorway network, public transport and the local shops. Kara House Residential Care Home DS0000005617.V255801.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and was carried out on 14 October 2005 from 11am to 4.30pm. Time was spent talking with the manager, staff and residents. This included discussing welfare matters relating to the residents the home supported and examining documentation in relation to the running of the home, the management arrangements, staffing, care planning and the residents’ satisfaction. The term of address preferred by the users of the service was confirmed as “residents”. It was felt this best reflected the function and purpose of the service. What the service does well: What has improved since the last inspection? Kara House Residential Care Home DS0000005617.V255801.R01.S.doc Version 5.0 Page 6 Since the previous inspection, the manager had purchased alcohol gel for sanitising staffs’ hands, which she was about to provide in staff areas. This is good practice. What they could do better: Not all aspects of residents’ needs were documented in sufficient detail in the care plans. Risk assessments were in need of development, the review of care plans was not consistently linked with risk assessments and changes in needs were not consistently documented. Overall, medication practice was appropriate. However, the need for each resident’s care plan to include a section on the administration of medication, including when required” (PRN) medication, which confirms why medication is prescribed and in what circumstances and for what conditions, PRN medication is given was discussed and a requirement was made accordingly. Sample signatures of staff administering medication were not held and the community nurses’ cupboard was not fitted with a lock. Alternative menu choices needed to be offered and documented. The residents did not have information on advocacy services. The home needed to hold a complaints record, to detail the investigation and outcome of complaints and staff needed to be familiar with Trafford Council’s Protection of Adults from Abuse Policy. Management of continence was creating a bad odour in 2 rooms. Some fire doors were wedged open which was unsafe. Although soap and hand towels were provided, liquid soap and paper towels were not used in toilets and bathrooms and this had the potential to compromise residents’ health and safety. Staff files and training information was not accessible to the manager, which inhibited her knowledge of the staff she managed. These records needed to be available for inspection by CSCI and the manager needed to complete an audit of training of her staff to ensure that training, including mandatory training, is up to date. At the time of the visit, the home did not have an up to date fire risk assessment which accurately reflected the situation at the home. Fire doors were not closing into rebates and the home was not consistently undertaking and recording checks of the fire alarm, means of escape and emergency lighting. Please contact the provider for advice of actions taken in response to this Kara House Residential Care Home DS0000005617.V255801.R01.S.doc Version 5.0 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Kara House Residential Care Home DS0000005617.V255801.R01.S.doc Version 5.0 Page 8 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 Kara House Residential Care Home DS0000005617.V255801.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Residents’ needs were assessed and documented. EVIDENCE: The home had a pre and post admission assessments. The pre admission assessment was used to take basic information about prospective residents, who were visited prior to admission by a representative of the home. A more detailed needs assessment was then completed on the admission of the new resident. Copies of the social worker’s statement of needs were kept on each individual file that was seen. Overall, needs assessments were detailed and clear, but the manager planned to further review the headings on the needs assessment form in the context of Standard 3. The home does not provide intermediate care. Kara House Residential Care Home DS0000005617.V255801.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9 Care plans set out an individual plan for each resident. However, not all aspects of residents’ needs were documented sufficiently. EVIDENCE: Overall, care plans included the information needed to meet residents’ needs. Some good practice was evident including documenting residents’ personal preferences e.g. bubble bath for bathing and numbering each aspect of the care plan for ease referencing. However, there was a need to review the content of the care plan in the context of Standard 3 and 7 of National Minimum Standards for Older People. This included completing a nutritional assessment for all residents. Risk assessments were in place to address the risk of falls. However, these were not always consistent with the care plan. One example was a resident deemed to be “low risk”, with “full mobility” and a “steady gait” on her falls risk assessment dated 30/07/05, yet her care plan dated 01/09/05 stated that she was “unsteady on her feet”, was “wandersome at night” and had suffered “several falls”. While a review of the care plan was being completed on a monthly basis, they needed to be linked with a review of the risk assessments and reviews should take place when a change in needs is evident. Kara House Residential Care Home DS0000005617.V255801.R01.S.doc Version 5.0 Page 11 A choice of G.P was offered wherever possible and clear records of the visits of health care professionals were maintained. Overall, medication practice was appropriate. Controlled drug balances were accurate and some good practice was evident including obtaining the GP’s approval in writing for the use of homely remedies and recording some details of personal preferences in taking medication. However, the need for each resident to have a care plan for the administration of medication, including when required” (PRN) medication, which confirms why medication is prescribed and in what circumstances and for what conditions PRN medication is given was discussed and a requirement was made accordingly. Sample signatures of staff administering medication were not held and the community nurses’ cupboard was not fitted with a lock. A requirement was made accordingly. Kara House Residential Care Home DS0000005617.V255801.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Visiting arrangements were appropriate and residents’ recreational interests were documented and accommodated where possible. Residents enjoyed a nutritious and appealing diet, but alternative choices needed to be offered and documented. EVIDENCE: The home has an open visiting policy and residents and visitors confirmed that the home welcomed visitors. Local churches visit the home on a weekly basis and the manager stated that a party of girl guides offered musical entertainment for the residents. The manager said that residents are consulted informally about activities. The home provided weekly craft sessions, of which one planned activity was taking place at the time of inspection and was seen to be enjoyed by residents. Movement to music, flower arranging, poetry reading and videos of films are also provided at the home. The residents did not have information on advocacy services and a requirement was made accordingly. The home had flexible mealtimes and the menu offered a varied and wholesome diet to residents. However, there was a need to provide Kara House Residential Care Home DS0000005617.V255801.R01.S.doc Version 5.0 Page 13 alternative menu choices and to maintain a formal recorded to confirm choice was offered to the residents. This was discussed with the cook and manager and a requirement was made about this. Although, residents did say that the food served was good. Furthermore, the cook did demonstrate a commitment to providing good wholesome food to the residents. Kara House Residential Care Home DS0000005617.V255801.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 A clear complaints procedure was readily available to allow residents to raise concerns but a record of complaints needed to be held. In addition staff were not familiar with the “Protection of Adults from Abuse Policy”. This limited knowledge had the potential to compromise residents’ safety. EVIDENCE: The home had a complaints policy and procedure, which was freely available. A complaints record, to detail the investigation and outcome of complaints, was not being held. A requirement was made accordingly. The home has an internal policy on the protection of adults from abuse. However, Trafford Council’s Protection of Adults from Abuse Policy was not readily available at the time of inspection and the manager and staff were not familiar with this policy. The manager was advised that it needed to be a working tool that all staff could locate with ease. A requirement was made to the effect that this policy must be readily available to all staff and that all staff must be familiar with its contents. Kara House Residential Care Home DS0000005617.V255801.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Overall, the home was clean, tidy and comfortable, with a good standard of furnishings and fittings. However, the management of continence was creating a bad odour in 2 bedrooms which had the potential to compromise residents’ dignity. Furthermore, some aspects of fire Safety and Infection Control had the potential to compromise residents’ health and safety. EVIDENCE: A partial tour of the premises was undertaken. Overall, the home was found to have a good standard of furnishings and fittings and was attractive, clean and comfortable. However, there was a bad odour in 2 of the bedrooms that were viewed. The manager stated that these bedroom carpets were shampooed on a daily basis. However, there was a need to review cleaning products or replace the floor covering to eliminate the smell. This was discussed with the manager and a requirement was made accordingly. Fire doors in bedrooms were wedged open with chairs or other objects. This practice must cease and a requirement was made accordingly. The carpet on the landing area was poorly fitted and had the potential to pose a tripping hazard. A requirement was made accordingly. Kara House Residential Care Home DS0000005617.V255801.R01.S.doc Version 5.0 Page 16 In toilets and bathrooms, including the staff toilet, bar soap and cloth towels were in use. The home needed to obtain the advice of the environmental health officer about the use of liquid soap and paper towels. A requirement was made accordingly. It was evident that the home was committed to minimising the risk of infection, as since the previous inspection, the manager had purchased alcohol gel for sanitising staffs’ hands which she was about to provide in staff areas. This is good practice. Kara House Residential Care Home DS0000005617.V255801.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 30 Staffing levels at the time of inspection were meeting residents’ needs and residents were happy with the staff. Organisational procedures limited the manager’s knowledge of staff training. EVIDENCE: The staffing rota for week ending 09/10/05 was examined. This demonstrated that the home met the recommended minimum guidelines set by the previous registration authority, Trafford Metropolitan Borough Council. Three carers and a manager or senior carer were deployed to meet the 21 residents’ needs from 8am to 4pm. After 4pm, 2 staff and a senior carer met residents’ needs until 9pm, when 2 night carers on waking duty were deployed until 8am. Residents said that the staff were good. It was not possible to assess Standards 28 and 29 or to fully assess Standard 30 as the manager did not have access to staff files or training information. The manager stated that staff files were locked up and only one of the directors of the organisation and the registered manager of another residential home owned by the organisation had access. The manager stated that this other manager planned all staff training and added that she was only recently involved in the recruitment of staff. A requirement was made to the effect that the manager accesses this information and that it is available for inspection by the CSCI. A requirement was also made to the effect that the manager completes an audit of training of her staff to ensure that training, including mandatory training, is up to date. Kara House Residential Care Home DS0000005617.V255801.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 and 38 The manager had a good rapport with residents and staff. However, the safety of residents and staff could be compromised by the shortfalls in the fire safety precautions being operated at the home. EVIDENCE: At the time of inspection, the manager had almost completed her NVQ Level 4 Management Qualification. She had a good rapport with residents and staff. At the time of the visit, the home did not have an up to date fire risk assessment, which accurately reflected the situation at the home. Fire doors were not closing into rebates and the most recent test of the fire alarm was recorded as 13/05/05. In addition, the home was not consistently undertaking and recording checks of the means of escape and emergency lighting. The manager acknowledged these findings and explained that the fire service had visited the home on 22/09/05 and highlighted areas of non-compliance and action required. Immediate requirements were made to the effect that the Kara House Residential Care Home DS0000005617.V255801.R01.S.doc Version 5.0 Page 19 advice of the fire department must be sought on the completion of a fire risk assessment for the home and fire safety checks must be consistently undertaken of the fire alarm, means of escape and emergency lighting and the outcomes recorded in the fire log book within 36 hours of the inspection. Kara House Residential Care Home DS0000005617.V255801.R01.S.doc Version 5.0 Page 20 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 2 Kara House Residential Care Home DS0000005617.V255801.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 & 13 Requirement The content of the care plan must be reviewed in the context of Standard 3 and 7. This also includes: a) Each resident having a nutritional assessment. b) Risk assessments being reviewed as part of the monthly review of the care plan. c) To make sure that changes in residents needs are evident in their care plans. Risk assessments must be in place to assess all risks applicable to an individual resident. These must be subject to consistent review to take account of any changes. A care plan for the administration of medication, including when required” (PRN) medication, which confirms why medication is prescribed and in what circumstances and for what conditions PRN medication is given must be in place for each resident. Timescale for action 24/11/05 2 OP7 13 & 15 24/11/05 3 24/11/05 OP9 13 Kara House Residential Care Home DS0000005617.V255801.R01.S.doc Version 5.0 Page 22 4 OP9 13 12 (3) 16 22 5 6 7 OP14 OP15 OP16 8 OP18 13 9 10 OP19 OP19 23 23 11 OP26 16 12 OP26 16 Sample signatures of staff administering medication must be held and the community nurses’ cupboard must be fitted with a lock. The residents must have information on advocacy services. Alternative menu choices must be provided and residents’ choices must be documented. A complaints record, which details the investigation and outcome of complaints, must be held. Trafford Council’s Protection of Adults from Abuse Policy must be readily available to all staff as a working tool and all staff must be familiar with its contents. Fire doors must not be wedged open with chairs or other objects. The carpet on the landing area must be refitted or replaced as it is ill fitting and may pose a tripping hazard. Cleaning products must be reviewed or the floor covering replaced in those bedrooms where odour was a problem. The home must take measures to minmise cross infection in the home by reviewing the use of bar soap and cloth towels in toilet areas. Staff files and training information must be available for inspection by the CSCI. The manager must complete an audit of training of her staff to ensure that training, including mandatory training, is up to date. 14/11/05 24/12/05 24/12/05 24/11/05 24/11/05 14/11/05 14/11/05 24/11/05 14/11/05 13 OP30 18 24/11/05 14 OP30 18 24/12/05 Kara House Residential Care Home DS0000005617.V255801.R01.S.doc Version 5.0 Page 23 15 OP38 23 16 OP38 23 17 OP38 23 The fire risk assessment must be dated and be subject to consistent review so that it accurately reflects the risks from fire at Kara House. The advice of the fire department must be sought concerning this Fire safety checks of the means of escape and fire alarm must be conducted on a weekly basis and the outcome recorded in the fire log book. Monthly tests of the emergency lighting must be undertaken and the outcomes recorded. The action required documented in the fire service report dated 22/09/05 must be addressed 17/10/05 17/10/05 24/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Kara House Residential Care Home DS0000005617.V255801.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ 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 Kara House Residential Care Home DS0000005617.V255801.R01.S.doc Version 5.0 Page 25 - 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!