CARE HOME ADULTS 18-65
Manor Barn Wattsfield Lane Kendal Cumbria LA9 5HF Lead Inspector
Ray Mowat Unannounced 19 May 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Manor Barn F58 F10 s22687 manor barn v227876 190505 ui stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Manor Barn Address Wattsfield Lane Kendal Cumbria LA9 5HF 01539 735025 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) The Oaklea Trust Carol Ann Pounder Care Home 5 Category(ies) of LD(E) - Learning Disability, over 65 registration, with number PD(E) - Physical Disability, over 65 of places LD - Learning Disability Manor Barn F58 F10 s22687 manor barn v227876 190505 ui stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 22 February 2005 Brief Description of the Service: Manor Barn is a converted barn, in a residential are of Kendal within walking distance of the the amenties of the town centre. It is registered to provide residential care for five people with a learning disability, some of whom may have elderly needs. The accommodation is arranged on three floors. There is ramped access to the property from a car park at the front of the building.. There is a small garden to the front and a larger private garden to the rear of the building that leads to a riverside walk. On the lower ground floor there is a self contained flat, this has a lounge area with kithen/diner, a single bedroom with en-suite and accessible shower facilities. Also situated on the ground floor but seperated from the registered accommodation, are several rooms used as offices by the Trust. The middle floor has three single bedrooms, two of which have en-suite fcilities and showers. There is a large lounge/dining room leading to a kitchen and utility room. The upper floor has a self contained flat with a single bedroom with ensuite facilities and a lounge with kitchenette. Also on this floor is a staff sleepin room, which is also used as an office. Manor Barn F58 F10 s22687 manor barn v227876 190505 ui stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 19th May at 7.45 am till 4.45pm. The inspector met with four residents during the day. The newly appointed manager of the home was also present, in addition the inspector met with four care staff. All areas of the home were inspected on this occasion. Records relating to the residents and also those required by regulation, for the effective running of the home were examined. The commission is awaiting an application in respect of the new manager, to become the registered manager for the home. What the service does well: What has improved since the last inspection? What they could do better:
The home must review the information issued to residents and ensure it is up to date and accurate and meets the requirements of the Care Home Regulations. In addition residents records must also be kept up to date. Manor Barn F58 F10 s22687 manor barn v227876 190505 ui stage 4.doc Version 1.30 Page 6 Training is also a priority, to ensure care practices value and respect individuals and their abilities, in particular promoting and supporting people to lead independent lifestyles. Poor practice in relation to the management and administration of medication was evident. Current practice must be reviewed and further training provided for staff, to ensure the safe management of medication in the home. Senior carers have now been made responsible for the management on-call service, however they are expected to manage this service when they are working on shift in a home. This is not appropriate and can put residents at risk and must be reviewed. The home must ensure safe working practices are followed at all times and relevant safety checks and maintenance are up to date and accurate. 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. Manor Barn F58 F10 s22687 manor barn v227876 190505 ui 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 Manor Barn F58 F10 s22687 manor barn v227876 190505 ui 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) 1, 2, 3, 4, 5. The relevant information and documents issued to residents were out of date and inaccurate, they must be updated, reissued and agreed with residents or their representatives. EVIDENCE: The home currently has a vacancy on the middle floor. A prospective new resident had recently been visiting the home, as a result of a referral from the social work team. There had been several visits arranged to the home, including meals, enabling the existing residents to spend time with the prospective new resident. In addition the staff visited the person in their current home to ensure a thorough assessment could be made. After a meeting with the social worker it was agreed the placement was not appropriate and the vacancy is to be advertised. The admission and assessment process was thorough and ensured existing residents were safeguarded from inappropriate placements and prospective new residents could “test drive” the home and make an informed decision. Information supplied to prospective new residents, such as the statement of purpose and service user guide, should be updated to incorporate the recent changes within the home. Contracts of terms and conditions held on file were now out of date and must be reviewed to ensure they are up to date and accurate and provide residents with all the necessary information in line with the National Minimum Standards and Care Home Regulations.
Manor Barn F58 F10 s22687 manor barn v227876 190505 ui 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) 6, 7, 8, 9, 10. The systems in place to record individual needs and choices are good, however the review of this information, ensuring it is relevant and accurate is inconsistent. EVIDENCE: The home has developed comprehensive care plans and needs assessments including informative pen pictures. The manager described how a member of the care staff is training, to be a training facilitator, for person centred planning. Once the training is completed with staff, person centred plans will be implemented in the home. Currently residents or their representatives do not sign care plans. It is recommended care plans are signed when reviews take place with significant parties. There was evidence of the care plans being kept under review, with previous minutes held on file and changing needs reflected. Risk assessments were in need of review, in particular where individual resident’s needs had changed and new hazards or potential hazards were present. Two areas of particular note, is when staff are supporting individuals on a one to one basis in the community and when taking residents out in the vehicle.
Manor Barn F58 F10 s22687 manor barn v227876 190505 ui stage 4.doc Version 1.30 Page 10 Communication passports, documenting preferred methods of communication had been developed for residents, this provided staff with valuable information to improve their level of understanding with regard to individual needs. Although staff meetings were held on a regular basis, the home had found one to one consultation more effective, in involving residents in decision making, rather than residents meetings. All personal and confidential information was securely stored, but accessible to both residents and staff when required. Manor Barn F58 F10 s22687 manor barn v227876 190505 ui 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) 11, 12, 13, 14, 15, 16, 17. Opportunities for personal development and participation in appropriate activities were limited. Some of the care practices observed were poor. EVIDENCE: The home has not had a regular manager or staff team in place for some time now, resulting in relief and agency staff covering shifts. It is evident basic needs have been met and residents have been kept comfortable and safe. However the quality activities and opportunities for personal development have suffered. Examples noted during the inspection included, a resident being shaved at the breakfast table by a member of staff, whilst another resident ate their breakfast. Not only was this undignified, it did not promote independence. Staff also prepared a residents packed lunch as they watched, although they were consulted regarding its content, the resident could have been actively involved with the activity, through verbal and gestural prompts. Two of the residents have elderly needs and lead a sedentary lifestyle, however there was a distinct lack of stimulation for them throughout the day. The provision of in-house and community activities was discussed with the manager. She described how a member of staff is developing an activity file to
Manor Barn F58 F10 s22687 manor barn v227876 190505 ui stage 4.doc Version 1.30 Page 12 be used with residents to choose and plan appropriate activities. However there is a need to review resident’s needs and preferences and research good practice, particularly with regard to age appropriate activities. Residents can also be assisted to participate in everyday activities and chores around the home. The two residents who live in the self contained flats are more actively involved in the routines of the home and also access community activities independently. They access the local amenities such as the post office, shops and library, on a regular basis, they also attend courses at the local college of further education. On the day of the inspection one of them had made his own shopping list and was supported by staff to complete the shopping. The inspector joined residents for lunch, which was freshly prepared. Menus had just been reviewed and a three-week menu agreed. During lunch one resident was using a spoon to eat their lunch. They were using their hand to stop food pushing off the plate, which was messy and undignified. Specialist equipment is available that can be used to promote independence and maintain dignity at mealtimes, which should be explored. Manor Barn F58 F10 s22687 manor barn v227876 190505 ui 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, 19, 20. The recording systems for personal and healthcare needs were good, with detailed information contained. Poor practice was observed with regard to the administration of medication. EVIDENCE: The recording systems in the home in relation to personal and healthcare needs were good. All routine and one off health interventions were recorded ensuring a good continuity of care was maintained. The home liaises with a range of relevant health professionals on an ongoing basis, in response to individual and specialist needs. Recent incidents with one resident, have resulted in the home working closely with the community nurse and behaviour intervention team, to develop new strategies to guide staff in dealing with violent incidents. Recording forms had been introduced to monitor and record specific behaviours. There was some poor practice observed relating to the administration of medication in the home. Morning medication had been signed for on the medical record sheet (MAR). However this had been transferred into an unmarked medication pot and left on the fridge in the kitchen, until the resident from the downstairs flat came up for it. Also on the MAR chart there were gaps where staff should have signed for medication. Staff were also seen to handle medication when not wearing gloves. PRN medication forms had been completed as required, however these should be held with the MAR chart,
Manor Barn F58 F10 s22687 manor barn v227876 190505 ui stage 4.doc Version 1.30 Page 14 to guide staff with administration. It is also recommended photographs of residents are fixed to the MAR chart to assist staff with identification, particularly as relief and agency staff are being used. All staff responsible for the administration of medication must receive appropriate training, ensuring they are competent to perform the task. Manor Barn F58 F10 s22687 manor barn v227876 190505 ui 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, 23. The policies and procedures of the home protect residents form abuse and ensure their views are acknowledged and responded to. EVIDENCE: Residents have been issued with both typed and audio versions of the complaints procedure. Staff were aware of policies and procedures and their role in relation to listening to and acting upon residents views. Through induction and NVQ training staff are aware of their role in identifying and responding to abuse and relevant reporting procedures. Staff sign a record of policies and procedures, in their supervision files, when they have read and discussed policies with their supervisor. The manager must clarify the Trust’s stance with regard to responsibility for purchasing replacement furniture. Manor Barn F58 F10 s22687 manor barn v227876 190505 ui 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, 30. Manor Barn provides a safe and comfortable living environment, which is decorated and maintained to a good standard. EVIDENCE: All the communal areas and private rooms were inspected on this visit. Bedrooms were decorated and furnished to a good standard with residents personalising them with their own belongings and choice of decoration. The maintenance of the home was good with all areas in a good state of repair. Bathrooms were adapted to suit the needs of the current residents, with staff liaising with specialist services when needs are identified. The manager was in the process of supporting a resident with purchasing new furniture as a result of a previous requirement. This was now on order, with the home manager awaiting clarification from senior managers regarding the financial procedure. Manor Barn F58 F10 s22687 manor barn v227876 190505 ui stage 4.doc Version 1.30 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35, 36. The staff levels in the home were improving, with plans in place to address the staff shortages. Levels of staff training were inconsistent, therefore the training needs of staff should be reviewed and a training programme developed. EVIDENCE: The new manager has been in post since the 1st April 05. She has picked up staff supervisions, ensuring all staff have had a supervision meeting. Records were sampled, these contained appropriate content and were signed by both parties. Staff spoken to said they could raise any issues of concern with the manager and that they received “good support”. On the day of the inspection an extra member of staff came to the home to offer their services. They had come from a neighbouring Trust home, where circumstances had changed, meaning they were not required in that home on specific days. This was not planned into the home’s rota and residents and staff were not aware of them coming. These hours should be planned, so that residents and staff are aware who will be on shift and to ensure maximum benefit is gained from the additional hours. The home was in the process of recruiting staff as they had continued to experience difficulty covering staff absences, resulting in the use of agency staff. The Trust were also recruiting staff to work as peripatetic carers, who
Manor Barn F58 F10 s22687 manor barn v227876 190505 ui stage 4.doc Version 1.30 Page 18 will have a set amount of contracted hours each week and will be used to cover staff absences across a number of homes. This is a positive step in ensuring a continuity of care is maintained in homes and will reduce the need to use agency staff. The manager had reviewed the rotas with the staff to ensure the contracted hours for the home were being used effectively, with there being a double up of staff each day. This has left four hours each week, which can be used flexibly to meet needs as they arise. It is recommended the new manager audit the training files to identify training needs of staff and develop a training programme for the home to meet these needs. Manor Barn F58 F10 s22687 manor barn v227876 190505 ui stage 4.doc Version 1.30 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 40, 41, 42, 43. The management of the home has been unsettled, which has had a detrimental impact on the quality of care provided. EVIDENCE: As described earlier the manager started in her role on 1st April 05. She has no formal supervisory or management experience at present but has been registered on the Trust’s management development programme, starting in June 05. This programme has been introduced in response to the continued difficulties experienced in the recruitment of managers. Candidates were invited to apply for the programme and underwent a formal selection and interview process to identify suitable candidates. This will result in the completion of the registered manager award. She is receiving supervision from the newly appointed operations manager and has a management mentor to provide ongoing support as she settles into the role. This support is essential due to her lack of relevant experience and qualifications. Based on
Manor Barn F58 F10 s22687 manor barn v227876 190505 ui stage 4.doc Version 1.30 Page 20 discussions during the inspection the new manager is getting the support and guidance required and has a good insight to her role and responsibilities. A Fit Person application must be forwarded to the Commission in a timely manner. As with other homes within the Trust, senior carers who are on duty in a home are covering the management on-call service. This is totally inappropriate when they are on shift, as it will distract them from their duties in the home, having a detrimental impact on the service provided to residents and possibly putting them at risk. They are also expected to be on-call, when they are supporting residents in the community on a one to one basis, this is also totally inappropriate and not safe. This issue must be addressed by the Trust and an alternative solution found. Staff maintain daily diary recordings and care notes to record significant events. It was evident that serious and violent incidents were recorded on monitoring forms held on care plan files, however they were not always referred to in the daily diary, which is used to pass information between staff on different shifts. This could leave staff in a vulnerable position and not aware of potential conflicts. The records required for inspection were examined, it was found that fire safety records were not complete and the cleaning regime for showerheads had not been followed. All other safety checks were found to be in order. During the inspection the COSHH cupboard was left open with the keys in the door, whilst staff were carrying out cleaning duties, this is poor practice and leaves residents at risk. Upon examination of the budget information for the home, there was a projected overspend. With the manager being new to the home she was not able to explain the reasons for this or how it will be managed. The manager must seek clarification of the budget situation to enable her to manage the home effectively. Manor Barn F58 F10 s22687 manor barn v227876 190505 ui 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 2 3 3 3 2 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 2 2 2 3
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 2 2 3 2 3 2 3 Standard No 31 32 33 34 35 36 Score 2 2 2 x 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Manor Barn Score 3 3 1 x Standard No 37 38 39 40 41 42 43 Score 2 2 x 3 2 2 2 F58 F10 s22687 manor barn v227876 190505 ui stage 4.doc Version 1.30 Page 22 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 5 Regulation 5 Requirement An up to date contract of terms and conditions, must be issued and agreed with all residents or their representitive. All risk assessments must be reviewed, ensuring changing needs are addressed. Residents privacy and dignity must be respected at all times. Residents must be consulted about their social interests and appropriate activities provided Medication must be administered in line with Royal Pharmceutical guidelines. MAR charts must be signed on administration, kept up to date and accurate. PRN medication guidelines must be held with medication administration records. All staff responsible for administering medication must receive formal training in the safe handling of medicunes. The new manager must complete the fit person process in a timely manner. On call management arrangements must be reviewed to ensure the safety of residents. Timescale for action 1st July 05 2. 3. 4. 5. 6. 7. 8. 9 16 12 20 20 20 20 13 12(4)a 16(2)m 13(2) 13(2) 13(2) 13(2) 1st August 05 1st June 05 1st July 05 20th May 05 20th May 05 23rd May 05 1st September 05 31st August 05 1st July 05 9. 10. 37 43 9 13 & 18 Manor Barn F58 F10 s22687 manor barn v227876 190505 ui stage 4.doc Version 1.30 Page 23 11. 42 12 12. 13. 42 42 13(4) 13(4) Relevant information must be shared by staff to ensure a continuity of care and the safety of residents and staff. COSHH substances must be securely stored at all times. Safe working practices and health and safety procedures and checks must be followed at all times, to ensure the safety of residents and staff. 1st June 05 21st May 05 1st June 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. 1. 2. 3. 4. 5. Refer to Standard 6 20 23 31 35 Good Practice Recommendations It is recommended care plans are signed by residents or their representitives. Residents photographs should be added to MAR charts to aid identification. The manager should clarify the organisations policy in relation to the replacement of furniture, ensuring residents rights are protected. Additional staff hours should be planned on the rota to ensure they are used effectively. It is recommended the home develop a training programme for the year, based on the needs of the staff group. Manor Barn F58 F10 s22687 manor barn v227876 190505 ui stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith, Cumbria CA11 9BP 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 Manor Barn F58 F10 s22687 manor barn v227876 190505 ui stage 4.doc Version 1.30 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!