Key inspection report
Care homes for older people
Name: Address: Nazareth House 118 Harlestone Road Northampton Northants NN5 6AD The quality rating for this care home is:
zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Keith Williamson
Date: 0 8 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People
Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home
Name of care home: Address: Nazareth House 118 Harlestone Road Northampton Northants NN5 6AD 01604751385 01604580435 sheila@naznptn.plus.com www.sistersofnazareth.com The Congregation of the Sisters of Nazareth care home 50 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 50 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Nazareth House is a care home providing personal care for Older People, it is a large home located on the outskirts of Northampton. The home has been established for many years and is run by The Congregation of the Sisters of Nazareth who also offer a comprehensive range of spiritual support and guidance to meet the individual religious needs and preferences of people living within the home. Mass and The Rosary are celebrated on a daily basis, in the Church which is attached to the home . Accommodation is provided over the ground and first floor, with access to the first floor being via a passenger lift, the ground floor provides all the communal amenities, Care Homes for Older People
Page 4 of 27 Over 65 50 0 0 6 0 4 2 0 0 9 Brief description of the care home along with bedroom and bathing facilities, whilst the first floor provides additional bathing facilities and bedrooms. Bedrooms in some instances include an en-suite facility. Nazareth House has a large and very well maintained garden, with mature trees, shrubs and plants and benefits from a large water fountain. Information about Nazareth House is provided in the form of a Service Users Guide and a Statement of Purpose. The Manager provided information on the day of the site visit with regards to fees. Fees range from £469.00 to £539.00 per week; the fee charged is dependent upon the specification and amenities of the personal accommodation. Care Homes for Older People Page 5 of 27 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of the inspection is on outcomes for residents and their views of the service provided. The main method of Inspection used was case tracking which involves selecting a sample number of people and tracking the care they received through talking with them where possible, and looking at their records and accommodation, in this case three residents were chosen. This visit took place over one day, commencing at 9.30am and took six hours to complete. An opportunity was taken to talk with residents, the acting manager and staff, look around the home, view records, policies and care plans. Residents, their relatives, staff and professionals (for example General Practitioner and District Nurses) visiting the home also made some comments that have been included in this report. Information was obtained from the Annual Quality Assurance Assessment, which gives information about the home, and is filled in by the registered manager. A copy of the last Care Quality Commission (CQC) report is displayed in the foyer of the home, and copies of this report are available from the registered manager. The quality rating for this service is 0 star. Care Homes for Older People
Page 6 of 27 This means the people who use this service continue to experience poor quality outcomes. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? Care Homes for Older People Page 8 of 27 There were four requirements made at the last visit, three have been dealt with appropriately. These included staff keeping accurate medication records and having satisfactory support in place for those people taking their own medication. The final requirement that has improved is around ensuring when people are employed, the appropriate references and security checks are in place. The acting manager is completing a monthly action plan. This is used to record what has been achieved, or needs further work to complete tasks. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents receive information on the home and have their needs assessed before moving in. Evidence: Prospective residents can expect to have their needs assessed before they move into the home this should ensure that staff have the experience and numbers to meet peoples needs. All the residents files were found to include an assessment of their needs completed by a social worker or the senior staff member from the home. The Statement of Purpose and Service User Guide have yet to be updated with the latest staffing changes. These are documents given to people considering moving into the home. This home does not provide Intermediate Care Care Homes for Older People Page 11 of 27 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all people living at the home are administered their medicines as prescribed by their doctor. This can be detrimental to their health and also means some may suffer with symptoms unnecessarily. Evidence: Three peoples medication records, daily records and care plans were viewed as part of case-tracking their healthcare needs and outcomes while living at the home. Other medication records, policies and procedures were also looked at to determine an overview of the current medication handling practices at the home. A person was prescribed a pain relief skin patch (Fentanyl) to control severe pain due to a frozen shoulder. The prescribers directions were incorrectly followed by the staff at the home on one occasion before this was pointed out on the day of the inspection. The records showed that a system had been put in place to continue to change a patch every 96 hours instead of every 72 hours. The Pharmacist Inspector spoke to this person who said the patch had not touched
Care Homes for Older People Page 12 of 27 Evidence: the pain. She said she is happy at the home and has no complaints. She also stated that she gets her medicines when she needs them and sees a doctor when she wants to. This persons daily notes described that on the day the pain relief patch had been replaced (a day late) that this person had started to complained again about pain in her shoulder and that this was making her anxious. The staff at the home did refer this person back to the GP promptly. There was minimum information regarding the healthcare needs of dealing with this persons pain relief in her care plan. The home had devised a system to deal with people who are required to take warfarin tablets. The home would refer to the anti-coagulant yellow book to ensure compliance to doses. On one occasion it was noted that a dose had been omitted and marked with a cross. This meant that the prescribers directions had not been followed. During a previous medication cycle a person prescribed a water tablet for very swollen legs had her dose changed. This medication record and subsequent records were not clear and it could not be established when the instructions had been followed and what was the amount of medicine given. Medication that requires cold storage was being stored in clinical fridges. The temperatures were being monitored regularly but the upstairs fridge had been showing a reading of 23C for the maximum temperature since January 2010 . This did not alarm the member of staff on duty nor had there been any action taken. For one person prescribed an antibiotic eye drop the home had not stored the medicines appropriately. This was kept in a medication trolley instead of the fridge as requested by the label on the bottle. The records showed that this person had been given these eye drops for a week. By the end of the inspection the manager of the home had organised a fresh supply of eye drops for this person. When people chose to administer and keep their own medicines this was being managed well at the home. Staff would keep a general overview on stock levels and whether medicines were taken correctly. All people at the home received their medicines continuously. Although for a newly admitted person there were discrepancies on the doses on the medicines accompanying him and those on the GP records. The home acted to resolve the situation but this did mean a this person had to miss some medication. The stock levels and the organisation of the medication trolleys had much improved Care Homes for Older People Page 13 of 27 Evidence: from the last Pharmacy inspection. Copies of permission sheets signed by the GP, were seen thus allowing the administration of an appropriate homely remedy from an approved list if the situation arose. Evidence was seen that regular audits are carried out on the medication administration record sheets. Residents care plans were up to date and continue to be reviewed regularly with the resident or a member of their family. Care plans are risk assessed, which gives staff vital information how to keep people safe in the home. Again these risk assessments continue to be reviewed periodically. From records kept by the home it was evident that health care services including General Practitioners and community nurses visit on the residents behalf. Surveys were forwarded to service users, staff and a number of health care professionals prior to the visit, comments from them and those made on the day include the following What the service users think the home does well. I feel the care provided looks after my needs very well. Friendly environment. When I ask for something they (the staff) get it, I dont need to ask twice. What peoples relatives think the home does well. Look after my Aunt. General caring. Personal care is good. What the health care professionals think the home does well. Caring. Very caring staff. Provide good care generally to the residents. What the health care professionals think the home could do better. They have improved medicine management significantly. Care Homes for Older People Page 14 of 27 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of one to one activities for some people could lead to them being more isolated. Evidence: Residents are still offered choice on a daily basis. The residents agreed these include when to get up or go to bed, what to wear, a choice of meals and whether to join in the activities provided. These are important as they ensure residents can retain a good level of control over their lives. Activities and pastimes continue to be offered, these include armchair exercise, music quizzes, jigsaws and reminiscence. There is an activities organiser employed to assist in this area, and there is evidence of a number of group activities. There also needs to be more one to one work with people to increase their awareness and quality of life. Spiritual comfort continues to be offered to people with the resident group of nuns from the attached convent. The menu system has been changed again and people are offered an extensive list of meals on a daily basis. Surveys were forwarded to service users, staff and a number of health care professionals prior to the visit, comments from them and those made on the day
Care Homes for Older People Page 15 of 27 Evidence: include the following What the service users think the home does well. The atmosphere is very caring and our visitors are welcome. There is a good programme of activities, although not everyone can participate. Everything is done well. Organising events out. What the service users think the home could do better. Dont know. Meal times. Happy with how it is. What peoples relatives think the home could do better. Food and entertainment. Poor quality and appropriateness of food offered, for example spicy chicken curry for the evening meal. Very few service users ate this, only options egg or limited sandwiches. Food choices very limited, few fresh vegetables or salads offered. Food on the whole is of poor nutritional value and repetitive. Too much time spent in rooms or in front of the t.v. (television). Very limited choice of community activities, bingo and exercise offered. Many of the service users have full mental facilities and there is nothing for them. They are very bored. I am not informed of Ys medication, sometimes she appears to be drugged up. I have never been told of her key worker. Care Homes for Older People Page 16 of 27 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents continue to be protected by people having a good knowledge of safeguarding and complaints information. Evidence: We looked at the complaints policy and procedure and there have been no changes recorded since the last visit. Residents are aware that there is a complaints procedure in place and are made aware of this at the point of applying to be admitted. There has been one complaint which was recorded and acted on appropriately. Care staff spoken with during the inspection were aware of what to do should they suspect any act of abuse. There has been further training on this subject. There have been no safeguarding issues forwarded directly to the Care Quality Commission (CQC). Care Homes for Older People Page 17 of 27 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The well-maintained environment provides a safe environment for people. Evidence: The home is clean and comfortable, and is set in extensive grounds, these are well kept and spacious, and many of the bedrooms have a pleasant outlook onto the garden area. Decoration continues to be of a good standard and furnishings in the communal areas are domestic in character and in good condition. A further selection of public and bedrooms were seen during the visit. These again included personal items and adaptations such as raised toilet seats which improves the lifestyle for people. Staff have received training in infection control and observations during the inspection again confirmed that staff used the appropriate protective clothing when carrying out their duties. The laundry is well appointed and the floors and walls are easily cleaned. This is important as it helps guard against cross contamination within the home. The laundry has had a new sorting system introduced, this should assist in clothes being put into
Care Homes for Older People Page 18 of 27 Evidence: the correct residents rooms. Surveys were forwarded to service users, staff and a number of health care professionals prior to the visit, comments from them and those made on the day include the following What the service users think the home does well. Cleanliness. What the health care professionals think the home does well. Very good premises. What peoples relatives think the home could do better. Sorting of laundry. Care Homes for Older People Page 19 of 27 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The improvement in the recruitment procedure has had a beneficial effect on protecting people within the home. Evidence: There have been a number of staff employed since the last visit. We looked at their employment and recruitment records and found them to be up to date and in place. Staff have been provided with uniforms, making it easier to recognise the different groups within the home. Care staff wear a red tabard when administering medicines. This is to attempt to ensure they are not disturbed, making the process safer. Residents and visitors have been informed of these changes. Training is ongoing, staff continue to undertake courses run by a variety of trainers from in the home and and external agencies such as Boots the chemist. Surveys were forwarded to service users, staff and a number of health care professionals prior to the visit, comments from them and those made on the day include the following What the service users think the home does well. Caring and friendly staff and management. Staff. Care Homes for Older People Page 20 of 27 Evidence: What the health care professionals think the home could do better. Provide carers with more support and education. Care Homes for Older People Page 21 of 27 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Safety within the home is not being successfully managed; with continuing failures to ensure appropriate medication is dispensed. Evidence: The manager has now commenced the process to become registered with the CQC. Quality Assurance (QA) continues to be developed in the home. Quality Assurance which is where the staff seek the views of people who live and others with an interest in the home. This is done through questionnaires being available to all in the foyer of the home. These are placed alongside the complaints procedure and copy of the latest CQC inspection report. The Responsible Person, who is appointed to see the home is safe and staff are meeting peoples needs, continues to visit and copies of the reports from these visits were seen. This again indicates the home is being overseen on a regular basis and any areas of improvement are being recorded. We again looked at the health and safety tests performed by staff. These were regularly performed and the outcomes recorded. The overall safety within the home is
Care Homes for Older People Page 22 of 27 Evidence: good, but the continuing failure by staff to ensure medication is administered safely is a problem that needs to be overcome. We have taken into consideration the new manager and the improvements she has put in place since taking up post. We have written to the Responsible Person and Manager outlining what action we will take if improvements are not made and maintained in the home. Surveys were forwarded to service users, staff and a number of health care professionals prior to the visit, comments from them and those made on the day include the following What peoples relatives think the home does well The service provided for X has improved with the employment of a new manager. She has invited her to take part in the (staff) interview process. This involvement has benefited Xs self esteem and being valued. What the health care professionals think the home does well. Since the new manager has been in post things have improved markedly. What the health care professionals think the home could do better. Improved management systems and staff training to provide consistency. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 9 13 All people living at the home 25/12/2009 must have their medicines administered in accordance to the Prescribers instructions This is to safeguard the health and welfare of people living at the home. Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 9 13 All medicines that need cold 31/03/2010 storage must be stored in a fridge where the temperature is maintained between 2-8C This is to ensure that people receive medicines that are clinically effective and will not cause them harm ll people living at the home must have their medicines administered in accordance to the Prescribers Instructions. This is to safeguard the health and welfare of people living at the home. 31/03/2010 2 9 13 3 38 12 The Registered Person shall 31/03/2010 ensure that the care home is conducted so as, to promote and make proper provision for the health and welfare of service users. Care Homes for Older People Page 25 of 27 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action This is to ensure people are safe in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 1 The Statement of Purpose and Service User Guide could be updated with the latest information to allow people to have the correct details on the home. All medicines that are to be used at specific intervals ie Patches or weekly medicines should be written up on the days to be taken and then the medication record shold be checked and countersigned by another appropriate staff member. All changes to dosages made verbally by a doctor must be countersigned on the medication record sheets by another person who is designated the role of administering medicines. A new prescription must be obtained from the prescriber when the directions have been altered and crossed checked as soon as possible. Medication profiles in care plans need to be updated too. All people who receive pain relief should have an action plan completed in their care plan as to explain the next steps staff are to take if there is not sufficient pain control. It would be good to date the returned activities questionnaires, this would ensure people were asked at an appropriately timed intervals. When asking people what activities they would prefer, it would be good to ask what people would like as an open choice, not be so descriptive on whats on offer. It would be usefull to offer and record meal choices on the day the meal is prepared, this would assist confused people retaining the information of what choices they had made. 2 9 3 9 4 9 5 12 6 12 7 15 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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!
