Inspection on 30/05/06 for Orchard House

This inspection was carried out on 30th May 2006.

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.

Other inspections for this house

Orchard House 12/03/09

Orchard House 17/07/08

Orchard House 23/01/06

Orchard House 29/09/05

Orchard House 26/10/04

Orchard House 17/05/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Orchard House 155 Barton Road Kettering Northants NN15 6RT Lead Inspector Mrs Sarah Smart Unannounced Inspection 30th May 2006 09:30 X10029.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 Orchard House DS0000012879.V293622.R01.S.doc Version 5.1 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 and Care Homes for Adults 18 – 65*. 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. Orchard House DS0000012879.V293622.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Orchard House Address 155 Barton Road Kettering Northants NN15 6RT 01536 514604 01536 485599 daryl.wilson@btopenworld.com rsonshomes@btopenworld.com R Sons (Homes) Limited 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) Mrs Daryll Louise Wilson Care Home 33 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (33), of places Physical disability over 65 years of age (10) Orchard House DS0000012879.V293622.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The total number of service users must not exceed 33 No one falling within the category of PD(E) may be admitted to the home when there are 10 persons of category PD(E) already accommodated in the home. No one falling within category DE(E) maybe admitted into the home when there are 18 persons of category DE(E) already accommodated in the home. 23rd January 2006 Date of last inspection Brief Description of the Service: Orchard House is located in a quiet residential area in Barton Seagrave, on the outskirts of Kettering. It is an extended detached property offering accommodation, in 26 single bedrooms and 3 double bedrooms, on the ground and the first floor, which can be accessed via stairs or a lift. There are extensive well-maintained and attractive grounds that are fully accessible to Service Users. Orchard House offers 32 places for older people over the age of 65 who require personal care and support due to age. Its registration includes the capacity to care for older people with physical disabilities and some with Dementia conditions. Orchard House DS0000012879.V293622.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection was undertaken between the hours of 09.30 and 2pm. Preparation for the inspection included, review of the previous inspection report, requirements and recommendations, and service history, and took approximately 4 hours. The primary method of inspection used was ‘case tracking’. This involves selecting a number of service users and tracking their care and experiences through review of their records, discussion with them, the care staff and observation of care practices. The following areas were covered during the inspection: case tracking, medication, sample of policy review, staff rota, staff files, quality assurance, staff supervision, accident records, complaints records, sample tour of the premises, previous requirements made, and staff and service user interviews. Two service users were case tracked, and were selected during the tour of the premises giving consideration to their needs. Two staff members, plus the manager, were spoken with at length, and several others briefly, whilst four service users were spoken to in detail. The fees charged by the home currently range from £342 to £450. What the service does well: All of the information gathered during the inspection satisfied the inspector that the service users needs are met. Positive feedback was received from all of the service users spoken to. Pleasant and appropriate communication was observed between the staff and service users at all times. All but one care plan was written appropriately, reviewed and agreed by the service user or a representative. Most areas of medication management were satisfactory. Service users stated that their privacy and dignity is respected, and that they are offered choices. They added that the food is very nice. A relative also gave positive feedback. The home has pleasant large grounds which are accessible to the service users. The home have not received any complaints since the last inspection. Staff demonstrated an acceptable knowledge of the complaints and abuse procedures. Redecoration of some areas of the home were underway. Staffing levels and training was satisfactory. Orchard House DS0000012879.V293622.R01.S.doc Version 5.1 Page 6 Staff files were maintained to an acceptable standard. Quality assurance monitoring is carried out annually, and positive feedback was observed. Service users money is appropriately handled by the home. Portable appliance testing was up to date. Accident recording was satisfactory. With one exception, the home was clean and tidy. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Orchard House DS0000012879.V293622.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Orchard House DS0000012879.V293622.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Quality in this outcome group is good. This judgment has been made using available evidence, including a visit to the service. Service users needs are met, and they are adequately supported in their daily lives. EVIDENCE: A sample of service users were cased tracked. From the evidence available, and observations carried out during the inspection, in addition to speaking with staff and service users, the inspector was satisfied that the service users needs are met. The service users gave positive feedback throughout to the inspector, and positive comments were also received from a visiting relative. Orchard House DS0000012879.V293622.R01.S.doc Version 5.1 Page 9 Pleasant and appropriate communication was observed between the staff and service users at all times. One service users file did not contain a contract of residency, whilst the second did have such documentation available. The home does not provide intermediate care. Orchard House DS0000012879.V293622.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome group is adequate. This judgment has been made using available evidence, including a visit to the service. Service users health and personal care needs were met. Management of medication could be more robust to protect service users. EVIDENCE: A sample of service users care plans were viewed. In all but one instance care plans were written appropriately. One service user who was reported by the Orchard House DS0000012879.V293622.R01.S.doc Version 5.1 Page 11 manager to wander, require supervision, and at risk of falls, did not have a care plan for this. Care plans were reviewed monthly, and signed by the service user or their representative. The manager advised the inspector that a new care planning format is currently being introduced throughout the home. One service users file contained one healthcare assessment in relation to pressure sores, however, the other file did not contain any. It is recommended that pressure sore, nutrition, and continence assessments, if applicable, should be introduced for all service users. The manager stated that such assessments are due to be introduced soon. The one assessment seen resulted in a high score, and the manager stated that the service user had been referred appropriately to the relevant healthcare professionals. A sample of medication was viewed. In one instance a prescribed cream belonging to one service user was found in the bedroom of another, and in several instances, it appeared that the labels had been removed from prescribed creams. The home does not currently sign the medication record sheets when prescribed creams are administered. The manager assured the inspector that this is to be introduced, therefore a requirement has not been made. A bottle of eye ointment with a short opened shelf life was in use past its expiry date. All of the service users spoken to stated that their privacy and dignity is respected. Observations during the inspection reinforced this. Orchard House DS0000012879.V293622.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome group is good. This judgment has been made using available evidence, including a visit to the service. Service users social needs are met, allowing them to lead a meaningful and fulfilled life. EVIDENCE: The home held potentially very detailed records in relation to activities, however they had not been completed for sometime. The manager stated that the records are very time consuming for staff to complete. A discussion took Orchard House DS0000012879.V293622.R01.S.doc Version 5.1 Page 13 placed in relation to how activities could be best recorded. Service users files contained a social history. At the time of the inspection a group of service users and staff were playing musical bingo. The service users spoken to stated that they do not get bored, and one service user stated that he enjoys the vast grounds which the home is surrounded by. Service users, and the relative spoken to, stated that relatives are welcomed into the home. All of the service users spoken with said that the food is very nice, and they are offered choices at all mealtimes. Lunch at the time of the inspection looked very appetising, and service users were heard to be offered choices of vegetables, sauces etc according to their preferences. Orchard House DS0000012879.V293622.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome group is adequate. This judgment has been made using available evidence, including a visit to the service. Despite poor policy content, service users are protected by the knowledge of the staff. EVIDENCE: The complaints policy was viewed. This did not inform the reader that the complainant may contact the Commission for Social Care Inspection at any time. The manager stated that they home had not received any complaints since the last inspection. Staff spoken with demonstrated a satisfactory knowledge of the complaint procedure. The adult protection policy gave misleading and incorrect information. The manager demonstrated that she was aware of the correct procedure, and that the home have a copy of the Northamptonshire Inter-agency abuse policy. It is recommended that the incorrect policy is removed. Staff spoken to demonstrated an acceptable knowledge of the procedure to be followed in the event of alleged abuse. Orchard House DS0000012879.V293622.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome group is good. This judgment has been made using available evidence, including a visit to the service. The premises and furnishings are satisfactory to meet the service users needs, and are acceptable to the service users. EVIDENCE: Orchard House DS0000012879.V293622.R01.S.doc Version 5.1 Page 16 A sample tour of the premises was undertaken. Some aspects of the premises and furnishings appeared a little worn, and redecorating was underway at the time of the inspection. Service users spoken with all stated that they are happy with their bedrooms. All areas of the home were clean and tidy, with the exception of one wheelchair. The home stands in huge grounds, which are accessible to the service users. The manager stated that there are significant plans for the premises and furnishings of the home over the coming months, particularly focussing around meeting the needs of the service users with dementia, for which the home has recently increased their registration. Orchard House DS0000012879.V293622.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome group is good. This judgment has been made using available evidence, including a visit to the service. Staffing levels and training is suitable to meet the needs of the service users. EVIDENCE: The staff rota was viewed. The home currently has 20 service users, for which there are four staff on duty during the morning shift, three in the afternoon, and two overnight. The manager stated that these numbers would increase as more service users are admitted to the home. At least one staff member was working additional hours. The manager stated that she monitors the performance of such staff, and their files demonstrated that they had signed Working Time Directive opt out agreements. Staff and service users spoken to stated that there is sufficient staff on duty. Orchard House DS0000012879.V293622.R01.S.doc Version 5.1 Page 18 The manager advised the inspector that 94 of the staff have National Vocational Qualifications. A sample of staff files were viewed. They generally contained the required information, although there was little evidence of staff supervision. This had been the subject of a previous requirement. The manager stated that staff supervision is to be reintroduced soon. A matrix in relation to staff training was viewed. It was evident that statutory training is up to date. Staff indicated that they had received training in several other areas relating to the needs of the service users. Orchard House DS0000012879.V293622.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome group is good. This judgment has been made using available evidence, including a visit to the service. Management of the home suitably protected the service users, and ensured their needs are met. EVIDENCE: Orchard House DS0000012879.V293622.R01.S.doc Version 5.1 Page 20 The registered manager has been in post for several years, and has active support from the owner of the home. Staff and service users spoke positively about the manager. The manager demonstrated that quality monitoring is undertaken annually. Feedback from the survey in 2005 was positive. The home also has a suggestions box. The quality assurance policy did not state when, or how often monitoring would take place. A sample of service users money was inspected. The records and finances were acceptable, and documentation was adequate. Fire check records had not been maintained timely, and one fire exit was partially blocked. This was improved during the inspection. Portable Appliance Testing was up to date. Accident records were satisfactory, and the manager was aware of trends in the accidents. Orchard House DS0000012879.V293622.R01.S.doc Version 5.1 Page 21 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 X 2 X 3 3 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 ENVIRONMENT Standard No Score 19 3 20 X 21 X 22 X 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 3 34 X 35 3 36 X 37 X 38 3 Orchard House DS0000012879.V293622.R01.S.doc Version 5.1 Page 22 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 OP7 OP8 OP9 OP18OP16 OP38 Good Practice Recommendations An identified service user should have a care plan in relation to wandering, supervision and falls prevention. Healthcare assessments should be introduced for all service users. The management of medication should be improved, to meet the required standards. The policies identified which need additional or alternative information should be updated. Fire check records should be maintained timely. Orchard House DS0000012879.V293622.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB 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. Orchard House DS0000012879.V293622.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!