Inspection on 18/01/07 for Partnership In Care, Sherrington House

This inspection was carried out on 18th January 2007.

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

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

Other inspections for this house

Partnership In Care, Sherrington... 15/01/08

Partnership In Care, Sherrington... 30/01/06

Partnership In Care, Sherrington... 21/04/05

Partnership In Care, Sherrington... 22/02/05

Partnership In Care, Sherrington... 13/01/05

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

CARE HOMES FOR OLDER PEOPLE Sherrington House 71 Sherrington Road Ipswich Suffolk IP1 4HT Lead Inspector Tina Burns Key Unannounced Inspection 18th January 2007 10:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sherrington House DS0000029250.V327238.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sherrington House DS0000029250.V327238.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sherrington House Address 71 Sherrington Road Ipswich Suffolk IP1 4HT 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) 01473 464106 01473 464107 The Partnership in Care Limited Mrs Nicola Reynolds Care Home 40 Category(ies) of Dementia - over 65 years of age (33), Old age, registration, with number not falling within any other category (40), of places Physical disability (5) Sherrington House DS0000029250.V327238.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One place in the category of DE(E), is to accommodate and provide care for one named person, as stated in the application of September 2005. 30th January 2006 Date of last inspection Brief Description of the Service: Sherrington House is registered to provide care for 40 older people. It is set within a residential development in Ipswich, close to shops and the main town. The town offers a range of facilities including cinemas, public houses, restaurants, shops, swimming pool, and a library and has good rail, bus and coach transport links. The home is divided into 4 areas called units. At the time of inspection Sunset, Park view and Horizon units provided care for a total of 30 older people, three of whom had a diagnosis of dementia. Dales View unit provided care for 10 older people with dementia. Each unit has their own lounge, dining room, communal bathroom and toilets. All bedrooms are single, and have a wash hand basin, 2 also have en-suite toilets. Residents can access all areas of the home by stairs or passenger lift. The large garden has seating areas, and there is car parking to the front and rear of the home. The home is a non-smoking home. Fees are 450.00 per week. Sherrington House DS0000029250.V327238.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, which focused on the core standards relating to care homes for older people. The inspection was undertaken on a weekday and took place over a period of approximately eight hours. The report has been written using accumulated evidence gathered prior to and during the inspection. The inspection process included examination of a range of documents including three staff records, three residents care plans and a range of policies, procedures and health and safety records. The inspector also toured the premises and spoke with eight service users and four care workers. Information was also gathered from the homes pre inspection questionnaire, five resident’s survey forms and 1 relative’s comments card. The registered manager was present during the inspection and fully contributed to the inspection process. What the service does well: What has improved since the last inspection? The home had responded well to requirements made at the last inspection. Records seen evidenced that changes to medication were appropriately recorded and acted upon. Call bell cords in bathrooms could also be reached by residents using the baths. Sherrington House DS0000029250.V327238.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Sherrington House DS0000029250.V327238.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sherrington House DS0000029250.V327238.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to recieve appropriate information about the home and make an informed decision about whether or not it can meet their needs. EVIDENCE: Since the last inspection the manager advised that the home has ceased providing transitional care (residents who have left hospital and are waiting to return home, or waiting for a permanent bed in a care home). In addition beds are now available to self-funding residents as well as those funded by the local authority social services. Residents records examined included appropriate contracts and the homes ‘Service Users Guide’ gave a summary of ‘Terms and Conditions’ of residency, which covers ‘Payment terms, and extra charges’. This included information on Sherrington House DS0000029250.V327238.R01.S.doc Version 5.2 Page 9 what was and what was not included in the fees (toiletries, hairdressing, chiropody, physiotherapy, dry cleaning). The homes certificate of registration and previous inspection report was prominently displayed in the homes foyer. Feedback from residents, records examined and discussion with the manager confirmed that appropriate assessments of need were undertaken before residents moved into the home including local authority assessments where appropriate. Assessments covered a wide range of needs and included individual and manual handling risk assessments. One resident spoken with that was new to the home had visited for a “trial stay” prior to their admission. Comments received from residents about the quality of care they received were positive and included “I am really happy here, they are marvellous”, “You couldn’t wish for better people” and “I think it’s alright”. Sherrington House DS0000029250.V327238.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to have their privacy and dignity respected. They are fully consulted about their care plans and can expect to see the quality and detail of the plans improve. Furthermore, they are protected by the homes medication policies and procedures. EVIDENCE: Records examined and residents spoken with evidenced that individual care plans were in place and had been developed in consultation with the residents. However, the three care plans examined did not fully reflect the resident’s assessments of need or provide adequate detail to ensure that care staff were clear about the tasks that needed to be undertaken. Discussion with the manager and examination of paper and electronic records indicated that full information had not been transferred to the electronic care plan system that had been introduced in April 2006. However, observations during the inspection and discussion with staff and residents indicated that care workers had a good understanding of resident’s needs, interests, likes and dislikes. Furthermore, the manager clearly understood the issues raised and showed a Sherrington House DS0000029250.V327238.R01.S.doc Version 5.2 Page 11 commitment to improving the quality of the electronic care plans as a matter of priority. Records examined included appropriate assessments in relation to resident’s physical and mental health care needs, including those needs associated with dementia, and covered areas such as nutrition, pressure care, continence, hearing and sight. Daily records also evidenced that the home ensures residents have access to health care services such as GP’s, community nurses and hospital outpatient services. However, the electronic system introduced did not consistently provide sufficient detail about resident’s health needs or evidence that resident’s health was appropriately monitored, for example, resident’s weights had not been entered onto the system. Staff training records seen, Medication Administration Records examined and observations made during a medication round confirmed that the home had appropriate procedures in place for the safe storage, handling and administration of medications. Records of monthly medication audits were also seen and demonstrated that the home monitor’s procedures and practice. All medication administration records seen had been appropriately completed, signed and dated. One resident spoken with that self-medicated had an appropriate risk assessment in place and secure storage in their room. Feedback from residents and observations made during the inspection evidenced that staff respected resident’s privacy and dignity. Personal care was provided in the privacy of the individual’s bedroom or privately in one of the homes bathrooms. Staff were observed knocking on residents bedroom door’s before entering. Sherrington House DS0000029250.V327238.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect their visitors to receive a warm welcome. Furthermore, the homes social and recreational activities seem to meet service users expectations and meals are healthy, nutritious and appetising. EVIDENCE: The home employ’s an activities co-ordinator that works between the hours of 9.00am -4.00pm, Monday to Friday’s. The co-ordinator organises a range of planned activities that residents are invited to participate in. A programme of the week’s activities was listed on a white board near the entrance of the home. This may have been better placed so that residents had sight of it in their units. Resident’s confirmed that they did not get individual copies of the programme delivered to their rooms. Overall residents seemed satisfied with the activities on offer. Several had participated in a game of bingo on the morning of the inspection and were happy to have won small prizes. The residents newsletter included reference to a week of “trips out” recently enjoyed by several of the residents. Care staff were also encouraged to initiate activities with the residents and each unit had a tray of activity cards giving examples/ideas of things to do such as cards, Sherrington House DS0000029250.V327238.R01.S.doc Version 5.2 Page 13 dominoes and quizzes. Many of the residents spoken with said that they preferred to occupy themselves, some preferring the privacy of their rooms, others enjoying the company of others in one of the communal lounges. Communal areas were appropriately equipped with televisions, books, board games and music systems and in addition the lounge in Park view included a piano. Residents visited in their bedrooms had their own televisions and personal belongings, for example photographs, pictures, ornaments, books, videos and jigsaw puzzles. Feedback from residents and observations made during the inspection indicated that staff made time to talk with residents and show an interest in their past and current lives. Many of the residents expressed appreciation that staff at all levels made time to have ‘a chat’. One member of staff spoken with said that one of the best things about working at the home was that “a lot of the carers go that extra mile”! Residents spoken with and observations made during the inspection confirmed that resident’s visitors are welcomed at the home. Several residents said that friends and family visit them regularly and one said that they often go out with members of their family. Feedback from residents, observations made and menu’s seen indicated that the home provides healthy, balanced and appetising meals. Each unit had the days menu choices displayed in the dining areas. On the day of inspection the main menu choices for lunch were sausage casserole, fisherman’s pie, potatoes and vegetables with bread and butter pudding or moose for dessert. Meals could be taken in the dining areas or in the privacy of the resident’s own rooms. Tables in the dining areas were nicely laid with tablecloths, place mats and condiments. Comments received from residents included “The food is marvellous, I’ve got no problem with the food”, “The foods not too bad” and “I think it’s alright”. Sherrington House DS0000029250.V327238.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can expect to have their complaints listened to, taken seriously and acted upon. They can also expect to be protected from abuse. EVIDENCE: The homes complaints procedure was prominently displayed in the entrance to the home. It included appropriate details about how to make a complaint and the stages and timescales of the complaints procedure. Complaints records examined indicated that eight complaints had been made in the previous six months. All of the complaints had been appropriately investigated and responded to within a suitable timescale. Overall feedback from residents confirmed that they felt listened to and knew how to make a complaint. Records seen and staff spoken with evidenced that care workers receive training to recognise the signs and symptoms of abuse and understand their roles and responsibilities regarding concerns and allegations. Discussion with the manager confirmed that the home continues to work within the framework of the local authority multi disciplinary guidelines for the protection of vulnerable adults. Sherrington House DS0000029250.V327238.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19. 20. 24 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to live in a comfortable and safe environment. EVIDENCE: Since the last inspection all communal areas had been redecorated with the exception of Parkview’s lounge. Carpets had been replaced in the lobby, downstairs hallway and upstairs hallways. The manager advised that areas that were showing signs of wear and tear would be addressed through the homes on-going maintenance and refurbishment plan. A tour of the premises confirmed that although some of the homes fixtures and fittings were outdated overall the home was safe and appropriately maintained. Each unit had communal lounge and dining areas that were suitable in size, warm, comfortable and furnished in a domestic and homely style. Bedrooms Sherrington House DS0000029250.V327238.R01.S.doc Version 5.2 Page 16 that were seen were also comfortable, appropriately furnished and equipped with wash hand basins. The home had suitable laundry facilities with commercial washing machines and appropriate procedures in place to handle soiled articles and linen. Concerns that had been expressed by one relative about clothes that had been ‘lost’ in the laundering process were addressed through the complaints procedure and seemed to be resolved. Staff were equipped with disposable gloves and aprons and understood the importance of infection control procedures. Overall the home was clean, tidy and hygienic but offensive odours were noticeable in one first floor and one ground floor corridor. The manager advised that the home was working hard to eliminate the odours and discussion indicated that appropriate steps were being taken in an effort to resolve the problem. Sherrington House DS0000029250.V327238.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall staff are appropriately trained and residents are protected by thorough recruitment procedures. EVIDENCE: Examination of the staff rota and discussion with the manager and care workers on duty evidenced that the home had six care staff, including one senior, on duty in the mornings, afternoons and evenings and three, including one senior, at night. The registered manager and deputy manager both worked full time in addition to the care staff. The home also had a range of support staff including an activities co-ordinator, cooks and kitchen assistants, domestics, an administrator, two maintenance/grounds men and a laundry assistant. Residents spoken with and observations made during the inspection indicated that resident’s needs were met by the homes staffing levels. However, four of the care staff on duty at the time of inspection were working a ‘double shift’, from 7.00am until 9.00pm. Discussion with staff on duty indicated that there was a shortfall in staff due to staff vacancies and sickness. The rota confirmed that over a two-week period a total of thirty-nine shifts were being covered by internal staff working additional shifts. Sherrington House DS0000029250.V327238.R01.S.doc Version 5.2 Page 18 Discussion with the manager, feedback from staff and examination of training records evidenced that staff receive appropriate induction and ongoing training. Staff training included fire prevention, infection control, protection of vulnerable adults, first aid, moving and handling, medication, dementia care and nutrition. Staff spoken with and records seen indicated that the home was committed to care staff achieving National Vocational Qualifications, however total numbers of qualified staff did not reach fifty percent at the time of inspection. The recruitment records relating to three care workers were examined and included photographs, verification of identity, declarations of health, written references and satisfactory Enhanced Criminal Record Bureau checks. There was also good evidence of face-to-face selection interviews and written application forms. Sherrington House DS0000029250.V327238.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health, safety and welfare of staff and residents are promoted and protected. Further more staff are appropriately supervised and residents are consulted about matters of the home. EVIDENCE: The home has an appropriate management structure in place with clear lines of accountability. There is a deputy manager and senior care assistants in addition to the registered manager. The registered manager has the overall responsibility for the home, although the deputy manager generally over sees the day-to-day care of the residents and the ‘on the job’ supervision of the care staff. The seniors have additional responsibilities to the homes care assistants, for example administration of medicines and taking responsibility Sherrington House DS0000029250.V327238.R01.S.doc Version 5.2 Page 20 for the home in the managers and deputy’s absence. The manager is appropriately qualified and has a range of qualifications that include the Registered Managers Award and NVQ level 4 Certificate in Management. Since the last inspection a number of quality assurance surveys have been undertaken covering areas such as activities, meals, overall satisfaction and relatives views. However at the time of inspection the home had not completed their annual quality assurance report for 2006. There was also evidence that the home has an active resident/relatives committee. Further more the manager undertakes a monthly audit that includes a wide range of health and safety and administrative checks. The home had safe systems in place for storing and recording resident’s monies held for safekeeping. Appropriate records were maintained for all monies held on behalf of residents. The manager was asked if she could confirm the total of the resident’s money currently held in the safe but this was not possible without adding the balance held for all residents. This led to discussion about insurance and the need to monitor the amount being held. Feedback from staff and records seen evidenced that care workers receive appropriate supervision through 1-1 planned supervision sessions and staff meetings. Discussion with the manager, records seen and observations during the inspection evidenced that the home promotes safe working practices. Records in place and maintained included accident records, fire records, water temperature checks and kitchen temperature records. Since the last inspection the home had also had a local authority health and safety inspection, fire inspection and food hygiene inspection. Discussion with the manager indicated that all recommendations had been met. Sherrington House DS0000029250.V327238.R01.S.doc Version 5.2 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 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 3 17 X 18 3 3 3 X X X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 3 X 3 Sherrington House DS0000029250.V327238.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 OP8 Regulation 15 Requirement The registered manager must ensure that care plans are appropriately detailed and fully reflect resident’s needs. Timescale for action 31/03/07 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 Refer to Standard OP12 OP27 OP28 Good Practice Recommendations The home should ensure that all residents have easy access to the homes activities programme. The home should explore ways of having a consistent ‘bank’ of relief staff to cover staff sickness and vacancies. The home should continue to monitor and ensure that all new staff are offered the NVQ level 2 training, as soon as possible, to support them in achieving having 50 of their staff trained to NVQ level 2 (or equivalent). The home should monitor the amount of resident’s money held in safe keeping, to ensure that amounts do not become too high. 4 OP35 Sherrington House DS0000029250.V327238.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Sherrington House DS0000029250.V327238.R01.S.doc Version 5.2 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!