Inspection on 22/05/07 for Priory Grange Care Home Limited

This inspection was carried out on 22nd May 2007.

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

Priory Grange Care Home Limited 21/05/09

Priory Grange Care Home Limited 14/05/08

Priory Grange Care Home Limited 13/06/06

Priory Grange Care Home Limited 20/01/06

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Snydale Care Home

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Priory Grange Care Home Limited Hessle High Road Hull East Yorkshire HU4 7BA Lead Inspector George Skinn Unannounced Inspection Key 22nd May 2007 09:30 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 Priory Grange Care Home Limited DS0000064778.V341346.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. Priory Grange Care Home Limited DS0000064778.V341346.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Priory Grange Care Home Limited Address Hessle High Road Hull East Yorkshire HU4 7BA 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) 01482 504222 01482 573966 Priory Grange Care Home Limited Position Vacant Care Home 41 Category(ies) of Dementia - over 65 years of age (41), Old age, registration, with number not falling within any other category (41) of places Priory Grange Care Home Limited DS0000064778.V341346.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th June 2006 Brief Description of the Service: Priory Grange is owned by Priory Grange Care Home Limited, a family company that have the one home. It is registered to provide personal care and accommodation for up to 41 people of either gender, over the age of 65, some of who may suffer from dementia. Priory Grange is located in the Hessle area of Hull to the west of the city centre. The home is purpose built with a rear garden and some car parking space. It is a short drive from the centre of Hessle where there is a wide range of shops, pubs and churches. The home provides accommodation in single rooms all with en-suite on two floors. There was a passenger lift connecting the floors. Downstairs there was a large conservatory and dining room, there was also a lounge and dining room on the first floor and a smaller smoking lounge. Priory Grange Care Home Limited DS0000064778.V341346.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 site visit undertaken over 7 hours. Prior to the site visit surveys were sent to service users, relatives, staff and health care professionals. The responses from these helped to shape the judgements made in this report. During the site visit service users were spoken with, the staff and the manager interviewed, and the building looked at. We also looked at some records which are kept for service users and staff. As part of the site visit an inspector trained to use a special observation tool called a SOFI (special observational tool for inspection) undertook a 2 hour observation to look at the quality of interaction between service users and staff. What the service does well: What has improved since the last inspection? What they could do better: The home need to make sure that the information which is given to people who are thinking of moving into the home is up to date to help people make an informed choice. The home must make sure that the information kept about the service users is kept up to date and that there is more information about their past lives. Priory Grange Care Home Limited DS0000064778.V341346.R01.S.doc Version 5.2 Page 6 The home must make sure that the medication is handled properly to make sure service users get the right medication at the right time. The home need to make sure that the service users have enough activities to choose from and they are able to be occupied. The home must make sure that all furnishing which is now appearing shabby is replaced and that the carpets in the corridor are replaced. The home must make sure that the service users can use the garden and that this is easily accessed for those people who use wheelchairs. The home needs to make sure that the staff are properly trained to look after the service users. 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. Priory Grange Care Home Limited DS0000064778.V341346.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 Priory Grange Care Home Limited DS0000064778.V341346.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): People who use this service experience adequate quality outcomes in this area. Service users needs are assessed prior to admission Information provided by the home does not enable prospective service users to make an informed choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Those service user files case tracked contained evidence of assessments being undertaken by the local authority-placing officer prior to admission. The statement of purpose is now out of date, as is the service user guide, this needs to be updated to reflect the current position at the home so potential service user can make an informed choice. Priory Grange Care Home Limited DS0000064778.V341346.R01.S.doc Version 5.2 Page 9 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): People who use this service experience adequate quality outcomes in this area. All service user have a plan of care but the quality of these is variable Service user heath care needs are ensured. The medication systems at the home ensure the safety of the service users. Service users are treated with dignity and their right to privacy is upheld. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home have now implemented new care plans for each of the service users. These now should contain lots of detailed information about the needs of the service users; these also contain sections on past life experiences, risk assessments and evaluations. Evidence indicated that the quality of recording information was variable, some care plans had been completed very comprehensively and other contained very little information. The past life experience had not been completed for any of the service users despite the staff having detailed knowledge of this. Priory Grange Care Home Limited DS0000064778.V341346.R01.S.doc Version 5.2 Page 10 The acting manager explained that the responsibility of completing the care plans was given to the senior care staff and circumstances had meant that the completing of care plans had been neglected; he had audited the care plans in January and identified areas of weakness and had set time scales for completion, however there was no evidence that this had been followed up by the acting manager and any short falls addressed by delegating to other staff for completion in the absence of the senior carer who had original responsibility. This should have been addressed earlier as these documents are vital to ensure the care is delivered in an appropriate way and evidence that the care provided. The acting manager explained that the completion of the past life experience was the responsibility of relatives there fore these hadn’t been completed as the relative were not that interested in doing this. If this is the case the acting manager should now be ensuring that these are completed as individuals past experiences hold vital information on their current behaviour and functioning; this is also an opportunity for the care staff to interact with the service users and maybe create life history books which can be used in individual reminiscences activities. The health care of the service users is ensured, evidence was seen during the site visit of regular visits from district nursing services. There was evidence of equipment provided for the staff to use to ensure the tissue viability of the service users and the treatment of pressure sores. There was evidence on the service users files which indicted that there was regular access to health care services and the service users health is monitored regularly. Service users spoken with confirmed that they can see the doctor when they wish and the staff react to request promptly. The handling of the medication was generally good. The storage and administration of the medication ensured the safety of the service users; there had been some problems earlier in the month which meant that some service users did not receive medication on the morning of the 15/05/07. The acting manager explained that the person who had responsibility for the ordering of the medication had not sent all the repeat prescriptions to the GP in time and this had resulted in the pharmacist not delivering the required medication due to not having a valid prescription. The acting manager needs to ensure that whoever is ordering the medication is doing this appropriately and in a timely way to ensure that service user are not missing medication. Evidence seen during the site visit indicated that the staff treat the service users with dignity and any personal care is conducted in private, the staff were observed to be using the service users preferred form of address. The rooms are all single and have en-suite facilities. Priory Grange Care Home Limited DS0000064778.V341346.R01.S.doc Version 5.2 Page 11 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): People who use this service experience poor quality outcomes in this area. Service users do not have the opportunity to participate in any meaningful activity which is based on their needs and interests. Service users have limited contact with the community. Service users can exercise choice but this is sometimes dependent on staffing routines. The service users receive a wholesome well balanced diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As part of the site visit an inspector trained to use a specialist observational tool called a SOFI (short observational framework for Inspection) undertook a two-hour observation of a sample of service users. The results of this were. The 2-hour observation took place in the downstairs lounge/dining room; the environment was pleasant, warm and homely. The chairs were comfortable and the five residents who were observed had chosen were to sit. The interaction between staff and residents was overall good and there were ten interactions that were adequate. No poor interactions were observed. It was clear that some staff had developed professional and caring relationships and rapport with the residents. Staff spoke to the residents in a respectful, polite and courteous manner. Priory Grange Care Home Limited DS0000064778.V341346.R01.S.doc Version 5.2 Page 12 Three residents had their nails cut during the observation and during this the interaction was very good between the staff member and the individual residents. It was appropriate, at their pace and involved them in the discussion. The staff member talked about their interests and past events, the residents positively engaged with the staff member. All five residents enjoyed fresh fruit that was prepared by another staff member. They were asked if they would like any and had a choice of fruit. Tea and biscuits were also offered and residents were given the option of what biscuits. There was no interaction between the residents and no other activities took place during the 2-hours. All residents were observed to be individual in dress and were all well presented. Two visitors were greet by staff and offered refreshment. The visitors chose to sit in the lounge area with their family member, the staff did offer to assist the resident to a private area. Three residents were spoken to on a regular basis by all staff, but two of the less communicative residents LB and B were less involved and staff asked if they were ‘alright’, but nothing in more depth. Staff appropriately assisted residents to the toilet and talked to them throughout the process, checking that they were ok and explaining what was happening. Lunch was served at the end of the observation, pork casserole, mashed potato and cauliflower – it was well presented and appealing to the eye. All residents were able to eat unassisted, one resident did request help from a staff member to cut up their food and this was carried out immediately. The residents all remained seated in their armchairs for lunch and ate from a portable table. The acting manager stated that this was by choice. During the site visit lots of service users spent all day in their rooms. The acting manager explained that this was their choosing. Observation made during the site visit indicated the interaction with those service users who spent time in their rooms was very limited and on a task basis for example taking drinks ensuring the service user went to the toilet etc. there was no meaningful interaction or opportunity for stimulation for those service users; they were observed to be spending long periods of time sleeping or watching TV. The acting manager has advertised for an activities co-ordinator but has received no applicants. Priory Grange Care Home Limited DS0000064778.V341346.R01.S.doc Version 5.2 Page 13 The opportunity for service users to access community contact was variable. Those service user who had relatives commented on being taken out of the building to local shops and visits. There was no evidence which would indicate that those service user dependent on staff had regular opportunities to leave the building. During the site visit it was observed that relatives were able to visit freely and were made welcome by the home. Service users were able to exercise choice in the daily lives. Those services spoken with confirmed that they could rise when they wished and go to bed when they wanted. Some commented no having to wait for staff to attend to their needs and some felt this was more for the convenience of the staff than to meet their needs. The service users commented on the quality of the food and were more than happy with the choice available. The acting manager has recently relocated the downstairs dining room into the lounge conservatory area. Observation made during the site visit indicated that the method of delivering the food to that area was inefficient and resulted in service user receiving cold food from a trolley which had been stood in the corridor for at least five minutes. Priory Grange Care Home Limited DS0000064778.V341346.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): People who use this service experience good quality outcomes in this area. Service users are confident that their complaint and concerns are taken seriously Service users are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home continue to have a complaints procedure which is displayed around the home and available in the service user guide. Those service users spoken with confirmed that they would know what to do if they had any complaints and were confident that the acting manager would take this seriously they confirmed that the acting manager is approachable and will listen to their complaints and concerns. The staff displayed knowledge on how to make a safeguarding adults referral, evidence indicated that not all staff have received POVA training. Priory Grange Care Home Limited DS0000064778.V341346.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): People who use this service experience adequate quality outcomes in this area Service user live in home which generally clean and tidy. Service users do not have access to the outside of the building. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The building is purpose built and all internal areas are accessible by service users. There is still no access to the rear of the building for wheelchair users. The acting manager stated that quotes had been obtained for work to be carried out. This is an outstanding requirement from previous inspections. There was no evidence that a programme of routine maintenance and renewal of the décor of the building. The home was generally clean and tidy, however there was a strong malodour on the first floor of the home. The corridor carpets are now looking shabby. The acting manager explained that quotes had been obtained and a grant had Priory Grange Care Home Limited DS0000064778.V341346.R01.S.doc Version 5.2 Page 16 been applied for the renewal of all carpets in the home both in corridors and bedrooms. The key pad lock on the front door may not meet the local fire safety officer requirements. Priory Grange Care Home Limited DS0000064778.V341346.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): People who use this service experience good quality outcomes in this area. Service users are cared for by staff in adequate numbers. Service users are cared for by staff qualified to meet their needs. Service users are protected by the homes recruitment procedure. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff are provided in numbers adequate to meet the needs of the service users. Rotas showed that there are 6 care staff on duty in morning, and 5 care staff on duty in an afternoon/evening. This does not include ancillary staff for example cooks, kitchen assistants and domestics. Service users spoken with commented no there not being enough staff on duty, but this could be, as mentioned earlier, due to the amount of time spent in their own rooms room resulting in limited contact with staff therefore giving false impression of the staffing numbers. Staff have received training and more that 50 of the care staff are qualified to NVQ level 2/3. Evidence seen indicates that some staff have not received all of the mandatory training. The acting manager has now completed a criminal records bureau (CRB) check for all staff. One CRB check was found to be outstanding for a long-standing Priory Grange Care Home Limited DS0000064778.V341346.R01.S.doc Version 5.2 Page 18 employee; this was dealt with during the inspection with an application submitted to the umbrella agency the home use. Priory Grange Care Home Limited DS0000064778.V341346.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): People who use this service receive adequate quality outcomes in this area. The acting manager of the home is not registered with the CSCI The service users benefit from a acting manager who is approachable. Service user and staffs health and safety is safeguarded a far as is possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The acting manager has a long experience of managing services of this type; he is currently unregistered. Staff and service users commented that he was approachable and dealt with any concerns raised. The home have an effective quality assurance system in place and this seeks the views of service user and all stakeholders in the service. Priory Grange Care Home Limited DS0000064778.V341346.R01.S.doc Version 5.2 Page 20 Some of the staff have not received all of the mandatory training. The home have health and safety policies and procedures in place and these are up dated as required. Priory Grange Care Home Limited DS0000064778.V341346.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 2 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X X X X 3 Priory Grange Care Home Limited DS0000064778.V341346.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4, 5 & 6 Requirement Timescale for action 30/08/07 2 OP7 3 OP9 4. OP12 5 OP19 The registered person must ensure that the statement of purpose and the service user guide is up to date and reflects the current situation at the home. This will help prospective service users make an informed choice. 15 The registered person must ensure that the plan of care is consistently maintained and that essential information is included. This will enable the care staff to deliver care in an appropriate manner. 13, 18 & The registered person must 19 ensure that the medication procedures ensure that all service users receive the correct medication at all times. 5, 12, 16 Service users’ interests must be & 23 recorded and they must be given opportunities for stimulation through leisure and recreational activities in and outside the home, which suit their needs. (Previous targets of 31/08/05 31/12/05, 30/04/06, 01/10/06) 5, 12 & 16 The registered person must DS0000064778.V341346.R01.S.doc 30/08/07 30/08/07 30/08/07 30/08/07 Page 23 Priory Grange Care Home Limited Version 5.2 6 OP19 16, 17 & 23 7 OP20 23 8 OP26 16, 23 & 37 9 10 11 OP30 OP31 OP33 18 & 19 4, 5, 18 & 19 ensure that the fabric of the building is repaired and maintained in timely fashion and that a record and plan of refurbishment is kept with dates for completion. The registered person must ensure that method used to lock the front door meet all the requirements of the fire safety officer. The garden must be made accessible to wheelchair users, service users with other mobility problems and those who suffer from cognitive impairments. (Previous targets of 31/08/05, 31/12/05, 30/04/06 01/10/06 not met). The registered person must ensure that the home is free from odours at all times and systems are put in place to eradicate these. Staff must have their mandatory training updated. 30/07/07 30/08/07 30/07/07 30/08/07 30/08/07 30/05/07 The registered provider must ensure that the acting manager is registered 4, 5, 6, The registered person must 14, 15, action requirements set by the 17, 21, 22 CSCI with the agreed time scales & 24 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. Refer to Standard OP26 Good Practice Recommendations It is recommended that the registered person undertakes a full audit of the premises and evaluates the level of DS0000064778.V341346.R01.S.doc Version 5.2 Page 24 Priory Grange Care Home Limited cleanliness and the condition of the furnishings including towels and bedding. Priory Grange Care Home Limited DS0000064778.V341346.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Priory Grange Care Home Limited DS0000064778.V341346.R01.S.doc Version 5.2 Page 26 - 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!