Inspection on 08/12/09 for St Theresa`s

This inspection was carried out on 8th December 2009.

CQC found this care home to be providing an Good service.

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

St Theresa`s 11/12/06

St Theresa`s 17/11/05

St Theresa`s 17/05/05

St Theresa`s 21/10/04

St Theresa`s 24/05/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: St Theresa`s The Admin Office, St Theresas Care Centre St Therese Close Callington Cornwall PL17 7QF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Mandy Norton     Date: 0 8 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: St Theresa`s The Admin Office, St Theresas Care Centre St Therese Close Callington Cornwall PL17 7QF 01579383488 01579383488 enquiries@sttheresas.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Aldington Group Ltd care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability terminally ill Additional conditions: Service users to include up to 15 adults with a physical disability (PD) Service users to include up to 3 adults with a terminal illness (TI) Service users to include up to 45 persons of old age (OP) Total number of service users not to exceed a maximum of 45 Date of last inspection Brief description of the care home St Theresas is part of the Aldington group of homes (responsible individual Hilda McKinley). It is a purpose built care home with nursing where accommodation is provided on one level throughout. It is situated in a cul de sac in a quiet residential area of Callington. There is a mini bus that can be used to transport some residents to the nearest amenities. Care Homes for Older People Page 4 of 26 Over 65 45 0 0 0 15 3 Brief description of the care home It provides care and accommodation for up to 45 people in need of care by reason of old age, physical disability or terminal illness. The accommodation is mainly in single rooms although two double rooms are available for people choosing to share. Approximately half the rooms have en suite facilities. The communal areas are situated centrally within the home where residents can see what is going on, or overlooking the garden which itself has been planned for visual effect and easy access, including wheelchairs. People are sent a letter to welcome them to the home , which explains the fees to be paid and includes a Service Users Guide. Also each year when the fees are increased the resident or their representative receive a letter to notify them about a month beforehand in order that those who pay directly to the home can make arrangements with the bank. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced Key Inspection took place from 9.30 am until 2.10 pm on 8th December 2009. It was conducted with the registered manager. A tour of the home was carried out and residents and staff were observed and spoken to informally during this time. A variety of records were seen during the course of the day. Other evidence gathered since the previous inspection such as notifications received from the home (e.g. regarding any incidents which occurred), the annual quality assurance assessment (AQAA) (a self assessment document that the home completes annually and submits to the Commission) and completed surveys from both care staff and residents/relatives was also used to help form the judgements made in the report. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: The manager should ensure that the Statement of Purpose and the Service Users Guide are updated regularly to ensure people are aware of all the services offered and what they may expect when they move into the home. The manager should ensure the 2nd drugs trolley is attached to the wall and the drugs fridge is locked when not in use, this reduces any risk of the trolley being removed from the treatment room when it is not in use.. The manager should ensure that all care plans include more detail about peoples social history this will make the plans are more personalised to each individual and ensure the nursing and care staff have enough information to look after peoples individual needs. The manager should ensure that she builds on previous good practice with supervision sessions and is confident an ongoing system is in place from January 2010 when the next supervision sessions are due. Care Homes for Older People Page 7 of 26 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service have information about the home in order to make an informed decision about whether the service is right for them. People are assessed prior to moving into the home on a permanent basis so people can be confident the home can meet their needs. Staff continue to have training and remain updated in areas of care and support the home offers to provide. Evidence: The manager said that people are always assessed prior to moving into the home permanently to ensure their needs can be met. If people are to be admitted they and their representatives are given as much up to date information about the service as possible, invited to look around and spend some time at the home and ask any questions they may have. Completed Service User surveys indicated that they Care Homes for Older People Page 10 of 26 Evidence: received enough information to help them decide if the home was the right place for them before they moved in. People who are admitted under the RATS scheme (emergency respite admissions) do not have a pre admission assessment but the manager/person in charge speaks with the RATS team prior to admission and expects to have a copy of then care plan done by them prior to the admission, the manager said this usually arrives promptly by fax. The AQAA told us that a full brochure and statement of purpose/service user guide is provided pre admission and a copy of the service user guide is provided in each bedroom. The manager was advised to ensure that the Statement of Purpose and Service Users Guide are up to date reflecting that some people who live at the home have or may develop dementia and that they provide palliative care. The manager told us that staff have had and are awaiting training relevant to the services they offer such as dementia care and palliative care. She said that the nursing and care staff therefore have the skills and experience to look after the current residents. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The practice regarding the planning and delivery of care means that people can be sure that their health and personal care needs will be met. Evidence: The manager said that all of the care plans are updated daily and reviewed monthly. The care staff complete daily records about a persons welfare and detail what care has been provided the nurses then add this information into the care plan and update it as necessary. The 3 care plans examined set out peoples needs and contained information about visits made by health care professionals such as GPs, opticians and dentists. Individual risk assessments seen were up to date and relevant and included use of bed rails, skin condition and nutritional status. A tour of the home showed that plenty of equipment to help skin stay in a good condition and for prevention of pressure sores is available and meets peoples current needs. The manager said that they have enough equipment. If any extra extra specialist equipment is required they may hire it or it can be supplied by the RATS team for short term use. The medicines are stored in 2 locked trolleys, which were clean and well organised. Care Homes for Older People Page 12 of 26 Evidence: One of the trolleys is locked to the wall the other one needs to be locked to the wall. The drugs fridge has its temperature taken and recorded daily, but it was noted that it has no lock on it, the manager was advised that the drugs fridge should also be locked. The records of administration were clear and a photograph of most residents is kept with the record to aid identification. The procedure for receipt, administration and disposal of unwanted medicines was explained and is in accordance with laid down legislation. Staff were heard and observed interacting with people appropriately and providing care and support in a discreet manner. Staff were knocking on doors before entering and doors remained closed whilst personal care was taking place. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of activities within the home mean that people have opportunities to participate in stimulating and motivating activities. Meals and mealtimes are not rushed and staff are available to help make them an enjoyable and social occasion for people where possible. Special diets are catered for, they are well presented and people can be sure their nutritional needs will be met. Evidence: People are encouraged to exercise choice in how they spend their time and activities are offered individually or in groups . The notice board showed that entertainers come into the home regularly. The upcoming Christmas party was advertised in the entrance foyer and the manager said that the previous evening the local hand-bell ringers had been in the home playing some Christmas tunes. Most of the completed Service user surveys indicated that the home provides activities usually and always. The home does not have an activities organiser (at the time of the inspection) and the manager said that the care staff have taken on doing the activities and are enjoying it and making a good job of it. The staffing levels allow time for activities to be built into peoples day. During the morning of the inspection a bingo session was taking place for a small number of residents. The care plans should include more information about Care Homes for Older People Page 14 of 26 Evidence: peoples interests and hobbies that can then be used when developing person centred care and ongoing activities. One person told us that they like to stay in their room but do mix with others when they want to. Visitors are welcomed at anytime and many people were seen coming an going freely during the inspection, the staff interacted well with them showing that there are good ongoing relationships with them. There is a patio area with a large pond, and seating areas to the rear of the house which is accessible to the residents. A number of people have meals in the dining room, some in their rooms, plated covered meals seen being taken to them. A number of people need support with eating and staff were on hand to help. Some people have specialist diets, the catering staff and nursing staff communicate regularly about these issues to ensure the diets are catered for. There is a 4 weekly menu rota, people are asked what they would like for their meal and there is always a choice. Drinks and snacks are available 24 hours a day. The AQAA states that Fruit and biscuits are provided mid morning and mid afternoon together with tea and coffee. Wine and other alcoholic drinks are offered with lunch. Two of the completed Service users surveys indicated that they always like the meals at the home, three that they usually do and one that they sometimes do. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Formal complaints and safeguarding policies and procedures are in place and are available to staff at all times. Some staff undertake safeguarding training. This means that people who live at the home are adequately safeguarded. Evidence: The complaints procedure is included in the Service Users Guide, a copy of which is kept in each persons room. The manager was advised that copy should also be displayed at the main entrance to the home. The procedure is comprehensive and gives options about who to contact (the local Department of Adult Care and Support address should also be added to the complaints procedure) and timescales for responses to be made. There have been 2 concerns made to the Commission in the last 12 months and the AQAA states that the home have received 9 complaints one of which was upheld. One of the four completed resident surveys indicted they did not know how to make a formal complaint the rest all said they did. Records show that some staff have attended safeguarding and Mental Capacity Act training, they also have information about safeguarding when doing National Vocational Qualification (NVQ) training and during induction training. The manager has Care Homes for Older People Page 16 of 26 Evidence: shown that she knows how to manage safeguarding alerts as 2 have been raised since the last inspection, neither on which were upheld. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Ongoing refurbishment, redecoration and maintenance means that people have a comfortable, homely and safe environment in which to live. Evidence: St Theresa`s is situated near to the local shops and facilities of Callington. On the day of the inspection 39 people were living at the home. A tour of the home showed that residents rooms contain personal items including furniture, ornaments and pictures. The home is well equipped to meet the needs of residents identified with moving and handling risks and disabilities that affect their capability to bathe (hoists, stand aids,showers and assisted baths). Specialist mattresses and adjustable beds were seen in place for those residents requiring them. There is call bell system throughout the home, residents seen in their rooms all had the bell placed within their reach. There are sufficient adapted toilet facilities throughout the home. The home has a sluice facility. Outdoor space consists of a patio leading from an area of communal space (there is a ramped access). The area is enclosed so residents can sit outside with privacy. There are shrubs and a pond with a small waterfall that the residents to enjoy. Visitors were seen coming and going throughout the inspection seeing people in the lounge and in their own rooms as they choose. Care Homes for Older People Page 18 of 26 Evidence: The home is well maintained, The manager said that the maintenance man works in the home 5 days a week and carries out routine maintenance inside and outside the home. The AQAA details the dates of maintenance and servicing activity that has been carried out such as fire equipment checks, PAT, health and safety checks, central heating checks and hoists and assisted baths. The home complies with the local fire service and environmental health departments. The home was clean and tidy and domestic staff were observed going about their work during the inspection. Five of the six completed Service user surveys indicated that the home is always fresh and clean and one that it usually is. Policies and procedures around infection control are up to date and available to staff at all times. In house training on the importance of infection control is routinely offered to staff. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing levels and skill mix are good meaning peoples needs are being met at all times. The recruitment procedure means that people who live at the home are being looked after by appropriate staff and their welfare is not at risk. Evidence: On the day of the inspection there were appropriate staff numbers and skills mix available to provide the required care and support for people. The manager (confirmed by the duty rota seen ) said that during the day, including her, there are 3 trained nurses and 9 carers on duty in the mornings, this allows for the care staff to carry out some group and individual activities with the residents. They are supported by administrative, catering, domestic and maintenance staff. The 2 completed staff surveys (there were over 10 sent out) indicated that there are sometimes and never enough staff to meet he individual needs of the residents. The AQAA states that 18 of the 31 care staff have completed at least an NVQ level 2 in care. An NVQ assessor was in the home carrying out some assessments of staff on the day of the inspection. Staff files we looked at all had completed application forms, 2 written references, CRB/POVA clearances, statements of terms and conditions of employment and job descriptions. Care Homes for Older People Page 20 of 26 Evidence: The AQAA states that 14 staff have completed an induction process and the 2 completed staff surveys indicated that their induction covered everything they needed to know to do the job when they started partly and mostly. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems and procedures in place are designed to meet the needs of the service as they strive to continually improve the service the home offers to the people that live there. The attitude to health and safety shown by the providers, nurses, care and ancillary staff means that people live in a safe and well maintained environment. Evidence: The registered manager is a level one trained nurse and is appropriately experienced having worked in management for several years.She is supported by nursing, care, administrative, catering, domestic, laundry and maintenance staff.There are clear lines of accountability within the home and the provider ensures a representative of the company carries out a monthly visit to the home that includes a tour of the home and speaking with residents and staff and a report is then prepared following each visit. The administrator picks at random 3 residents a month to ask about their satisfaction Care Homes for Older People Page 22 of 26 Evidence: with the service provided. She also asks their relatives or representatives to meet with her or discuss any issues they may have about the residents care. The responses are documented and any actions required are taken and details of the actions written on the completed quality assurance form.The manager said has an open door policy for staff and visitors to bring any issues or concerns to her. We have seen in the past (the procedure has not changed since the last inspection) written records kept of all financial transactions on behalf of the residents, they included income and outgoings and receipts. Secure facilities are used for storage of money and any valuables. Supervision of staff is undertaken and appropriately recorded. Records of some supervision sessions were seen in staff files examined.The person who did organised and carried out most of the supervision sessions has recently left. The next sessions are due form January 2010 onwards and the manager said a system will be put in place to ensure that supervision continues. The registered providers maintain the health, safety and welfare of the residents through implementation of their policies and procedures. Appropriate records were seen to demonstrate this. The maintenance person carries out ongoing routine house and garden maintenance. Outside contractors are used for bigger jobs. The completed AQAA indicates that all equipment is regularly maintained and tested. Servicing labels and PAT test certificates were seen on a variety of equipment during a tour of the home. The accident and fire log book were examined and found to be completed as required. Numerous safety notices were displayed throughout the home including action to be taken in case of fire. Staff files seen showed that statutory training if fire safety and manual handling is currently up to date. Care plans seen included individual risk assessments around manual handling and use of bed rails. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The manager should ensure that the Statement of Purpose and the Service Users Guide are updated regularly to ensure people are aware of all the services offered and what they may expect when they move into the home. The manager should ensure that all care plans include more detail about peoples social history this will make the plans are more personalised to each individual. The manager should ensure the 2nd drugs trolley is attached to the wall and the drugs fridge is locked when not in use. The manager should ensure that she builds on previous good practice with supervision sessions and is confident an ongoing system is in place from January 2010 when the next supervision sessions are due. 2 7 3 9 4 36 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 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!