Inspection on 25/05/07 for Thames House

This inspection was carried out on 25th May 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

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

CARE HOME ADULTS 18-65 Thames House Thames Street Rochdale Lancs OL16 5NY Lead Inspector Steve Chick Unannounced Inspection 25th May 2007 12:01 Thames House DS0000068666.V337956.R01.S.doc Version 5.2 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 Thames House DS0000068666.V337956.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Thames House DS0000068666.V337956.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Thames House Address Thames Street Rochdale Lancs OL16 5NY 01706 751840 01706 713366 thames@exemplarhc.com OR ctaylor@exemplarhc.com Thames Health Care Ltd 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) Christine Anne Taylor Care Home 20 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10), Physical disability (20) of places Thames House DS0000068666.V337956.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 20 service users to include: *Up to 20 service users in the category of PD (Physical disability under 65 years of age); *Up to 10 service users in the category of MD (Mental disorder excluding learning disability and dementia. The 10 places for service users with a mental disorder must only be used for persons suffering from Huntingdon`s disease. N/A 2. Date of last inspection Brief Description of the Service: Thames House is a purpose built, specialist provision for people with Huntingdon’s disease. The building is nominally split into two units, one on each floor. Each unit has its own lounges and dinning room. All bedrooms are single and include ensuite facilities. There is ample provision of aids and adaptations for people with restricted mobility. A sensory bathroom is also available. Thames House is located in Rochdale. Fees for the service are negotiated on an individual basis. Thames House DS0000068666.V337956.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection included an unannounced site visit to the home, this means the manager was not informed of the inspection beforehand. All key standards were assessed. For the purpose of this inspection one service user was interviewed in private and three service users completed questionnaires, with support. Additionally, discussions took place with the manager and two staff members were interviewed in private. Also, two visiting professionals were interviewed in private. The inspector also undertook a tour of the building and looked at a selection of service user and staff records, as well as other documentation, including medication records. The manager had completed and returned an Annual Quality Assurance Assessment (AQAA). Some of what the manager told us in the AQAA is referred to in the body of this report. All the people who made comments, either written or verbally, were positive about the service the home offered. The service user spoken to described the home as offering “a five star service”. At the time of this site visit there were three service users resident at the home. Because of this, it was difficult for the home to demonstrate conclusively how effective its policies, procedures and practices would be if the potential 20 service users were resident. What the service does well: The home undertakes a very thorough assessment process which includes social, cultural and faith needs, as well as physical and psychological needs and considers the compatibility of other service users. This means that the manager is able to make sure that the needs of the service user can be met by the staff at the home. The physical accommodation is of a good standard, with appropriate aids and adaptations available for service users. Staff have access to appropriate training opportunities. The staff present as being service user focused and have a thorough understanding of Huntingtons disease. Thames House DS0000068666.V337956.R01.S.doc Version 5.2 Page 6 Service users are enabled to maintain their independence. The home has an ethos of effective risk management rather than a policy of being risk adverse. This encourages services users to remain independent. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Thames House DS0000068666.V337956.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Thames House DS0000068666.V337956.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 4. Quality in this outcome area is good. Service users’ needs are appropriately assessed and they, or their representatives, are able to visit before a decision is made that the home is appropriate for them. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: A selection of service users’ files was looked at. All had evidence of an assessment having been undertaken by staff at the home. Some aspects of the documentation provided by the organisation had not been completed. In itself, this is not problematic although it was not necessarily clear whether issues had been assessed but not recorded or considered to be not relevant. Thames House DS0000068666.V337956.R01.S.doc Version 5.2 Page 9 Discussion with the manager indicated that the assessment period was seen as extremely important. The manager had reported in the annual quality assurance assessment (AQAA) documentation that the assessment took into account an individual’s “cultural, social, faith, physical and mental needs whilst also looking at the compatibility of others living in the home.” During this visit the manager was able to cite an example of a service user who had not been offered a place at the care home due to the assessed negative impact on service users already living there. Visiting professionals who were talked to, commented that the assessment by the home had been very thorough and transparent, including taking note of clinical input. These professionals also reported a lengthy and appropriate introduction period, which they felt had been positive for the service user. All returned service user questionnaires indicated that they were asked if they wanted to move to this home. Similarly, all service users who could recall, reported that they received enough information before moving in to decide if it was the right place for them. Thames House DS0000068666.V337956.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. Procedures and practice in the home enable service users to make decisions about their lives, including taking appropriately informed risks. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: In the selection of service users files seen, all had a written plan of care. There was documentary evidence that these were periodically reviewed and amended where necessary. Generally, the documentation and record keeping appeared to be of any good standard. Some examples were seen where more detail would have been helpful, particularly in connection with specific actions which were recommended in specific circumstances. However, given the very small number of service users resident at the time of this visit, staff who were interviewed confirmed that the documentary care planning process was complemented by staffs personal knowledge of the service users, a Thames House DS0000068666.V337956.R01.S.doc Version 5.2 Page 11 communication book and verbal hand over at each shift change. All staff who were asked, were confident that the overall system gave them adequate information to ensure that care was delivered competently. The manager had reported via the AQAA that individual care plans are implemented with the “full collaboration of the service user”. One service user who was talked with during the inspection visit confirmed that he was involved in discussions and decision making about his care. Visiting professionals who were interviewed also expressed the view that service users were involved in decision-making processes. Records relating to money held by Thames House on behalf the service users were looked at and presented as being appropriately maintained to provide a clear ‘audit trail’. There was documentary evidence of appropriate risk assessment having been undertaken for certain tasks. These presented as enabling service users to take reasonable risks. Service user questionnaires indicated that service users were able to make decisions about what they did each day. Visiting professionals who were talked to, reported positively on their experience of staff encouraging service users’ independence and managing risk, rather than trying to avoiding risk situations. Thames House DS0000068666.V337956.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. Service users are able to take part in age, peer and culturally appropriate activities, as a part of the local community. Service users’ rights and responsibilities are recognised and appropriate food is provided.. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The manager reported, both via the AQAA and verbally at the site visit, that service users are facilitated to allow them to follow their social, intellectual and physical activities. Examples given of this included, one service user fulfilling a goal of participating in canoeing; participation in a local college course and the re-establishment of contact with family members. Thames House DS0000068666.V337956.R01.S.doc Version 5.2 Page 13 Discussion with visiting professionals and a service user confirmed this range of activities and social contacts. The manager reported that friends and family were encouraged to visit as often as they wished. This was confirmed by observation and by discussion with the service user. During the tour of the building the “visitors suite” was seen which, the manager reported, was available for relatives who required an overnight stay. Documentary evidence was seen of detailed and helpful social profiles held in respect of each service user. During this site visit one service user was being escorted to the shops, an activity which was identified in their care plan, and another was being visited by family members. The service user who was interviewed described Thames House as being like a “five-star hotel”. Daily routines did not impinge on service users, and mealtimes were reported by the manager as being flexible as “some residents are late risers”. There was documentary evidence that service users underwent a nutritional assessment as part of the process of moving to the home. There was also documentary evidence that this was followed up by the maintenance of weight charts, etc. It was reported by the manager that, at the time of this visit, food was prepared “to order”. It was recognised that this was a luxury which could only be maintained as there were so few service users resident. The service user spoken to was very positive about the provision of food. They described it as “fantastic” and confirmed that they were always asked what they wanted, and that their favourite vegetable juice was always available. There was documentary evidence that speech and language therapists are routinely involved to offer assessment and advice. The manager reported that they were aware of the potential for culturally sensitive issues around the provision of food and was able to cite an example of providing Halal meat for a Muslim service user on respite care. The manager reported that it was intended, when more service users were living at the home, to employ a full-time activities co-ordinator and “Lifestyle coach”. Thames House DS0000068666.V337956.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. The service users’ physical and emotional health needs are met in ways which they prefer. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: As mentioned elsewhere in this report, detailed social profiles are compiled in conjunction with the service user. This is indicative of a person centred approach which would serve to maximise the probability of service users receiving personal support in the way in which they prefer. The service user spoken to during this visit was very clear that he was able to influence the way in which his care needs were met. He reported that he was “treated like a human being” and that staff “treat you as you are, [they] are not judgemental.” Thames House DS0000068666.V337956.R01.S.doc Version 5.2 Page 15 All of the returned service user questionnaires reported that service users were well treated by the staff. Two of the three respondents said that carers ‘always’ listened and acted on what they said and one responded that they ‘usually’ listened and acted on what they said. The visiting professionals who were spoken to commented on the positive approach of Thames House in connection with the way in which they related to service users. Staff were described as having learned with the service user and, over a period of time, the care package had evolved to the benefit of the service user. This was seen, by these professionals, as a very positive and appropriate way of working. Observation and discussion indicated that staff maintained appropriate relationships with service users. The service user spoken to reported positively on the way in which staff members worked with him. There was documentary evidence that service users have access to a full range of medical and paramedical services available within the community. The service user spoken to was confident that medical support would be appropriately obtained. The manager reported that, at the time of this visit, no service user was administering their own medication, although subject to a risk assessment this could be done. The manager reported that staff were trained in the administration of medication. This was confirmed in discussion with staff. The home uses a pre-dispensed monitored dosage system to administer medication. Medication was seen to be stored appropriately. Medication administration records presented as being appropriately maintained. Thames House DS0000068666.V337956.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. Service users are confident that their views are listened to and acted on and that they are protected from abuse and exploitation by the implementation of the homes policies and procedures. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The home has a written complaints policy which was not inspected at this site visit. It was reported that there had been no formal complaints since the unit had opened. Service user questionnaires all indicated that they knew who to speak to if they were not happy. The service user spoken to expressed the view that any complaints would be taken seriously by the staff team. Staff members who were interviewed were also confident that the home would respond appropriately to any complaint which was made. It was reported by the manager that all staff receive training in connection with the protection of vulnerable adults as a part of their induction. This was confirmed as being the case by staff who were interviewed. It was also reported that this training is updated on an annual basis. Staff were aware of the whistleblowing policy and the manager was confident about the potential use of Rochdales protection of vulnerable adults procedures. Thames House DS0000068666.V337956.R01.S.doc Version 5.2 Page 17 It was reported that all staff had received NAPPI training (non abusive physical and psychological intervention). Staff who were interviewed confirmed this. Thames House DS0000068666.V337956.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is excellent. Service users live in a homely, comfortable and safe environment which is clean and hygienic. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: During this visit a tour of the building was undertaken. The home is divided into two units, one on the first floor and one on the ground floor. Both these units have lounges and dining rooms, as well service users’ own personal rooms. At the time of this visit only one unit was being used as there were only three service users resident. Thames House DS0000068666.V337956.R01.S.doc Version 5.2 Page 19 The building had been purpose-built and presented as having appropriate aids and adaptations for people with a physical disability. This included diningroom tables which could be raised or lowered to easily facilitate people using wheelchairs, and a bathroom equipped with lighting and sound systems which could be controlled by service users when in the bath. No remedial issues were identified in connection with the fabric of the building at this visit. The manager reported both verbally and via the AQAA, that appropriate maintenance was routinely undertaken, including in connection with health and safety assessments. Given the ‘newness’ of the building documentary evidence to support this was not looked at during this visit. The building presented is clean and tidy throughout. This was confirmed as the usual state by staff and the service user spoken to. Similarly, all service user questionnaires returned described the home has always being “fresh and clean”. Thames House DS0000068666.V337956.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. Service users are supported by trained and competent staff, in adequate numbers, who have been thoroughly vetted by the application of the recruitment procedures and deemed suitable to work with young adults. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: There was documentary evidence of a wide range of training opportunities for staff. This included a thorough induction programme and specialist training in connection with Huntingtons disease. This training package was verbally confirmed by the manager and was identified in the written AQAA. Similarly, staff who were interviewed confirmed that training was available, that they were encouraged to attend and that it gave them appropriate competencies to meet the needs of the service users. Thames House DS0000068666.V337956.R01.S.doc Version 5.2 Page 21 A small selection of staff files was looked at. These provided evidence that appropriate vetting had been undertaken before any staff worked with any service user. The documentary evidence demonstrated that staff had commenced work before a POVA first or Criminal Record Bureau disclosure had been obtained. However, at the time of these staff members’ appointments, there were no service users resident at Thames House. Discussion with the manager indicated that she clearly understood that appointing staff before these checks would not be appropriate when service users are resident. The companys application form only requests an employment history for the previous ten years. This is inappropriate, as the regulations require a full employment history to be obtained, together with an explanation of any gaps. Thames House DS0000068666.V337956.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. Service users benefit from living in a well-run home where their safety and welfare are promoted and protected. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The manager had recently completed the “fit person” process for registration as the registered manager. She reported that at the time of this visit she was working towards the registered managers award (RMA). It was also reported that the deputy manager already holds the RMA. Thames House DS0000068666.V337956.R01.S.doc Version 5.2 Page 23 During this visit the manager demonstrated a good understanding of the needs of the service users. Staff who were interviewed reported that the manager, and the management team, were approachable and supportive. As the home has not been functioning for a full 12-month period, an annual development plan, based on an assessment of the previous year’s work, had not been completed. However, the manager reported that the company undertook periodic internal quality audits. Given the small number of service users, it was quite appropriate that no structured and formal service user meetings had been organised. However, it is equally clear from discussion with staff and the service user that service users’ views were taken into account in the running of the home. The visiting professionals commented on how relaxed service users were with the staff, who were clearly trusted. The manager reported that all appropriate health and safety requirements were met. Staff confirmed the availability and mandatory use of personal protective equipment, such as disposable gloves and aprons. There was documentary evidence seen on staff files confirming that training had been undertaken in connection with health and safety, moving and handling, food hygiene and first aid. Thames House DS0000068666.V337956.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 4 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Thames House DS0000068666.V337956.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations The registered person should ensure that care planning records are comprehensive and in sufficient detail that planning and strategies for meeting needs can be clearly understood by service users, staff and any representatives of service users. The registered person should ensure that the application form is redrafted to enable a full employment history to be easily recorded and appropriate vetting undertaken to safeguard service users from the appointment of inappropriate staff. 2 YA34 Thames House DS0000068666.V337956.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Old Trafford M16 9HU 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 Thames House DS0000068666.V337956.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!