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Inspection on 23/08/06 for The Mews Nursing Home

Also see our care home review for The Mews Nursing Home for more information

This inspection was carried out on 23rd August 2006.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Care staff are committed to providing a good environment for people living at the home and try to support them sensitively. The home uses all of its communal space and gardens for the benefit of service users who are also able to spend their time in areas of their own choosing. The quality of meals is good and service users have a choice that extends further than the written menu choice. Some service users have detailed social assessments in their care plan. The home has a sheltered and pleasantly planted garden area that is used by service users and their relatives when the weather permits.

What has improved since the last inspection?

Some carpets have been replaced but the universal use of black persists. Some decoration has been carried out. One upstairs lounge is used as an activities room and contains period posters and other items of nostalgia.

What the care home could do better:

The home should replace the black carpet that is in all corridors and in some rooms with something that looks less industrial and more in keeping with the idea of homeliness. The light levels in bathrooms must be improved in line with the requirements in the last inspection report. There are still some bedroom doors held open with wedges rather than automatic closure devices. There is still odour emanating from one sluice machine, probably due to badly fitted overflows linked to a defective extract fan. The cleanliness in the kitchen must be improved as outline in earlier inspection reports. The home should have a loop system to support those service users with hearing difficulties.

CARE HOMES FOR OLDER PEOPLE The Mews Nursing Home Southburn Terrace New Herrington Houghton Le Spring Tyne & Wear DH4 7AW Lead Inspector Mr Tom Moody Key Unannounced Inspection 10:00 23rd August 2006 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 The Mews Nursing Home DS0000018210.V293018.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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. The Mews Nursing Home DS0000018210.V293018.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Mews Nursing Home Address Southburn Terrace New Herrington Houghton Le Spring Tyne & Wear DH4 7AW 0191 512 0097 0191 512 0959 the.mews@fshc.co.uk www.fshc.co.uk Tamaris Healthcare (England) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Care Home 50 Category(ies) of Learning disability (1), Old age, not falling registration, with number within any other category (50), Physical of places disability over 65 years of age (40), Terminally ill (5) The Mews Nursing Home DS0000018210.V293018.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 5 places for palliative care 17 years and over Date of last inspection 7th February 2006 Brief Description of the Service: This home provides 50 places for elderly persons. This includes 5 respite places for persons requiring palliative care. The current scale of charges is between £410 and £643. The home is purpose built and the internal space is generous. There is a variety of lounge and dining areas. The bathrooms and WC’s have handrails and appropriate equipment for disabled service users. The home is constructed in a traditional style incorporating brick and a tiled roof. It has two floors with passenger lift access to the upper floor. Ground floor access is level. The home stands in grounds shared with another care home. The garden area is well maintained and there is adequate parking. There is a secure patio area for service users. The home is located in a village, in a suburban area. There are local facilities close to the home including shops. The Mews Nursing Home DS0000018210.V293018.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit took place over one day in August 2006 and was carried out by a single inspector. Information was obtained before the site visit from several sources, including the providers self-assessment and comment cards submitted by service users and relatives. Records were examined and a tour of the premises took place. Discussion took place with the manager and other members staff. The midday meal was observed and inspectors also spoke to service users, staff, and visitors throughout the inspection period. The feedback from service users and relatives was generally positive. The home is reasonably well equipped with aids and adaptations suited to the client group’s age and lifestyle preferences. The home has plenty of space in all areas. It is popular with service users and their families. What the service does well: Care staff are committed to providing a good environment for people living at the home and try to support them sensitively. The home uses all of its communal space and gardens for the benefit of service users who are also able to spend their time in areas of their own choosing. The quality of meals is good and service users have a choice that extends further than the written menu choice. Some service users have detailed social assessments in their care plan. The home has a sheltered and pleasantly planted garden area that is used by service users and their relatives when the weather permits. The Mews Nursing Home DS0000018210.V293018.R01.S.doc Version 5.1 Page 6 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 Mews Nursing Home DS0000018210.V293018.R01.S.doc Version 5.1 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 The Mews Nursing Home DS0000018210.V293018.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. Quality in this outcome area is good. This judgment has been made from evidence gathered both during and before the visit to this service Service users have contracts. The assessments of needs seen by the inspector were accurate and comprehensive and ensure that service users needs are met. Service users and their relative can visit the home before making the choice to move there. EVIDENCE: Examples of contracts were seen for service users and the manager confirmed all service user’s have contracts. The manager told of relatives visiting before placing service user’s in the home although the physical condition of some service users may prevent them visiting in person. The Mews Nursing Home DS0000018210.V293018.R01.S.doc Version 5.1 Page 9 Relatives confirm they are able to visit the home before relatives are placed there. Service users commented that they are happy with information and choice of home although several indicate this was done by relatives. The manger stated that the assessment of service users needs is carried out by placing authorities and confirmed by herself or senior staff. Care planning documentation records this and portrays an accurate assessment of service users needs. The Mews Nursing Home DS0000018210.V293018.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgment has been made from evidence gathered both during and before the visit to this service. Care plans had comprehensive information in relation to healthcare needs. The care plans demonstrate that the home is meeting all of service user’s healthcare needs. The homes medication systems are being adhered to and service users are protected by as safe system of medication that is properly operated by staff. EVIDENCE: The providers self-assessment indicates there have been eighteen deaths in the last year. This is not excessive given the dependency and client category of this home. Care plans contained much useful information including risk assessments. It was evident that care plans had been updated in line with changes in service user’s needs. The manager said that she carries out a regular audit of care plans to ensure they are kept accurately. The Mews Nursing Home DS0000018210.V293018.R01.S.doc Version 5.1 Page 11 Doctor’s visits are recorded and there was other evidence that primary care teams were involved in service user’s care. Hospital appointments and letters indicated that service users saw clinical specialists when this was necessary. Medication storage was secure and administration was properly recorded. Stock balances of medication were checked and these were accurate. Service users views and preferences were noted in their care plans. Staff were aware of service users needs for privacy, and staff knocked at bedroom doors before entering. The Mews Nursing Home DS0000018210.V293018.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgment has been made from evidence gathered both during and before the visit to this service. The service users can make full use of all of the homes facilities and show signs of having their own interests and possessions. There is evidence of visitors’ involvement in care and recreational activities. This indicates service user’s needs and preferences are being met by the home and that they have choice and control over many areas of their lives. Service users enjoy an appetizing selection of meals in well-decorated and pleasant surroundings. Unfortunately the level of cleanliness in the kitchen has not improved much since the last inspection and this raises questions over the wholesomeness of food served from this area. EVIDENCE: A number of service users had their own selection of videos, books or music in their own rooms. The manager spoke of service user’s preferences and patterns of activity throughout the day. Service users were able to use all of the communal space and they spoke of enjoying the garden area when the The Mews Nursing Home DS0000018210.V293018.R01.S.doc Version 5.1 Page 13 weather was good. One service user has bird feeding stations outside their room. Service user’s commented positively on their care. A typical comment was that, “I am very happy here.” Visitors were present throughout the inspection. There were photographs of earlier social events that had taken place. The home has an activities co-ordinator, and the service users were taking part in a quiz organised by her. Service users spoke positively about the home stating that, “It’s lovely in here, it’s like my home.” Others said, “I’m quite happy with the home, I get on well with the staff” and, “ We are looked after.” Some relatives have expressed concerns that the home did not have enough staff at certain times. The manager feels this is a personal perception but the possibility of rescheduling of tasks was discussed. Service users made positive comments about the quality of meals. They also indicated that a choice of alternatives was available if the menu was not to their liking. A mealtime was observed and any assistance required by service users was provided discreetly and sensitively. Unfortunately the level of hygiene in the kitchen was concerning. Food preparation surfaces were cleaned but, as with the last inspection, there was debris present under benches and behind equipment. The nature of this indicated it had been there for some time. There was an accumulation of dust and food splashes on surfaces. The floor was stained and dark, although staff indicated that it was mopped regularly. The mop that was present in the kitchen was grimy and staff indicated this was only changed once a week. The kitchen staff agreed they had sufficient hours to carry out cleaning and that the kitchen had a regular “deep clean”. They were unable to explain the dust and staining pointed out in areas that had been cleaned according to their cleaning schedule. It was stated by staff that one door had been washed the previous day. There were obvious accumulations of dust and finger marks that were of much older than 24 hours. This was discussed with the manager at the time of discovery. The Mews Nursing Home DS0000018210.V293018.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgment has been made from evidence gathered both during and before the visit to this service. Service users and most relatives are comfortable about raising issues with staff and the manager. They are sure that issues will be dealt with appropriately by the manager, but some comments indicate that concerns may not always be received sympathetically by some staff. Staff have had training and have a good awareness of protection issues. The local authorities approach, and the company’s policy combine to protect service users from abuse. EVIDENCE: The comment cards received indicate service users know how to use the complaints procedure and would approach the manager. Providers self-assessment indicates there have been 7 complaints, 6 of which have been substantiated or partially substantiated. All of these were responded to within 28 days. The Mews Nursing Home DS0000018210.V293018.R01.S.doc Version 5.1 Page 15 Service users relatives spoke of their satisfaction with the care provided and most confirmed that they are able to raise issues with staff members or the manager. One relative indicated that concerns that were expressed were not always well received by some staff members. This was brought to the manager’s attention and may be an issue for further training. The home has appropriate adult protection policies. Staff are aware of protection issues and have received training in the local authority procedures on protecting vulnerable adults. The Mews Nursing Home DS0000018210.V293018.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 Quality in this outcome area is adequate. This judgment has been made from evidence gathered both during and before the visit to this service. The environment is generally safe and the home is well maintained. The continued use of door wedges compromise fire precautions and in this respect the home does not provide a completely safe environment. Rooms are well furnished with service user’s possessions and are generally suited to their needs apart from unpleasant and institutional carpeting. The home has aids and adaptations to meet most service users needs but there is little adaptation for those with sensory loss. This has been highlighted in earlier reports. The home is generally clean, tidy but some areas and equipment were not kept in a hygienic condition, potentially compromising the welfare of service users. EVIDENCE: The Mews Nursing Home DS0000018210.V293018.R01.S.doc Version 5.1 Page 17 There is a variety of different environments in the home including quiet rooms and a reminiscence room. The dining area has pleasant wood-effect flooring and the dining room furniture is pleasant and well constructed. Although a number of door guards have been installed, several room doors were still being held open with wedges. It has been pointed out in previous reports that this practice could potentially place service users and staff at risk. As pointed out in earlier reports, the use of a rather “institutional” black carpet fitted in all corridors, and some bedrooms, tend to spoil the homely aspect of the rest of the décor . The home has suitable grab rails fitted in toilets and bathrooms. Handrails are available throughout the building to assist service user mobility. Hoists are available in several areas and there is level access to showers. It was noted that, as in previous inspections, light levels were low in bathrooms and showers. This could be a problem for those with defective vision. There is still no loop system in the home to help those with hearing loss. The home is clean and tidy in most areas occupied by service users. The problem of odour persists in one of the sluices. This is probably linked to the lack of proper overflows to sanitary fittings and an inefficient extraction fan. Some equipment, such as a mobile hoist, was not properly cleaned. The kitchen was another area where cleaning has not improved in spite of previous inspection requirements. It is unfortunate that so many areas weakness persist in spite of them being subject to earlier inspection requirements. The possible consequences, in terms of regulatory sanction, were pointed out to the manager on the day of inspection. The Mews Nursing Home DS0000018210.V293018.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, 30 Quality in this outcome area is good. This judgment has been made from evidence gathered both during and before the visit to this service. The number of staff on duty was sufficient to meet service users care needs. The homes recruitment policy and practice safeguards service users. The home does not have the required number of NVQ trained staff which could undermine the quality of care to service users. EVIDENCE: The staff on duty were engaged with service users and service users did not have to wait for attention. Call buzzers were answered promptly. The manager said that there had been no recent changes in staffing levels. The Mews Nursing Home DS0000018210.V293018.R01.S.doc Version 5.1 Page 19 Comments were positive from relatives but some indicated that higher staffing levels would be preferred because staff did seem to be under pressure at certain points during the day, such as mealtimes. The organisation of this was discussed with he manager and it was suggested that the medications need not be given at exactly the same time as the midday meal. This would give staff more time to focus on supporting service users at the mealtime. Deficiencies in cleaning originate from poor supervision and lack of clarity about whose responsibility it is to clean things, rather than lack of staff. Staff were using equipment that was dirty and not taking any action because “it is the night staff’s job to clean equipment”. Recruitment policies and procedures are appropriate. Records indicate that these policies are adhered to and that recruitment is carried out in a safe manner. Providers self-assessment and staff records indicate training takes place and staff confirm they receive an induction. There are too few carers trained to NVQ level 2. Discussions with staff revealed a reluctance to undertake training because courses have failed in the past and they perceive this as wasting their time. Some staff are also reluctant because of the company policy which states costs of training may be recovered if staff leave within a certain time of completion. The company must address these disincentives if they are to meet the NMS on training and NVQ qualification. The Mews Nursing Home DS0000018210.V293018.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36, 38 Quality in this outcome area is adequate. This judgment has been made from evidence gathered both during and before the visit to this service. The home is reasonably managed in most areas, although certain weaknesses persist. The manger should ensure control over all aspects of the homes operation, to ensure service user’s well being. Management need to ensure that the service users are cared for in a safe environment by staff who act in their best interests. EVIDENCE: The Mews Nursing Home DS0000018210.V293018.R01.S.doc Version 5.1 Page 21 The manager is a registered nurse who has experience of managing other care homes. She has not yet completed registration as the manager of The Mews. The manager feels she is well supported by the senior management team of Four Seasons. However, as pointed out in the previous section, some company’s policies discourage staff from taking up NVQ training. The manager spoke of staff turnover being low and records confirmed this. Morale among staff has been maintained. The manager spoke of supervision being carried out and stated that the homes was subject to regular audit as part of Four Seasons quality assurance system. In discussion with the inspector it was, again, pointed out that her control of the home should extend to all areas, including the kitchen and other aspects of cleaning, where there were weaknesses in the home’s operation. The manager should also ensure all fire precautions are observed. The Mews Nursing Home DS0000018210.V293018.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 3 2 3 3 2 2 STAFFING Standard No Score 27 3 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 x x 3 x 2 The Mews Nursing Home DS0000018210.V293018.R01.S.doc Version 5.1 Page 23 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 OP15 Regulation 13, 16 Requirement The kitchen and equipment must be maintained in a clean and hygienic condition. The manager must ensure that fire precautions are observed by staff and doors must not be held open with wedges The manager must ensure that fire precautions are observed by staff and doors must not be held open with wedges Equipment must be provided for those with sensory deficits. Adequate light levels must be maintained in all areas used by service users Suitable carpeting must be provided in rooms All areas of the home must be properly cleaned and odour must DS0000018210.V293018.R01.S.doc Timescale for action 30/09/06 2. OP19 13, 23 30/09/06 3. OP38 13, 23 30/09/06 4. OP22 16, 23 30/09/06 5. OP25 13, 23 30/09/06 6. 7. OP24 OP26 16 13 16(2)(k)(l 30/12/06 30/09/06 The Mews Nursing Home Version 5.1 Page 24 ) 8. OP28 18 be controlled. A minimum of 50 of staff must be trained to NVQ level 2. 30/12/06 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 OP16 Good Practice Recommendations The manager should ensure complaints are sympathetically handled by all staff. The Mews Nursing Home DS0000018210.V293018.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Mews Nursing Home DS0000018210.V293018.R01.S.doc Version 5.1 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!