Inspection on 28/02/08 for The Oaks

This inspection was carried out on 28th February 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Oaks 09/01/07

Similar services:

Flint House

Hillview Farm

Dalewood Respite Care

Orchard,The

Heather House Nursing Home

REACH Upton Court Road

The Cotswold Home

Fairways

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

CARE HOME ADULTS 18-65 The Oaks 91 Hulbert Road Bedhampton Havant Hampshire PO9 3TB Lead Inspector Michelle Presdee Unannounced Inspection 28th February 2008 10:00 The Oaks DS0000067905.V357028.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 The Oaks DS0000067905.V357028.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. The Oaks DS0000067905.V357028.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Oaks Address 91 Hulbert Road Bedhampton Havant Hampshire PO9 3TB 02392 412 430 02392 413 193 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) Dolphin Homes Ltd ** Post Vacant *** Care Home 8 Category(ies) of Learning disability (8), Physical disability (8), registration, with number Sensory impairment (8) of places The Oaks DS0000067905.V357028.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th January 2007 Brief Description of the Service: The Oaks is a large detached house that has been converted to provide support and accommodation for up to 8 people who have learning disabilities and associated physical disabilities. Bedrooms are situated on the ground and first floor and there is a lift, which provides access to the upper floor. All bedrooms and communal areas are fully wheelchair accessible. The home is situated in a quiet residential area and is situated close to local shops and access to public transport services. The home has a minibus that is equipped to provide transport for physically disabled service users. Dolphin Homes Limited manages the home. Basic fees at the home range between £900 - £1249 per week. Service users are responsible for paying for their own chiropody, toiletries and items of a personal or luxury nature. The Oaks DS0000067905.V357028.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The home currently does not have a manager; the deputy manager is currently taking on responsibilities of managing the home and assisted the Commission with the inspection. The deputy manager is still considering if he is going to apply to be the registered manager. On the day of the inspection six residents were in the home at separate times as they were attending college and social activities. Resident’s abilities to communicate verbally were varied, but nonverbal communication and interactions with staff were observed. Discussions with one resident who was out on the day of the inspection took place at a later date. Six residents use wheelchairs outside of the home and five use them inside the home. We looked around the home and saw the lounge/dining room, the kitchen, the laundry, and all bedrooms. The home sent us their Annual Quality Assurance Assessment on time. This and other paperwork seen on the day including assessments, care plans, staffing records and medication records has helped form the judgements made in this report. What the service does well: What has improved since the last inspection? No areas were identified as needing improving on the last inspection report. The Oaks DS0000067905.V357028.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Oaks DS0000067905.V357028.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 The Oaks DS0000067905.V357028.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs will be met; accurate assessments are undertaken and include all a persons needs. EVIDENCE: One resident has moved into the home since the last inspection. Evidence was seen, which demonstrated the home had taken into account if they could meet the person’s needs before they came to live at the home. Joint multi disciplinary meetings had been held with those previously involved with the persons care. The person had not come to view the home before moving in as it had been decided this would be detrimental for this person. However he had been given photographs of the home, his room and the other residents. The current residents had been informed somebody new would be moving into the home and they had been shown a photograph of him. The Oaks DS0000067905.V357028.R01.S.doc Version 5.2 Page 9 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, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have clear plans and know their changing needs will be recorded and met. People are encouraged to make choices and supported to take risks to allow independence as much as possible. EVIDENCE: All the people in the home have their own individual plan. The acting manager is currently updating these and making them more age appropriate. The plans are extensive and give a very clear picture of each person’s needs, aspirations, wishes, likes, dislikes and social activities. The person is encouraged to help develop the plans and attend all reviews but if they do not want to their choice is respected. The plans are kept in the lounge so the person can access them at any stage. The first page includes a photograph of the person and states what they like to be called. An up to date statement of purpose, service user guide and complaints procedure are in each file. Plans include information on personal care, meal times, behaviour, emotions, communication and night time routines. Daily notes are maintained for each key part of the plan, which The Oaks DS0000067905.V357028.R01.S.doc Version 5.2 Page 10 differs for each person. The plans had been reviewed on a regular basis and other professionals had been invited to the reviews. It was clear from observations on the day and from reading notes people make decisions about their lives and are encouraged to do this. One person came back from one activity and stated he did not want to go to the next planned activity. This was cancelled on his behalf. It was clear from reading service user plans activities had been changed due to the persons choice. House meetings are arranged on two weekly basis and all the people in the home are encouraged to attend. The minutes demonstrated each person has a choice and influence on the meals served in the home. It also gives people the opportunity to state what they are not happy with or would like changing. It was noted one person had stated they would like more fish for the fish tank and another had stated they would like their room painting. We (the Commission) were advised the fish had already been bought and the bedroom was going to be re-decorated. All the people in the home are encouraged to be as independent as possible. Risk assessments are included in the service user plan and detail the risk, the persons understanding of the risk, the support needed and ways in which the risk can be minimised. Risk assessments had been reviewed on a regular basis. The Oaks DS0000067905.V357028.R01.S.doc Version 5.2 Page 11 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, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People in the home take part in activities they enjoy. People are independent as possible and encouraged to take risks. People have healthy diets and are involved in the choice of meals. EVIDENCE: The majority of the people in the home were out on the day of the inspection at a range of activities both at college and in the community. Each person has a timetable of daily events in their service user files. It was noted when reading the notes events included events as small as going to the local shop to buy drinks, which had been listed as one of the things the person liked doing, to organising a holiday. A holiday had been organised the previous year for all people in the home. One person and a member of staff were arranging an evening out to celebrate a birthday. In one survey it stated more staff in the evening would be beneficial as then more outings in the evening could be arranged. One member of staff spoken to stated, they thought this would be a good idea as it is hard to arrange outings in the evening. The Oaks DS0000067905.V357028.R01.S.doc Version 5.2 Page 12 The majority of residents do not have many informal visitors most are other professionals visiting the home. Contact and visits have been made for two residents to meet with family members. A member of staff explained how communication has been aided by being able to use computer packages to change the language of the written communication to the language of the family member. The people in the home are encouraged to be involved in all decisions to do with the home. Two weekly meetings are held and discussions are held on the running of the home and minutes are taken. We were advised residents help keep the home clean and tidy and one resident agreed with a member of staff they enjoyed brushing up and vacuuming. When walking around the home it was clear each bedroom was individual and maintained to the choice of each person, which staff respected. At the two weekly meetings menus are discussed and picture menus are available. At this time the menus are planned and the choice of each person is recorded. It was noted special events had been recognised with food choices for example the Chinese New Year. All records of meals are recorded and staff stated residents are always offered a choice. On the day staff frequently asked residents if they would like a drink or snack. The Oaks DS0000067905.V357028.R01.S.doc Version 5.2 Page 13 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, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive support from staff in a way they prefer. Their physical and emotional health needs are met and people are supported in a safe way with their medication. EVIDENCE: Service user plans gave very clear details on how personal care should be given. Evidence was seen that the plans had bee done in consultation with each person and where they wanted they had been involved in the review. The use of a hoist is needed with one person and we were informed other professionals had been consulted in the use of the hoist. The home has a range of health professionals who visit the home. Staff stated they received good support from other professionals and could always ask for more information. From records seen it was clear professionals are called in when needed. A referral had recently been made to the local learning disability nurse regarding the behaviour of one resident. In another situation there were concerns over the medical status of one person who was reluctant to undergo tests. Discussions had taken place with a range of health professionals as to how this should be best addressed and good records were maintained. The Oaks DS0000067905.V357028.R01.S.doc Version 5.2 Page 14 The home uses a monitored dosage system for medication. No resident is currently able to self medicate. We were informed all staff involved with medication have received training in the administration of medication. The home had a clear procedure for all medication including “when required” medication. Records were well maintained, although one member of staff on duty did declare he had forgotten to sign the record for one resident the previous night after administering medication. The Oaks DS0000067905.V357028.R01.S.doc Version 5.2 Page 15 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, 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People know how and who to complain to. Staff need to have access to safeguarding procedures and training to ensure they know how to safeguard people from abuse and take any action if an allegation is made. EVIDENCE: The home has a very clear complaints procedure, which is displayed in the home and each resident has a copy in his or her service user guide. The home has received no complaints since the last inspection. Staff were aware of the complaints procedure. The home had a lot of information on abuse and differing types of abuse but no procedure could be found regarding adult protection. The acting manager could not find a copy of the Hampshire Adult protection Procedure and was unsure if they had a procedure, but felt there had been one in the home in the past. The acting manger was clear what steps should be taken if abuse was suspected but did state not all staff have up to date training in this area. Training records did not identify if all staff had training in this area and in staff surveys some staff indicated they did not have adequate training, which is relevant to their job. The Oaks DS0000067905.V357028.R01.S.doc Version 5.2 Page 16 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, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides adequate space and facilities, which promote independence. All bedrooms are personalised. All furniture needs to be safe to meet the needs of the people in the home and all areas need to be kept clean. EVIDENCE: All areas of the home were seen. The home is laid out over 2 stories. Downstairs there are 4 en-suite bedrooms with showers, and a bathroom with bath and WC and there is also a separate WC. There is a large kitchen and a large lounge/dining area. We were advised considerations are being given to erecting a conservatory to give more communal space. The 1st floor has 4 ensuite bedrooms with showers and a bathroom with bath and WC. Two new hydraulic beds have been purchased and another one is being considered. Track hoists are going to be fitted in two bedrooms with access into the shower room. In one bedroom there had been a water leek, which had gone though to the en-suite in the room below causing damage to the paintwork. We were advised this was going to be painted. In another bedroom the fan in the enThe Oaks DS0000067905.V357028.R01.S.doc Version 5.2 Page 17 suite did not turn off, which was very noisy and could be heard in the next room. We were advised this would be fixed very soon. In another room the resident had ripped off the wooden headboard and the front of a drawer. The headboard being removed had left exposed broken wood, which posed a risk to the resident and staff. It was agreed a new bed would be purchased. Window restrictors were not fitted in all bedrooms and in some bedrooms they had been broken. In one bedroom the resident had pulled the curtains of the rail, we were advised this is a frequent occurrence and new curtains are being looked into. Some walls and woodwork have been damaged by the wheel chairs. Wall guards had been fitted to some walls to stop the damage from wheel chairs. It was noted in some bedrooms and en-suites there were areas, which were dusty and in need of cleaning. Some carpets were in need of hovering. The communal areas were clean and on the day two residents were helping a member of staff clean out the fish tank. It was noted on the en suite doors there were notices and temperature charts maintained, it was agreed these should be removed and stored elsewhere as they were for the staff and not for the residents. The Oaks DS0000067905.V357028.R01.S.doc Version 5.2 Page 18 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, 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels are not consistent and do not ensure the needs of the people can be met at all times. Appropriate checks are not taken on all staff to ensure the safety of residents. The induction programme, training and supervision do not provide staff with adequate support for them to meet the needs of all residents. EVIDENCE: We were advised the home usually has a consistent staff team who know the residents well. However with holidays and sick leave and two members of staff leaving we were advised it has put pressure on staff. The acting manager has been working on the care side to ensure all residents needs can be met. We were advised there are usually four members of staff on duty through out the day but in the last two weeks only three members of staff have been on duty for some shifts. For the first time agency staff had been used on a weekend. Staff and records reflected this had had a negative effect on residents making them more unsettled. Some social activities had had to be cancelled, which residents were unhappy with. Staff surveys reflected they felt there was usually enough staff on duty to meet peoples needs, none had stated they felt there was always adequate staff on duty to meet people’s needs. We were advised two new members of staff had been recruited and were due to start The Oaks DS0000067905.V357028.R01.S.doc Version 5.2 Page 19 work in the home in the next two weeks. A new induction programme has been introduced, but it was agreed with the pressure of covering care hours the induction programme and training programme have lapsed recently. Training in some areas for some staff were out of date including moving and handling, first aid and infection control. Two staff surveys had stated they felt they had not received adequate training. The staffing records of four members of staff were looked at. Some records are held on the premises and some are held at head office. It was noted for those looked at there were some discrepancies. All only had one written reference, one did not have confirmation a check with the Criminal reference bureau had taken place and start and leaving dates were not recorded. The acting manager stated he was aware of the discrepancies and had asked head office to look into it, who were taking the appropriate action. The acting manager stated he felt he was receiving good support from colleagues in the organisation. Staff spoken to felt there was always some one available to discuss concerns with if they had problems. However formal supervision has not taken place on a regular basis for all staff. Staff surveys reflected some staff did not feel supported with some stating they had never had supervision, some stating sometimes and some stating often and regularly. The Oaks DS0000067905.V357028.R01.S.doc Version 5.2 Page 20 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 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have confidence in the home as it is well run. The people’s opinions in the home are central to further developments. The environment could be made safer for people concerning health and safety practices. EVIDENCE: The home is currently without a registered manager and the acting manager is considering applying to become the registered manager. It was clear form observations and discussions on the day the home is run in the best interests of those who live there and decisions where possible include the residents. The home carries out a quality audit every month on each person in the home. Forms are completed and looked at to ensure the person has achieved all they The Oaks DS0000067905.V357028.R01.S.doc Version 5.2 Page 21 expected to and have been involved in community and leisure activities. Members of Dolphin homes carry out regular monitoring visits. A risk assessment on the building has taken place. Considerations regarding health and safety need to be given to parts of the environment including the use of window restrictors the broken head board, the unlocked laundry, which had a large box of washing powder left out, staff moving residents and using hoists without appropriate training. The firelog book was seen, which recorded all appropriate testing and checks. The home had an accident book, which was being completed appropriately. We were advised all necessary equipment in the home including the fire alarm, gas safety, hoists, electrical equipment and the hot water system had been serviced on a regular basis. The Oaks DS0000067905.V357028.R01.S.doc Version 5.2 Page 22 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 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 1 33 X 34 1 35 X 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 X X 2 X 3 X X 2 X The Oaks DS0000067905.V357028.R01.S.doc Version 5.2 Page 23 No 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 YA23 Regulation 13 Requirement A procedure incorporating Hampshire Adult Protection Procedure must be developed and be available to staff. The environment must be well maintained and kept safe at all times. Staffing levels must be consistent to ensure the needs of residents can be met at all times. All checks must be carried out before a member of staff works in the home. All members of staff must undertake an induction and training in moving and handling, infection control, adult protection and first aid. All staff must receive at least six supervision sessions in a twelve month period. The home needs to appoint a manager to the home. Timescale for action 16/04/08 30/04/08 16/04/08 2 3 YA24 YA33 23 18 4 5 YA34 YA35 18 18 16/04/08 30/04/08 6 7 YA36 YA37 18 8 30/04/08 30/05/08 The Oaks DS0000067905.V357028.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Oaks DS0000067905.V357028.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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 The Oaks DS0000067905.V357028.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!