CARE HOMES FOR OLDER PEOPLE
The Old Rectory Nursing Home, Exeter 45 Old Tiverton Road Exeter Devon EX4 6NG Lead Inspector
Ms Rachel Fleet Unannounced Inspection 27th January 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Old Rectory Nursing Home, Exeter DS0000026674.V274256.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 Old Rectory Nursing Home, Exeter DS0000026674.V274256.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Old Rectory Nursing Home, Exeter Address 45 Old Tiverton Road Exeter Devon EX4 6NG 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) 01392 431839 01392 253700 enquiries@southernhealthcare.co.uk Southern Healthcare (Wessex) Limited Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44) of places The Old Rectory Nursing Home, Exeter DS0000026674.V274256.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Staffing levels to be in place as agreed in the letter dated 23 June 2003 12th October 2005 Date of last inspection Brief Description of the Service: The Old Rectory Nursing Home accepts people over retirement age with general nursing needs. The home is on the eastern side of the city of Exeter, in a residential area approximately one mile from the centre. The former Rectory - which dates back to 1875 - has been converted and extended for its present use, but retains some original features. Accommodation for 44 residents is on three floors, although most bedrooms are on ground floor level. A shaft lift and platform lift provides level access within the home. There are two conservatory areas overlooking well-tended gardens to the rear, including a pond and enclosed courtyard garden. There is a small area for car parking at the front of the home, with time-limited roadside parking available in the area. Mature trees screen the front of the building from the road below. A health centre, Anglican church, pub and local shops are relatively close, with a bus stop opposite the home. The Old Rectory Nursing Home, Exeter DS0000026674.V274256.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Rachel Fleet and Dee McEvoy (Regulation Inspectors) visited the home for just under seven hours. There were 39 residents at the home. The inspectors spoke with nine residents in some depth (as well as meeting with others more briefly), and with four relatives, a visiting health professional and nine staff (including maintenance and domestic staff), around the home. Completed CSCI comment cards were returned from one resident and five relatives/visitors. Documents and records were also reviewed, including four care plans and associated records used for case-tracking purposes. The visit ended with feedback of findings to Margot Whittaker, Director of Nursing for Southern Healthcare (Wessex) Ltd., who was at the home throughout the day. Recruitment is underway to appoint someone to become the home’s registered manager. Some standards were reported on following the last inspection, which was carried out on 12 October 2005. This report should therefore be read together with that report, since standards met on that occasion have not been reinspected. What the service does well:
Several residents felt that the staff were very good. One said, “I have confidence in the staff, they are kind and patient with me”. Others said the staff were friendly and cheerful. Residents were also positive about the food, one said, “It is really lovely - really can’t complain!” Residents are cared for as individuals, and staff respect them. Health care needs are currently generally well met. A wholesome diet is available, and provided in an appropriate manner. The environment is generally well maintained. Staff are enabled to acquire basic care skills and improve their knowledge of particular care needs. The home is run with the residents’ interests at heart. There are good systems for managing residents’ personal monies. The Old Rectory Nursing Home, Exeter DS0000026674.V274256.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
Residents in the sitting room said the temperature of the room could be improved, as it felt very cold on the day of the inspection. Social needs and changing needs of some residents (for example, health needs) should be included in all care plans, to ensure staff have sufficient guidance on meeting residents’ needs. Aspects of medication-related practices must be addressed to ensure safe systems are used. Residents’ privacy would be better promoted if bathrooms and toilets had door-locking devices. Specific areas of the home should be regularly reviewed to ensure adequate facilities throughout the home. The laundry, for example, and washing facilities that at present do not include a shower. Use of potential restraints such as bedrails and lapbelts should be better managed, to safeguard residents’ welfare. And residents’ interests would be more fully protected if two individuals were to confirm transactions using residents’ monies. Staff should be sufficiently available to ensure residents’ overall wellbeing. And residents would benefit in the longer term if more staff had skills developed to a nationally recognised standard. Staff recruitment procedures must be made more robust to fully protect residents.
The Old Rectory Nursing Home, Exeter DS0000026674.V274256.R01.S.doc Version 5.1 Page 7 A registered manager should be appointed as quickly as possible, to ensure longer term management issues are addressed. A copy of any ‘quality of care’ review has to be given to the Commission, and a copy made available to residents. One aspect of health and safety needed to be fully addressed, to ensure the welfare of residents and staff. The provider has taken appropriate action since the inspection. Wheelchairs also need regular maintenance, to promote residents’ safety and comfort. 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 Old Rectory Nursing Home, Exeter DS0000026674.V274256.R01.S.doc Version 5.1 Page 8 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 Old Rectory Nursing Home, Exeter DS0000026674.V274256.R01.S.doc Version 5.1 Page 9 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): None of these standards were inspected on this occasion; relevant core standard were met at the previous inspection. The home does not provide intermediate care. EVIDENCE: The Old Rectory Nursing Home, Exeter DS0000026674.V274256.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): 7-11 Residents are cared for as individuals. However, there is a risk that social and needs and changing needs of some residents (for example, health needs) may not be addressed appropriately, because of insufficient information to guide staff. Health care needs are currently generally well met. Aspects of medication-related practices must be addressed to ensure safe systems are used. Staff respect residents, but residents’ privacy would be better promoted if bathrooms and toilets had door-locking devices. The home is working towards providing very skilled care to the dying in their care, which includes giving residents the opportunity to discuss their wishes with staff. EVIDENCE: One resident, when asked what the home does well, said “The nurses here are very good, very caring.” Some care plans had excellent information on
The Old Rectory Nursing Home, Exeter DS0000026674.V274256.R01.S.doc Version 5.1 Page 11 residents’ needs and preferences, with evalutions reflecting the outcome of care. Staff spoken with had good knowledge of residents’ needs, etc. However, some care plans had not been updated to reflect changing needs, although in one such case it appeared the resident and their relatives were getting the care and support they needed. And some care plans lacked detail the range for normal blood sugars for example. Social and personal information (about interests, etc.) was not as well addressed as other needs, being brief or absent in the majority of care plans seen. The psychological assessment for one resident was not acceptable. Most risk assessments were satisfactory, covering the use of bed rails, swallowing difficulties, falls. One, however, had not been reviewed recently despite significant changes in the resident’s needs relating to diet intake. Appropriate tools were used to assess certain health risks, including for nutrition and risk of pressure sores. A visiting health professional was happy with the standard of care provided at the home and described good working relationships with the home, saying, “The care is excellent”, particularly the wound care. There were good daily records for individuals needing monitoring of fluid and diet intake. Medication charts seen were satisfactory, and there were appropriate systems for disposal of unwanted medication. The home is trying to obtain a ‘minimum/maximum’ readings thermometer for the drug fridge and appropriate storage for controlled drugs; stock levels checked tallied with records kept. A medication with a relatively short shelf-life had not been dated when opened. Residents who were asked said staff were respectful; staff were seen to be caring and sensitive when with residents. Comment cards from visitors said they could see the resident in private, if they wished to. The home will provide individual lockable storage facilities for residents who request one. Locks recommended for the toilets and bathrooms have been obtained but are still to be fitted. Progress has been made regarding recording of residents’ wishes for care during deteriorating health and following death, with the majority of care records having some relevant information. The Old Rectory Nursing Home, Exeter DS0000026674.V274256.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): 15 A wholesome diet is available, and provided in an appropriate manner. EVIDENCE: Comments about the food provided were generally positive. One resident said, “The food is first class”. Residents confirmed that choices were available. There was a pleasant, relaxed atmosphere in dining rooms at lunchtime during the inspection, with staff taking time to assist residents. Menus seen included traditional English meals, the main meal being planned for lunchtime, and offering a variety across the four-week cycle. One resident, who needed a special diet and assistance, said portions were not big enough; it was also noted that they did not have vegetables included in their meal during the inspection. Senior staff said they would look into these matters, once they were made aware of them. Care records included evidence of regular monitoring of this person’s nutritional needs. The Old Rectory Nursing Home, Exeter DS0000026674.V274256.R01.S.doc Version 5.1 Page 13 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): 18 Some action has been taken to try to ensure residents are protected from abuse. Use of potential restraints should be better managed, to safeguard residents’ welfare. EVIDENCE: All staff – including ancillary staff - receive some training relating to protection or safeguarding of adults. The home’s written policy on protection of vulnerable adults is available to staff. Two of three residents had a signed consent form for the use of bedrails. An accident record referred to a lapbelt, but there was no risk assessment or consent form relating to the lapbelt in the resident’s care notes. The Old Rectory Nursing Home, Exeter DS0000026674.V274256.R01.S.doc Version 5.1 Page 14 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): 21, 25 & 26 The environment is generally well maintained, but there are specific areas that should be reviewed to ensure facilities are adequate throughout the home. EVIDENCE: Décor is of a good standard, and residents’ bedrooms are personalised. There was a good standard of cleanliness on this unannounced inspection. The preinspection questionnaire showed maintenance and servicing has been carried out in the last year on gas, electric and water systems. Garden areas were attractive and well maintained. The provider is still considering installation of a shower facility. Extractor fans, which caused concern at the last inspection, had been replaced or cleaned. Call bells were now available in the Oak room and downstairs sitting room. Residents in a sitting room complained that the room was cold, which it was. The inspectors informed staff and a gas fire was then put on, which effectively warmed the room. The curtains were closed to stop any drafts, which is an unsatisfactory solution in the long term, given that it was daytime when this occurred. A new central heating boiler was installed in January 2006.
The Old Rectory Nursing Home, Exeter DS0000026674.V274256.R01.S.doc Version 5.1 Page 15 The Laundry facilities are still being reviewed. It is cramped, and staff could not get to the handwashing facilities. The Old Rectory Nursing Home, Exeter DS0000026674.V274256.R01.S.doc Version 5.1 Page 16 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, 28, 29 & 30 Staff are caring, but sometimes are not sufficiently available to ensure residents’ overall wellbeing. Staff are enabled to acquire basic care skills and to improve their knowledge of particular care needs. Residents would benefit in the longer term if more staff had skills developed to a nationally recognised standard. Recruitment procedures are not robust enough to fully protect residents. EVIDENCE: Residents looked well cared for, and were positive about the staff who cared for them. Five visitors’ comment cards said they were satisfied overall with the care provided. Residents had some concerns relating to availability of staff. One resident who was generally happy with the care provided said, “I have to wait at times – for example, waiting to use the toilet”. Another said their visitors had to wait a while to be let into the home. Five visitors’ comment cards indicated they felt there were enough staff on duty, though one included ‘usually’. Several residents were left unattended in the downstairs sitting room for lengthy periods during the inspection, and the inspectors had to alert staff to the fact that some were feeling cold. One resident said the only improvement would be to have someone to talk to; staff were “always too busy”. One senior carer said staffing was much the same as at the last inspection. They said mornings were very busy, but the team was “good”. Additional ancillary staff are employed for cooking, housekeeping, etc.
The Old Rectory Nursing Home, Exeter DS0000026674.V274256.R01.S.doc Version 5.1 Page 17 Some staff files contained evidence of training including health and safety topics, and training specific to residents’ needs (palliative care, safeguarding, diet and nutrition, challenging behaviour, for example). English lessons are being arranged for staff that wish to attend them. The pre-inspection questionnaire indicates that two of 21 care assistants have a Care NVQ2 or higher, with another five taking the course. Of four recruitment files initially requested, two for new staff could not be found. Only one had all the necessary information. Others were missing appropriate references and/or CRB checks. The written induction programme seen is linked to recognised national standards. Appraisals have been carried out, as required to achieve the Investors in People award. The Old Rectory Nursing Home, Exeter DS0000026674.V274256.R01.S.doc Version 5.1 Page 18 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, 33, 35 & 38 In the absence of a registered manager, interim arrangements appear to be dealing with day-to-day care issues although other matters need attention. The home is run with the residents’ interests at heart. Results of quality surveys must be shared with residents and the Commission, so that residents are kept fully involved in development of the home. There are good systems for managing residents’ personal monies, but residents’ interests would be more fully protected if an additional safeguarding measure were used. Generally there are good systems for promoting health and safety. However, two aspects must be fully addressed in practice, to ensure the welfare of residents and staff. The Old Rectory Nursing Home, Exeter DS0000026674.V274256.R01.S.doc Version 5.1 Page 19 EVIDENCE: Recruitment of a manager is underway. Two staff felt morale had declined since the manager’s departure, but one staff said there had been no real changes or problems and that they were happy with present management arrangements. One said, “Margot [Whittaker] keeps up a good standard of care - she is very thorough”. A visiting professional felt care had not been affected by the management changes. A few recommendations and requirements have arisen from this inspection. One resident said they’d like to be more involved in the running of the home. Other residents confirmed meetings were held with the Responsible Individual, one saying these were so worthwhile they wished they were held more often. Comment cards indicated visitors felt they were kept informed as appropriate. A quality assurance survey was carried out by the home in November 2005. Analysis of results was seen; these had been reported to the home’s Relatives Support group, but were yet to be provided formally to CSCI or for residents to see. Margot Whittaker said she would attend to this. A report on the provider’s own monthly visits has been received by CSCI, a new template for these having been developed by the provider. Margot Whittaker has involved all staff in addressing any shortfalls in the service. The home will hold personal monies for residents if they wish it, or bill them monthly for any expenditure, if they prefer. Personal monies and associated records were checked for four residents and found to tally. Only one signature is obtained for transactions related to these accounts. The inspectors issued an immediate requirement to repair a faulty emergency light, and regarding several fire doors that were “wedged” open around the home. The home has since responded to confirm they have taken action to address these safety issues. Fire safety records were good, with the necessary checks being recorded. Some wheelchairs being used during the inspection did not have footplates, and one had a flat tyre. New staff begin their employment with two days of training on health and safety subjects; this was taking place during the inspection. Two kitchen staff had recently up-dated food hygiene training. The Old Rectory Nursing Home, Exeter DS0000026674.V274256.R01.S.doc Version 5.1 Page 20 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 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 X X 2 X X X 2 2 STAFFING Standard No Score 27 2 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 2 The Old Rectory Nursing Home, Exeter DS0000026674.V274256.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 13(2) Requirement Timescale for action 31/03/06 2 OP29 19 Sched. 2 3 OP38 23(4)(b)& (c i) You must make arrangements for the safekeeping & safe administration of medicines received into the care home. This is regarding 1) recording of minimum & maximum readings of drug fridge temperatures, when insulin is being stored; 2) a system to enable monitoring of medications’ shelf-life once opened; 3) controlled drug storage to ensure safe storage that meets legal requirements. You must not employ a person to 31/03/06 work at the care home unless they are fit to work at the care home, which includes that there is full and satisfactory information available about them as specified in Schedule 2. You must, after consultation with 27/02/06 the local fire authority, provide adequate means of escape & make adequate arrangements for containing fires. This is regarding a faulty emergency light over the stairs & inappropriate devices used for holding doors open.
DS0000026674.V274256.R01.S.doc Version 5.1 The Old Rectory Nursing Home, Exeter Page 22 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 OP7 Good Practice Recommendations It is recommended that all care plans include social care needs and contain adequately detailed information, to ensure that staff know what action to take to meet residents’ needs. It is recommended that all bathroom and toilets have appropriate locks. It is recommended that risk assessments and fully informed consent be evidenced when potential restraints such as bed rails and lapbelts are used. It is recommended that there is a shower facility to enable service users to have a choice of washing methods. You should ensure heating of the accommodation meets the needs of residents. It is recommended that hand-washing facilities should be prominently sited in the laundry. You should, with regard to the size of the home, the number & needs of the residents, ensure that at all times suitably experienced persons are working at the care home in such numbers as are appropriate for the welfare of residents. You should submit an application to register a manager as soon as possible. You must supply a copy of ‘quality of care’ reviews to the Commission, and make a copy available to residents. You should ensure residents’ financial interests are as fully safeguarded as possible, by obtaining two signatures to verify transactions on residents personal monies accounts. You should ensure that equipment - such as wheelchairs is properly maintained, to ensure residents’ welfare is protected. 2 3 4 5 6 7 OP10 OP18 OP21 OP25 OP26 OP27 8 9 10 11 OP31 OP33 OP35 OP38 The Old Rectory Nursing Home, Exeter DS0000026674.V274256.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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 Old Rectory Nursing Home, Exeter DS0000026674.V274256.R01.S.doc Version 5.1 Page 24 - 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!
