Inspection on 10/10/06 for Thornhill House

This inspection was carried out on 10th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Thornhill House 22/12/09

Thornhill House 19/09/07

Thornhill House 24/01/07

Thornhill House 07/12/05

Thornhill House 13/06/05

Thornhill House 08/12/04

Thornhill House 09/06/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Thornhill House Church Lane Great Longstone Derbyshire DE45 1TB Lead Inspector Susan Richards Key Unannounced Inspection 10th October 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 Thornhill House DS0000002093.V304800.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 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. Thornhill House DS0000002093.V304800.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Thornhill House Address Church Lane Great Longstone Derbyshire DE45 1TB 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) 01629 640034 John Thornhill Memorial Trust Vacant Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Thornhill House DS0000002093.V304800.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registration to include the accommodation of two named service users (as specified on the notice of proposal) into Thornhill House under the category DE,E not transferable to any other service users, other than those as named. The maximum number of persons to be accommodated within Thornhill House is 17 7th December 2005 2. Date of last inspection Brief Description of the Service: Thornhill House provides nursing and personal care and support for up to 17 older persons. It is purpose built single storey accommodation located in the village of Great Longstone, approximately 3 miles north east of the market town of Bakewell. The home provides all single room accommodation with an en suite facility to each. There is a choice of lounge and dining facilities and suitable bathing and toilet facilities. There is a central kitchen and separate laundry facility and a range of equipment both environmental and individual to assist those persons with physical disabilities, including an emergency call system throughout. The gardens are very well maintained and provide level access for service users, together with seating. Car parking spaces are also provided. There is an acting Manager in post having recently applied as registered manager with the Commission – her application is being processed. The Manager has the support of a team of nursing, care and hotel services staff, together with a number of volunteers from the local village and surrounding area. There are good arrangements to enable residents to engage in activities of their choice, which are planned by the activities co-ordinator employed. Close links are also well established with the local community and there is a meals’ on wheels service, which also operates from the home via volunteers. Thornhill House DS0000002093.V304800.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced, key inspection of Thornhill House, where all key standards as set out in the Department of Health’s National Minimum Standards document for Older Persons were inspected. Case tracking was used as part of the methodology, which involves the random sampling of a number of service users, whose care and service provision is more closely scrutinised in accordance with those national minimum standards. Discussions were held with them about their care and also with staff and representatives as available. Their care plans and associated care records were also examined and their private and communal accommodation inspected. At the time of the inspection there were 17 service users accommodated, two in receipt of rehabilitative care and support. The Inspector had the assistance of the Deputy Manager and administrator. What the service does well: What has improved since the last inspection? Records are properly kept in respect of the administration of medicines to individual service users and also in terms of monitoring storage conditions of medicines requiring refrigeration. Staff are signing and dating residents written care plans. Thornhill House DS0000002093.V304800.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. Thornhill House DS0000002093.V304800.R01.S.doc Version 5.2 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 Thornhill House DS0000002093.V304800.R01.S.doc Version 5.2 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): 3, 4, & 6 Quality outcome in this area is adequate. This judgement has been made using evidence available, including a site visit to the home. Residents’ needs were being met and opportunities to maximise their independence were suitably promoted, although the lack of recorded individual needs assessment information undermined the home’s ability to evidence its practise. EVIDENCE: Case tracking was undertaken with three residents and individual’s care needs were discussed with two of those residents, including the arrangements for their assessment. The Inspector was unable to engage in meaningful discussion with the third due to their confusion. Although there were written care plans detailing individual’s daily living arrangements there was no recorded needs assessment for each of those in accordance with a recognised care model or as detailed under National Minimum Standard 3 for Older Persons. Residents admitted via care management arrangements did have pre-admissions assessments and single care plans as provided by those Thornhill House DS0000002093.V304800.R01.S.doc Version 5.2 Page 9 arrangements. Two of the residents accommodated, including one case tracked were in receipt of intermediate care. Each had their own equipment and supportive links and inputs with outside specialist service and relevant professions, including occupational and physiotherapists. The service user case tracked expressed satisfaction with the care and services, which were provided in respect of their rehabilitation and was looking forward to return to their own home. Discussions were also held with the acting manager and staff about those residents needs and also with regarding to the arrangements for staff training. Staff is fully conversant with residents needs. Thornhill House DS0000002093.V304800.R01.S.doc Version 5.2 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 outcome in this area is good. This judgement has been made using evidence available, including a site visit to the home. Service users health care needs are fully met and they are effectively consulted about their care and treated with the utmost of respect. EVIDENCE: The individual written care plans for those service users case tracked were examined and discussions held with them about their care. Discussions were also held with staff about the arrangements for care delivery. Care plans were well documented in accordance with the nursing process and were formulated in accordance with identified aspects clinical risk concerned with the recognised care of older persons, including pressure ulcer and nutritional risk and risk of falls. Residents who were able were involved in their care planning, including reviews with them on a regular basis, which were also recorded. Thornhill House DS0000002093.V304800.R01.S.doc Version 5.2 Page 11 Records were also maintained in respect of the arrangements for each service user to access outside health care professionals, including for the purposes of routine health care screening and service users confirmed their access to these. The arrangements for the management and administration of medicines were examined and discussed with the acting manager for those service users case tracked. These were satisfactory and in accordance with recognised practise for nurses in respect of medicines administration and record keeping. However, one of the service users case tracked was due to undertake an assessment of their ability to self medicate as part of their planned rehabilitation programme. A discussion was held with the registered nurse who was to undertake this. There was no policy guidance/standardised format of approach in respect of this, although the nurse and deputy manager recognised the need to develop one for the home. The arrangements for personal care and support were discussed with service users and also staff’s approaches with them. All said that the care and support they received was ‘second to none’ and ‘they couldn’t wish for any better and that staff were ‘absolutely marvellous’ and treated them with dignity and respect and consulted with them at all times about their care, daily living arrangements and lifestyle preferences. Thornhill House DS0000002093.V304800.R01.S.doc Version 5.2 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 outcome in this area is excellent. This judgement has been made using evidence available, including a site visit to the home. Service users are fully consulted with in respect of their daily living arrangements and their rights to live meaningful, social lives in accordance with their chosen and/or known lifestyle preferences is very well promoted. The standard of food and meal provision is excellent. EVIDENCE: Discussions were held with service users about the arrangements for them to engage in leisure, social and religious activities, maintain personal and social relationships and also regarding food and mealtimes. Discussions were also held with staff and records examined in relation to these. Residents felt that the arrangements for the above were good, with regular provision of choice of individual and group activities both in and outside the home and that provision was frequent and varied. All said they were able to choose the frequency and type of activities they engaged in, in accordance with their lifestyle preferences and individual choices. An activity co-ordinator is employed who maintains records of activities engaged in by each service Thornhill House DS0000002093.V304800.R01.S.doc Version 5.2 Page 13 user. Reminiscence type activities were well promoted and there had been a recent tea dance organised which residents had particularly enjoyed. Views were expressed by staff regarding the importance of engaging those residents with confusion in activities, which are relevant to their known lifestyles and gave clear examples as to how these were organised and promoted. There is a welcoming and friendly atmosphere in the home, which has good links established with the local community, within which the home is well respected. A number of volunteers come into the home to assist with the social support of residents and the serving of drinks. Information is provided for residents and their relatives/representatives regarding how to contact advocacy services. Samples of menus were provided with the pre-inspection questionnaire. These detailed a varied and nutritious diet. Service users spoke highly of the standard of food and meals provided. Some said they were ‘excellent’ with ‘a high standard of home cooking’ and that they were consulted about these. Foods are freshly supplied from local producers. Lunches and teas were prepared and served during the inspection. They were very well presented and service users individual preferences were upheld in relation to their choice of food and where they ate it. Individual trays and tables were set with cloths, napkins and good quality tableware and cutlery. Trays were individually labelled. Service users confirmed that meals were always presented in this manner. There were no service users accommodated with special religious or cultural dietary needs. Special diets are catered for. Thornhill House DS0000002093.V304800.R01.S.doc Version 5.2 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): Quality outcome in this area is good. This judgement has been made using evidence available, including a site visit to the home. Service users knew how to complain and are protected from abuse by staff’s knowledge regarding recognising and reporting abuse and the home’s policy and procedural guidance in this respect. EVIDENCE: There is a clear written complaints procedure for the home, which is openly displayed. Service users spoken with knew how to complain, although all said they had no cause for complaint. The home’s complaints record was examined. There have been no complaints about the home over the last 12 months, either directly to the home or to the Commission. Discussions were held with staff regarding the prevention of abuse in care. All staff had received instruction/training in respect of recognising abuse and was conversant with the procedures to be followed in the event of the recognition or witnessing of the abuse of any service user. The arrangements for the management, handling and safekeeping of residents’ monies were discussed with the deputy manager and administrator and examined for those service users case tracked. These were satisfactory. Thornhill House DS0000002093.V304800.R01.S.doc Version 5.2 Page 15 Thornhill House DS0000002093.V304800.R01.S.doc Version 5.2 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, 21, 22, 24, 25 & 26 Quality outcome in this area is excellent. This judgement has been made using evidence available, including a site visit to the home. Service users live in a safe, comfortable, clean and well-maintained environment, which provides purpose built accommodation to a high standard and to the satisfaction of service users who accommodated there. EVIDENCE: The private and communal accommodation of service users case tracked was inspected. All areas seen were furnished and decorated to a high standard and well maintained. Service users own rooms were well personalised and those spoken with expressed their satisfaction with these and the environmental standards throughout the home. All areas of the home were clean, odour free, well lit and ventilated and warm. There are suitably laundry facilities and also separate sluicing facilities, including a mechanical sluice. Thornhill House DS0000002093.V304800.R01.S.doc Version 5.2 Page 17 There is an operational programme in place for the ongoing redecoration, repair and renewal of the fabric of the home. Since the previous inspection of the home, there have been some changes to the internal layout of the home, with an increase in the number of bedrooms from sixteen to seventeen. All bedrooms are single room accommodation, having en suite facilities. The home is purpose built with all accommodation provided at ground floor level and having full disabled access. It is noted that the manager admitted a service user into the additional room before obtaining registration approval for its use (which has since been granted). This has been raised separately in writing with the registered provider. Thornhill House DS0000002093.V304800.R01.S.doc Version 5.2 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, 28, 29 & 30 Quality outcome in this area is poor. This judgement has been made using evidence available, including a site visit to the home. The lack of individual induction records for staff undermined the home’s ability to evidence its induction practises and service users were not adequately supported and protected by the home’s recruitment practises. EVIDENCE: Details of staff employed, staff turnover, training and deployment were provided by way of the pre-inspection questionnaire. These were discussed with the deputy manager during the inspection and records were examined in relation to these, including staff duty rotas. The arrangements for staff recruitment and induction were also discussed and the personal files of four more recent staff starters were examined – two Registered Nurses and two care support staff. Records were in place regarding ongoing staff training, including core health and safety training (see also management section of this report), which were satisfactory. A total of 16 care staff, which equates to just under 62 of staff employed, have achieved at least NVQ level 2 or above in care. However, there were no formal records of induction for each staff member. Discussions were held with staff about the arrangements for their induction and training. The need to ensure that staff undertaken structured induction training in accordance with current and recognised training standards and to keep a Thornhill House DS0000002093.V304800.R01.S.doc Version 5.2 Page 19 record of that induction training for each staff member was raised as a requirement at the previous inspection for this service. This was not met at this inspection. This was discussed with the deputy manager in relation to recognised occupational standards for care staff via Skills for Care. The personal files examined for the four staff indicated above did not contain confirmation of the outcome of any CRB/POVA check or POVA first checks. Only one written reference had been obtained for two of those staff, where two are required. A total of 13 staff commencing between December 2005 and September 2006 had worked or were continuing to work in the home without these, including the acting manager, who commenced on 03 January 2006. This was raised as a serious concern with the acting manager and responsible individual (who visited the home) during the inspection and instructions given in respect of the action they must immediately take. This has also been raised separately in writing with the registered provider following the inspection. This was also raised as a serious concern at the previous inspection for this service carried out in December 2006. Thornhill House DS0000002093.V304800.R01.S.doc Version 5.2 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, 33, 35, 37 & 38 Quality outcome in this area is poor. This judgement has been made using evidence available, including a site visit to the home. The rights and best interests of residents are not always consistently and effectively safeguarded by the home’s record keeping procedures and practises, and its management practises, which may place service users at risk. EVIDENCE: There is a manager in post who commenced her employment with the home on 03 January 2006. She was not present at the inspection. She is not registered with the Commission. A registration application was received from her on 05 October 2006 and is currently being processed. Thornhill House DS0000002093.V304800.R01.S.doc Version 5.2 Page 21 Discussions were held with the deputy manager regarding quality assurance and monitoring systems operated within the home. The deputy manager was not aware of the operation of any formal quality assurance system, including mechanisms for formal consultation with service users and their representatives about the care and services the home aims to provide, such as satisfaction surveys. A representative of the registered provider visits the home on a monthly basis. Reports of those visits were provided. The arrangements for the management and handling of service users monies were discussed and examined. These were satisfactory and in accordance with the home’s policy guidance. A number of records, which are required to be kept in the home, were examined. These are referred to in the relevant sections of this report. Record keeping in relation to service users’ needs assessment information, staff recruitment and staff induction was poor. Over the last 12 months, the Commission are notified in writing of one death of a service user in the home. However, information provided on the pre-inspection questionnaire and in the home’s record of admissions, discharges and deaths both recorded the death of four service users. The arrangements to promote safe working practises in the home were discussed with the deputy manager and staff, including core health and safety training for staff. Overall these were satisfactory, although there was no formal training record in place for any staff member in relation to infection control. Details of the required maintenance of equipment were provided in the preinspection questionnaire and these were satisfactory. The arrangements for the reporting and recording of accidents in the home were examined. These were satisfactory, with the exception of that relating to the required written notification of incidents to the Commission as detailed above. Thornhill House DS0000002093.V304800.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 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 2 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X 3 3 X 3 3 4 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 X 1 3 Thornhill House DS0000002093.V304800.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? YES 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 OP3 Regulation 14 Requirement There must be a recorded full needs assessment for each service user, which is regularly reviewed in accordance with NMS 3.3 The registered person shall not allow any person to work at the home until satisfactory confirmation of their fitness has been determined. (Original timescale 07/01/06). All staff must received induction training, which is structured in accordance with nationally recognised training standards and a record kept of that induction training for each staff member. (Original timescale 28/02/06) A person shall not manage a care home unless they are fit to do so and without being registered under Part 2 Section 11 of the Care Standards Act 2000. A formal quality assurance and monitoring system must be operated for the purposes of reviewing and improving the DS0000002093.V304800.R01.S.doc Timescale for action 30/11/06 2. OP29 19 11/10/06 3. OP30 17, 18 31/12/06 4. OP31 9 11/10/06 5. OP33 24 31/12/06 Thornhill House Version 5.2 Page 24 6. OP37 17 7. OP37 37 quality of care provided at the home, including the quality of nursing care, which shall provide for consultation with service users and their representatives. Records must be maintained and kept in the home in accordance with Schedules 2, 3(1)(a) & 4(6). (Original timescale 31/01/06). Written notification must be provided to the Commission without delay, the occurrence of the death of any service user. 30/11/06 31/10/06 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 OP9 Good Practice Recommendations Policy guidance should be developed regarding selfadministration of medicines by any service user, including a standardised approach to recording the assessment of their individual capability in this respect in accordance with recognised practise. Thornhill House DS0000002093.V304800.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Thornhill House DS0000002093.V304800.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!