Inspection on 24/07/06 for White Hill House

This inspection was carried out on 24th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

White Hill House 10/04/08

White Hill House 26/04/07

White Hill House 31/01/06

White Hill House 15/09/05

White Hill House 22/03/05

White Hill House 28/10/04

White Hill House 23/03/04

White Hill House 07/01/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE White Hill House 128 White Hill Chesham Bucks HP5 1AR Lead Inspector Chris Sidwell Unannounced Inspection 24th July 2006 09:00 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 White Hill House DS0000023059.V291155.R02.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. White Hill House DS0000023059.V291155.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service White Hill House Address 128 White Hill Chesham Bucks HP5 1AR 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) 01494 782992 Mrs Anita Larkin Mr Julian Larkin Mrs Anita Larkin Care Home 8 Category(ies) of Dementia (1), Old age, not falling within any registration, with number other category (8) of places White Hill House DS0000023059.V291155.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 8 people over 65, one of whom has dementia Date of last inspection 31st January 2006 Brief Description of the Service: White hill House is a small, privately owned and family run care home registered to care for eight older people. It is situated a short distance from Chesham. It is an Edwardian building set back from the main road. There are pleasant gardens to the rear. Seven rooms are single and one double. A married couple was using the double room at the time of the inspection. There are care staff on duty during the day and two members of staff sleep at the home at night, although there are no waking night staff. The fees range from £550 pounds per week. Additional charges are made for hairdressing and chiropody. Information about the home can be obtained by contacting or visiting the home. White Hill House DS0000023059.V291155.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over a period of four days and included an unannounced one-day visit to the home. Prior to the visit all previous information about the home was reviewed. Comment cards were sent to residents and their families and to other professionals who have contact with the home. Two residents, two family members, the general practitioner and chiropodist returned the comment cards. The care of two residents was case tracked. Residents, staff and the manager were spoken to on the day of the unannounced visit. The home’s approach to equality and diversity was observed. What the service does well: What has improved since the last inspection? What they could do better: All staff should have medication and Protection of Vulnerable people training. Further advice should be taken from the fire safety officer must be taken and implemented regarding the dead end corridor on the ground floor that is currently being used as an office. The staffing levels at night must be monitored and risk assessments for all residents should be undertaken to demonstrate that residents are safe and their needs can be met at night. White Hill House DS0000023059.V291155.R02.S.doc Version 5.1 Page 6 The staff induction programme should be formalised and recorded. All staff should have basic mandatory training. Staff should be encouraged to undertake the National Vocational Qualifications in Care at level 2. A system of staff supervision should be implemented. The manager should undertake the National Vocational Qualifications in Care and Management at Level 4 and update her knowledge and skills. The staffing levels must be monitored to ensure that staff can be released for the appropriate training. A quality assurance programme should be implemented and action should be taken to address the requirements of inspection reports in a timely way. A qualified first aider should be on duty at all times. The electrical wiring should be tested and a safety certificate obtained. The call bell systems should be tested and evidence obtained to state that they work satisfactorily. 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. White Hill House DS0000023059.V291155.R02.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection White Hill House DS0000023059.V291155.R02.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including an unannounced visit to the home. Potential residents are assessed prior to their move to the home and have the opportunity to stay at the home for prior to moving, to assess whether the home can meet their needs. EVIDENCE: The care of two residents was case tracked. Their files contained evidence that their care needs had been assessed prior to moving to the home. Two or the residents spoken to said that they had had the opportunity to stay at the home to see whether they liked it before they moved permanently. Two residents were moving to the home for two weeks on the day of the unannounced visit. One lady said that she had visited fourteen homes and this was the first that she felt comfortable in. The documentation meets the recommended standards. There was no written evidence however that care needs were reviewed formally at the end of the four week trial period, although the staff and residents said that this was done. It is recommended that this be recorded. The home does not offer intermediate care. White Hill House DS0000023059.V291155.R02.S.doc Version 5.1 Page 9 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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including an unannounced visit to the home. Residents’ health and personal care needs are met in a timely way. The safety of medication administration for residents would be improved if staff were to have formal training. Residents’ needs at night must be kept under regular review to ensure that they are safe in the absence of waking night staff. EVIDENCE: The care plans have improved since the last inspection. All the residents whose care was tracked had care plans, which had been updated on a regular basis. The care of those residents who receive social services support in any way should be reviewed by their care manager on an annual basis. The manager should arrange for this if it is not initiated by the care manager. Residents may remain with their own General Practitioner or register with the local General Practitioner. Residents’ risk of developing pressure damage had been assessed. The district nurse who was visiting on the day of the unannounced inspection was spoken to and she said that the home were aware of residents needs and she felt that appropriate action was taken to meet their health care needs in a timely way. The General Practitioner who returned the White Hill House DS0000023059.V291155.R02.S.doc Version 5.1 Page 10 comment cards said that he could always see residents in private and that any specialist advice that he might make was incorporated into the residents care plan. He had not received any complaints about the home. There was evidence in the files that residents are weighed on admission and at regular intervals. The residents spoken to said that they felt that they had enough to eat. One lady is partially sighted and she said that staff were very aware of her needs and help her when necessary. She had an appointment for the hearing clinic to ensure that her hearing was as good as possible Two residents however had had falls in the night. The accident record stated that one fell between 12.30 and 07:30 and the other was found at 03:00 on the floor at the front door. She had come down the stairs unaided. There are medication policies and procedure in place. Medication is administered from dosette boxes, provided on a weekly basis by the local pharmacist. The staff responsible for medication administration have not had formal medication administration training. This should be undertaken. The residents spoken to were satisfied that their privacy and dignity was maintained. They may have a telephone in their room and all mail is delivered unopened. The staff spoken to were very clear that this was the residents’ home and that they should be aware of this when entering residents’ rooms. White Hill House DS0000023059.V291155.R02.S.doc Version 5.1 Page 11 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 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including an unannounced visit to the home. The routines in the home are flexible and families are welcome at any time. There is an informal activities programme although residents would have liked to go out more. The standard of food is good and meals are a sociable occasion. EVIDENCE: A number of relatives were visiting the home on the day of the unannounced inspection. Although there were no activities in the home on the day of the visit, the staff said that they sometimes played cards, board games or dominos with residents. The residents spoken to said that they had plenty to do although one lady would have liked to go out more. When the staff were asked to name one thing that they felt they could do to improve the lives of residents, one said that she would like to take residents out more frequently. She described taking one lady out and how much she enjoyed this. The staff felt that staffing levels were too low to enable this to be a regular event. There is no formal activity programme, which is notified to residents in advance. Both the family members and those spoken to on the day said that they were welcome in the home at any time. Mealtimes were observed to be a social occasion. Residents have the choice of remaining in their rooms to eat if they wish, although the statement of purpose states that this is only with the agreement of the manager. The statement of purpose should be amended to White Hill House DS0000023059.V291155.R02.S.doc Version 5.1 Page 12 reflect the current practice. A choice of main course is not available although the staff and residents said that an alternative would be provided if a resident did not like that which was on offer. Residents do not appear to have any input to the menus and the shopping is done on a day-to-day basis by the manager. Menus are not planned although a record is kept. All residents spoken to however said that they enjoyed the food. One lady is vegetarian and she said that she usually had varied meals. There were no residents who required special diets on health or cultural grounds at the time of the visit. White Hill House DS0000023059.V291155.R02.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): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including an unannounced visit to the home. Complaints policies and procedures are in place and residents feel that their concerns are addressed promptly. Safeguarding policies and procedures are in place although residents would be better protected if staff had training in this topic. EVIDENCE: The home has a complaints policy and procedure and records of complaints are kept. The residents and families spoken to said that they felt able to raise any concerns and said that they would be dealt with promptly. The Commission for Social Care Inspection has not received any complaints since the last inspection. The home has a copy of the Buckinghamshire multi agency strategy for the protection of vulnerable adults. The staff were sensitive to the need to protect vulnerable adults although none had had training and they were only aware of some of the ways in which vulnerable adults could be harmed. Staff should receive recognised training in this topic. White Hill House DS0000023059.V291155.R02.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): 19, 22, 24, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including an unannounced visit to the home. The home is homely although because of the number of steps and lack of lift it is only suitable for residents who can walk independently. The safety of residents is compromised by the failure to implement the fire safety officer’s recommendations. EVIDENCE: There is a routine plan of maintenance and some records are kept to describe this. The home is homely with a number of sitting areas, although there are a number of steps within the home. The gardens are attractive and offer shady seating areas. There are a number of trip hazards going from the house to the garden and the home is really only suitable for those who can walk independently. There are no CCTV cameras. The fire officer last visited the home on the 31st October 2005 and made recommendations that the dead end corridor, which is currently being used as an office, forms a protected route and as such should be clear of combustible material. This has not yet been implemented. The manager stated that she has received alternative advice White Hill House DS0000023059.V291155.R02.S.doc Version 5.1 Page 15 from a privately funded fire safety adviser. It is a requirement of this report that this issue is resolved with the Buckinghamshire and Milton Keynes Fire Safety Officer and that his advice is taken. There is no lift or stair lift in the home and it is not suitable for those who not independently mobile. There are a number of steps throughout the home, some of which have handrails. There is an assisted bath and shower. There are plans to upgrade these facilities. Individual rooms vary in size. Some are very small and do not provide all the furniture specified in the standards. Most rooms have been personalised and the residents spoken to said that they enjoyed their rooms. Doors to private rooms do not have locks and keys. Radiators and pipe work is now covered and thermostatically controlled valves are in place. An up to date Legionella assessment was not available. The laundry facilities are situated in a separate area from the kitchen from the kitchen and the manager state that laundry is normally taken down the fire escape and not through the kitchen. There are infection control policies and procedures in place although not all staff have had training in this topic. White Hill House DS0000023059.V291155.R02.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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including an unannounced visit to the home. The staffing levels are such that residents’ needs may not be met at night. The staff, although caring, have not had the required training to ensure that they have the knowledge and skills to care for residents. EVIDENCE: There are six members of staff who cover the rota. They have a generic role and undertake care, cooking and cleaning duties. There are no staff awake at night. The registered manager and one member of staff sleep in the home at night. The manager states that she goes to bed late and checks all residents at 02:30. No records of these checks are kept. There are no formal arrangements to cover the manager when she is a way. The accident records show that one resident was found at 07:30 having fallen. The time of fall was recorded as between 12:30 and 07:30. One resident was also found on the floor by the front door at 03:00 although the dogs barked and the manager was alerted. There are three residents with poor mobility at present, who may be liable to falls. The manager is required to demonstrate to the Commission for Social Care Inspection that the night staffing levels are adequate to meet the needs of residents at night and to undertake risk assessments for all residents with regard to their needs and vulnerability at night. Two of the six members of staff hold the National Vocational Qualifications in Care at level 2. The staff were enthusiastic about obtaining this qualification. All recruitment files were checked and found to contain the correct documentation. This is an improvement on previous inspections. There is an induction pack although White Hill House DS0000023059.V291155.R02.S.doc Version 5.1 Page 17 completion of the induction programme is not recorded. Not all staff have had the mandatory training. A system must be put in place to ensure that all staff have an induction programme which is recorded and to demonstrate that all staff have mandatory training in a timely way. White Hill House DS0000023059.V291155.R02.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, 36 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including an unannounced visit to the home. The management arrangements are haphazard and residents’ safety may be compromised by inadequate maintenance checks of the home. There is no formal quality assurance system in place and formal supervision of staff has not yet been implemented. EVIDENCE: The registered manager is experienced in managing a care home although she stated that she has not undertaken the National Vocational Qualification in Care and Management at Level 4 and expressed concerns that she did not have enough time to undertake this. She does not have a job description and stated that she has not undertaken any further training during the last year. There is an informal quality assurance system and regular audit of care and procedures is not undertaken. The deputy manager is working on a resident satisfaction survey although this has not yet been implemented. The residents White Hill House DS0000023059.V291155.R02.S.doc Version 5.1 Page 19 spoken to said that they were involved in decisions regarding their care but not regarding the conduct of the home. The policies and procedures have been reviewed during the last year. Action is not taken in a timely manner to address the requirements of previous reports and several remain outstanding from previous reports. The home does not hold any money on behalf of residents and all expenditure made on their behalf is invoiced to them. There are safes available if personal valuables need to be stored in the home. The manager said that she had not yet implemented formal supervision of staff although both she and the staff said that issues were addressed as they occurred. There are manual handling policies in place and staff records showed that they had had training. Some staff have had first aid training although not all and there is not a qualified first aider on each shift. Those staff who handle food have had food hygiene training. Hazardous substances are stored on shelves in the laundry but are not in a locked cupboard. The pre inspection questionnaire showed that maintenance checks had been undertaken for all equipment with the exception of the electrical safety certificates, the emergency call system and a Legionella assessment. Given the age of the building and the fact that there are no waking night staff these maintenance checks must be undertaken. Obtaining an electrical safety certificate has been a requirement of previous reports. White Hill House DS0000023059.V291155.R02.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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 X X X X 3 2 3 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 1 X 1 White Hill House DS0000023059.V291155.R02.S.doc Version 5.1 Page 21 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 2 3 Standard OP9 OP18 OP19 Regulation 13 13 23 Requirement Staff who administer medication should have medication training All staff should have protection of vulnerable adults training The requirements of the Buckinghamshire Fire Authority dated October 2005 must be implemented The manager must demonstrate that the night staffing levels meet residents’ needs and undertake risk assessment for all residents with regard to their night care and their vulnerability at night. The manager should have a plan in place to ensure that 50 of staff hold the National Vocational Qualifications in Care at Level 2 All staff should have an induction programme, which is recorded, and the basic mandatory training necessary to care for residents. The provider/manager should commence the National Vocational Qualification in Care and Management at Level 4. The provider/manager should establish a system for reviewing DS0000023059.V291155.R02.S.doc Timescale for action 31/12/06 31/12/06 30/09/06 4 OP27 18 30/09/06 5 OP28 18 31/12/06 6 OP30 18 31/12/06 7 OP31 9 31/12/06 8 OP33 24 31/12/06 White Hill House Version 5.1 Page 22 9 OP36 18 10 11 OP38 OP38 13 13 12 13 OP38 OP38 13 13 and improving the quality of care provided at the home. Staff should receive regular supervision. This is an unmet requirement of previous reports and a new timetable has been set. There should be a staff member who holds an up to date first aid certificate on each shift The safety of the electrical wiring system should be tested. This is an unmet requirement of previous reports and a new timetable has been set. A person qualified to do so should test the call bells. A Legionella assessment should be undertaken. 30/09/06 30/12/06 30/10/06 30/10/06 30/10/06 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 2 2 3 Refer to Standard OP1 OP3 OP12 OP15 Good Practice Recommendations It is recommended that the statement of purpose be amended to state that residents have a choice if they wish to eat in their rooms. It is recommended that residents’ care needs be reviewed at the end of the four-week trial period. It is recommended that a planed programme of activities is established which includes assisting people to go out if they wish. It is recommended that the menus be planned in advance and that residents are involved in this. White Hill House DS0000023059.V291155.R02.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR 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 White Hill House DS0000023059.V291155.R02.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!