Care Home: Baroda Residential Care Home

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What the care home does well The service provides a very pleasant and clean environment with large singel room accommodation. The home is set in lovely gardens and has a peacful atmosphere. The assessment for admission is thorough and information is gathered from a whole range of medical professionals who may be involved with the service user. Detailed risk assessments are written to cover all aspects of risk, allowing the serive users as much autonomy and independance as possible within a risk assessment framework. The home has employed mental health nurses and a senior clinician who is well qualified, to lead the team. What has improved since the last inspection? The manager has commenced her Registered Managers Award. All radiators have been covered. All staff must have suitable training to ensure their competence with regard to administering medication. The requirements from the previous report have been met. What the care home could do better: No requirements were idenfied at the time of this inspection. The service will be tested further at the next inspection. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Baroda Residential Care Home 34 Merdon Avenue Chandlers Ford Eastleigh Hampshire SO53 1EP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Janette Everitt     Date: 1 2 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Baroda Residential Care Home 34 Merdon Avenue Chandlers Ford Eastleigh Hampshire SO53 1EP 02380261764 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Joan Josephine Vijayanathan Type of registration: Number of places registered: Branksome Care Limited care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 12. The registered person may provide the following category/ies of service only:- Care home with nursing - (N) to service users of the following gender:- Either Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home Baroda is a residential care home with nursing and is located in a residential area of Chandlers Ford, Eastleigh, close to shops and the local amenitites. The home is a large extended house set in a spacious landscaped garden and provides accommodation for twelve service users. The home was granted a major variation by CSCI in July 2008, to change the service category from older people to adults with mental disorder who are in need of nursing care. The accommodation is in single rooms, ten of which have enCare Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 12 Brief description of the care home suite facilities, over two floors, though most resident’s rooms are on the ground floor. There are two lounges, one with doors leading out into the garden and a smaller lounge area. A dining room leads from the main lounge. Mr and Mrs Vijayanathan took over the ownership of the home in July 2006. Mrs Vijayanathan is also the registered manager of the home and a registered nurse. The scale of charges were quoted by the manager as being between £850 and £1200 depending on the needs of the individual. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This report details the evaluation of the quality of the service provided at Baroda Residential Nursing Home and takes into account the accumulated evidence of the activity at the home since the service category has changed and the change in the operational structure of the home. The home has only admitted two service users since the registration, one of which died in hospital recently. Evidence for the judgements made in the report have been drawn from the visit to the home on 12th November 2008 at which time the manager, senior clinician and two care staff were spoken with. The judgements made took into account the comments Care Homes for Adults (18-65 years) Page 6 of 28 received in inspection questionnaires from six staff members and the one service user in residence. The homes Annual Quality Assurance Assessment (AQAA) was returned prior to the visit. The information in the AQAA could not accurately evaluate and compare the improvements over the last year owing to the changed category of care and the lack of evidence on how successful the improvement plans will be, over a sustained period of time with more service users in residents. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are issued with information about the home and are thoroughly assessed before they go to the home to live to ensure the home is suitable for their needs. Evidence: The home has only one service user in residence currently. The manager told us that since the new category of care has been registered they have received referrals from commissioners in Hampshire and the Surrey boarders but do not envisage admitting people from out of county. The referring authority will request information about the service. A meeting will then be arranged to meet the person referred along with the person who has referred them and the mental health team, if they are involved. The home has employed a clinical manager who is very well qualified and has many years experience in mental health and he looks at the referrals and undertakes all the pre-admission assessments to ensure the home can meet care needs. Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: The person is then invited to visit the house, gather information about the home, and if they wish to stay over night to familiarise themselves with the environment and meet other service users already living in the home and this would help them to make their own decision about going to the home to live. Care Homes for Adults (18-65 years) Page 11 of 28 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users needs and goals are assessed with them and stated in their individual plans of care. Service users are supported to make decisions about their lives and take risk as part of an independent lifestyle. Evidence: The care plans, risk assessments and records were viewed for the one service user in residence. These demonstrated that thorough information is gathered prior to the person coming to live at the home. The care plans are written around the risk assessments and all aspects of the persons physical, mental, emotional and social needs is addressed in the assessment and records of care. The records maintained are person centered and revolve around every aspect of that persons needs, whilst identifying support needed to encourage independence and autonomy around their activities of daily living. The manager told us that service users can be involved with their plans of care and it is Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: important that they contribute to setting their goals and to the formation of their care plans especially if they are at the home for a period of rehabilitation. The one service user in residence was spoken with. She had just returned from a shopping trip and lunch out with two carers. She was enthusiastic to show us her new clothes and had chosen them with the support of the carers. She returned a survey that said she was happy living at the home. The manager and senior clinician told us that the vision for the home is that service users will be encouraged to live autonomously with appropriate support and that they will go out into the community independently within a risk framework. Risk assessments are undertaken and would be discussed with the service user as to the balance of risk, safety and choice and discuss their limitations with the service user. Care Homes for Adults (18-65 years) Page 13 of 28 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are treated with respect and are supported to participate in daily social activities and be part of the local community. The home will support service users to have personal relationships outside the home. Service users are provided with a well balanced diet. Evidence: The AQAA states that the home promotes life skills through collaborative planning and promotes the acquisition of new skills and knowledge through formal and informal education. This has not yet been tested as the home has one service user in the home. The AQAA describes how the home would support the service users with their person development and support them to take part in culturally appropriate activities. The service users who is in residence can choose what she wishes to do each day. This Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: is very dependant on how she is feeling but on the day of this visit she had enjoyed an outing to the local shops and lunch out. The AQAA also states that the home would support the service users to form positive relationships outside of the home and maximize autonomy for independent relationships and promoted responsible citizenship. The senior clinician told us that relationships outside of the home would be supported and that policies are in place to ensure safe procedures are followed to enable this to take place within acceptable parameters. The home has employed a cook and is advertising to employ a cook who can teach service users cooking skills. The four weekly menu was viewed and the planned menu looked nutritious and wholesome with alternative food on offer at each mealtime. Service users will be nutritionally assessed and have their weights recorded. If a risk is identified the manager said she would contact the GP for referral to the dietitian. The AQAA states that the home is developing a training package for all staff on improving nutiritional care These standards will be tested at the next key inspection when the service is fully functional and the manager has audited outcomes to benchmark progress and what improvements need to be made. Care Homes for Adults (18-65 years) Page 15 of 28 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users receive personal support in a way they prefer to meet their psysical and psychological needs. The home has policy and procedures to promotes service users to control their own medication within a comprehensive risk framework. Evidence: The home has the service of a local GP and also a psychiatrist who will visit the home as needed. The AQAA says that the home is well supported from the other health professionals associated with the mental health primary care team. The care plan viewed evidenced that visits from health care professionals are documented with outcomes from the visit recorded. The home anticipates gaining feedback from all health professionals, and other professionals that visit the home, as part of the quality assurance. Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: The care plan viewed demonstrated that the service users have access to all health care professionals should they need them. The previous people living in the home had more physical needs as they were elderly. Staff spoken to said that they have had extensive training to support them with the change of service user category and has given them an understanding of the needs of this client group. The home employs qualified mental health nurses and the registered manager is a general registered nurse and has undertaken further training courses in subjects associated with mental health. The responsible individual is also a registered mental health nurse with many years experience of working with people with mental health needs. The AQAA states that the service will promote self-medication through rigorous assessment and support. A self medication policy is in place to reflect this. The service user in residence at the time of this visit was not able to self-medicate. The medication room and records were viewed. As the home has only one service user in residence currently, the medication administration records (MAR) sheet had been transcribed by the manager. It was discussed with the manager that if this was to be the method of recording the medication, then a second person must check the transcription and sign to evidence that the information on the MAR sheet was correct. The manager told us she acknowledged that this was not good practice and that from next month the pharmacist would be sending print-outs of the MAR sheets. The storage of medications was observed to be safe and all cupboards and the trolley were clean and tidy. The home has records for controlled drugs and records of any medication that is to be returned to the pharmacist, which is signed by them as evidence of the return. The administration of PRN(as needed) medication was discussed with the manager and agreed that the care plan should reflect the reasons and occasions that PRN medication may be necessary to give. Care Homes for Adults (18-65 years) Page 17 of 28 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a clear complaints procedures and service users know their views are listened to and acted on. The stated policy and procedures of the home protect service users from abuse and neglect. Evidence: The AQAA states that the home has a robust complaints procedure in place and a log in which the manager will record any complaints and outcomes from the complaints. She told us that she will analyse what the complaint is about and promote positive outcomes from any complaints. The policy and procedure for people to make a complaint was viewed and stated that the service will follow through all complaints until resolution. This has been untested as the complaints log did not record any complaints to date. The survey received from the service user in residence indicated that she does know who to speak to if she is not happy and wanted to make a complaint. All six surveys returned from staff indicated that they know what the procedures are if a service user, or their relative, have an issue. Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: The home has safeguarding procedures in place that follow the Hampshire safeguarding procedures. The manager is aware of her role if there are any safeguarding issues reported to her. Staff have received one whole days training on this and have undertaken a written test following this training. A training booklet was also shown to us outlining the content and outcomes of the training. Staff spoken to, who had worked in the home for some considerable time, were able to discuss their role in reporting any incidences or suspicions of abuse. Care Homes for Adults (18-65 years) Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides a safe, clean, homely and well maintained environment in which service users can live. Evidence: The communal space is comprised of a dining room, and two lounges. Bedrooms are generally larger than the standard suggests and are single occupancy. All but two of the bedrooms have en-suite toilet facilities and many have baths. The manager told us that it is anticipated that in the next year en suites will be fitted in the other two rooms. The manager said that the home has ongoing maintenance and re-decoration and that a maintenance person is employed for the home. The environmental requirements that were highlighted in the previous report have been complied with. The gardens are extensive and well kept. The home employs a separate housekeeper to undertake the cleaning and general domestic duties of the home. The laundry was seen and was fit for purpose with Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: recently purchased machines installed. It was observed that hand washing facilities were available in toilets and bathrooms and the AQAA states that all staff have received infection control training. Care Homes for Adults (18-65 years) Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by an appropriate skill mix of compentent staff. Service users are protected by robust recruitment practices. Evidence: Currently there is only one person in residence and therefore the staffing numbers are not to their full capacity but at the time of this visit there were two care staff on duty, the senior clinician and the manager. A separate housekeeper and cook were also on duty. The manager said at night there are two waking staff on duty, one registered mental health nurse and the other a support worker. The manager told us that as more service users become resident, staff will be deployed accordingly. The AQAA told us that the home employs four registered nurses and eleven care staff part time. The staffing group is of mixed gender and culture. A sample of recruitment files were viewed and these demonstrated that all the required checks for Criminal Bureau (CRB) and Protection of Vulnerable Adults (POVA) had been undertaken on staff together with two references received by the service before they commenced employment. There was evidence in records of an induction programme that included all health and safety training and was based on the Skills for Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: Care Induction programme. The staff have undertaken a wide range of training since the previous service user group have left the home and the home having admitted only two service users since then, there has been time for staff to undertake training in subjects appertaining to mental health and specifically to the client group they will be caring for. The manager has not yet developed a training matrix but staff have certificates in their files as evidence of the training they have undertaken. The manager told us that four staff have NVQ level 2 and one with level 3. Staff are supported and encouraged to undertake the NVQ level 2 qualification. Staff training needs are identified at supervision when the manager meets with staff every two months and at their yearly appraisal. The manager told us that staff can identify any training they would like to undertake to widen their knowledge of the client group and this would be fully supported by the organisation. Staff surveys returned and speaking to staff at the time of this visit confirm that they consider they have received relevant training and have been well supported by the management team through the transition period and now look forward to using their new skills when more service users are admitted. The records also demonstrate that all staff have attended a workshop on diversity and equality. Care Homes for Adults (18-65 years) Page 23 of 28 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager runs the home in the best interests of the serivce users. The quality assurance system has not been tested fully owing to the recent change of category. The health and safety of service users and staff are promoted and protected. Evidence: The AQAA states that the registered manager is a registered general nurse and has certificates in Teaching and Assessing Clinical Practice, Care of the Elderly and Counselling. The manager is currently undertaking her Registered Managers Award and is attending the local college. She anticipates this to be completed within the next six months. The AQAA quite comprehensively states that the home will seek the views of the service users and other stakeholders which will be rigorous evaluation and that the home will have ongoing evaluation and networking with other similar facilities to monitor standards. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: The manager told us that she intends to seek feedback from the service users and stakeholders and is currently making up questionnaires to distribute to service users, relatives and other stakeholders in the service. She told us that she wants to use the feedback to improve the service and will report her findings. A sample of maintenance certificates were seen for systems and equipment and these were evidenced to be up to date. The AQAA states that 5 staff have undertaken the Food Handling and Hygiene course and that other mandatory health and safety training has been undertaken by staff. The fire log was viewed and this evidenced recent servicing of the fire alarm system and fire systems being tested at appropriate intervals. Staff fire training was recorded to have taken place twice yearly. There were no recorded accidents. Accident monitoring was discussed with the manager who said she would audit the accident records as they were completed to identify any emerging themes with accidents Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 28 of 28 - 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!