Care Home: Pembroke Rest Home

What the care home does well The home provides a good range of information to people thinking of coming to the home, so they can make an informed decision. The home stores medicines safely, and administers them correctly and safely. Residents say that staff treat them well and treat them with respect. The home is working hard to provide a stimulating atmosphere in the home, with appropriate social activities for residents. Residents are encouraged to keep in regular contact with family and friends, who say they are always made welcome in the home. Residents are also encouraged to take as much control over their own live as they are able, and make their own decisions. Residents are very complimentary about the food, and there is a balanced diet. The home is kept clean, hygienic and free from odours. The manager is experienced and is providing positive leadership to the home. The home is being run in the best interests of the residents. The health and safety of the residents and of the staff are protected by the policies and systems of the home. What has improved since the last inspection? The home has undergone a major variation since the last inspection it has changed from providing care to older people to providing care to younger adults with brain acquired injury. Requirements and recommendations from the previous inspection no longer apply as a different set of standards are used at inspection. What the care home could do better: The home must ensure all of the necessary records are available at the time of inspection. Residents should have the opportunity to go out more often. Daily menus should be on display for the residents information. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Pembroke Rest Home 2 Pembroke Avenue Walkergate Newcastle Upon Tyne Tyne & Wear NE6 4QU     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: Karena Reed     Date: 2 6 0 9 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 30 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 30 Information about the care home Name of care home: Address: Pembroke Rest Home 2 Pembroke Avenue Walkergate Newcastle Upon Tyne Tyne & Wear NE6 4QU 01912245803 01912245803 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Jennifer Houghton care home 14 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 who can be accommodated is: 14 The registered person may provide the following category of service only: Care Home Code PC To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following category: Mental Disorder, excluding learning disability or dementia - Code MD, maximum number of places 14 Date of last inspection Brief description of the care home Pembroke House provides care and support for 14 younger adults who require residential care due to brain acquired injury. This may be due to hereditary illness e.g. Huntingtons disease and Multiple Sclerosis. Also brain damage from toxins such as alcohol,chemotherapy or radiotherapy, infections e.g. meningitis,trauma head injuries and brain haemorrage and trauma. The Home is situated in a residential area of Walkergate. A pleasant garden area is available to the side of the building and there is a yard to the rear of the Home. The Home has good access to local facilities and transport systems. On-road parking is available to the front of the building. A Statement of Purpose and service user guide are available at the home. These guides Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 14 Brief description of the care home describe the services and facilities provided by the home and how staff are trained to meet residents care and support needs. CSCI inspection reportsare also available at the home detailing the quality of care provided. Fees payable for living at the home at the time of inspection in September 2008 are £575 per week. Care Homes for Adults (18-65 years) Page 5 of 30 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: The quality rating for this service is two stars.This means that the people who use the service experience good quality outcomes. We have reviewed our practice when making requirements,to improve national consistency.Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations,but only when it is considered that people who use services are not being put at significant risk of harm.In future,if a requirement is repeated,it is likely that enforcement action will be taken. How the inspection was carried out Before the visit we looked at Information we have received since the last visit. How the service dealt with any complaints and concerns since the last visit. Any changes to how the home is run. The view of the provider of Care Homes for Adults (18-65 years) Page 6 of 30 how well they care for people. The views of people who use the service and their relatives, staff and other professionals. The Visit An unannounced visit was made on date 26 September 2008 During the visit we talked with people who use the service, relatives, staff, the manager and visitors. Looked at information about the people who use the service and how well their needs are met. Looked at other records which must be kept. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the parts of the building to make sure it was clean,safe and comfortable, Checked what improvements had been made since the last visit. We told the person in charge what we found. 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. Care Homes for Adults (18-65 years) Page 8 of 30 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 9 of 30 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 10 of 30 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. There are good arrangements in place to ensure that prospective residents and their relatives can make an informed choice about the home and that the home can meet their needs. Evidence: Records for three residents showed that when they were admitted to the home an assessment of their care needs had been carried out before their admission. The resident and the relevant people who knew them were involved in the initial assessment. The assessment form encourages staff to explore issues relating to equality and diversity as it refers to gender ,cultural,religious,spirituality,educational and social histories,preferred daily routine and preferences. It also looks at mood ,speech, behaviour, mental health, risks, sexuality and living skills. This information and the care managers assessment of the residents care needs were used to ensure all the needs of the resident could be met by staff. The records contained a range of information. Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: Residents have the opportunity to visit the home as often as they need in order to decide if they want to live there. A resident may come for meals, have overnight stays and be introduced to other residents at the home at a pace suitable to the individual. Comments include:Provides a friendly home for all people who are at risk in the community. It is just like one happy family. The home is alright the way it is. The atmosphere is relaxed and friendly and like a proper house and not a home. Care Homes for Adults (18-65 years) Page 12 of 30 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. There are good arrangements in place to ensure that residents care and support needs are recorded and to ensure that residents are involved in all decision making in their lives. Evidence: There are detailed assessments in residents care plans. There is a system of reviewing the changing care needs of residents. Residents are well supported by staff and care plans show the amount of care and support that staff are providing to residents, and they are updated as necessary. The staff on duty said that they are always given upto date information about the residents and their needs. Residents are asked individually and consulted about decisions involving themselves Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: and the running of the home. Meetings are held quite regularly with residents about the running of the home.The service users said that they make decisions about what they do each day, and that they can do what they want to do during the day, evenings and at weekends. Up to date assessments were being carried out with residents to record their capacity to make decisions as required by the Mental Capacity Act. The home supports residents to remain independent and take risks in order to live a more fulfilled lifestyle and upto date risk assessments were present in residents care records. A care planning system is in place with the residents key worker meeting formally monthly with the resident to update their care plan. Care Homes for Adults (18-65 years) Page 14 of 30 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. Residents have access to a variety of activities which helps them to enjoy a good quality of life. Residents are also supported to keep in touch with their families. Evidence: Residents records,comment cards ,residents meeting minutes provided evidence that all residents are consulted and asked their opinion and encouraged to make decisions. Conversation with residents and staff show that residents are provided with the necessary levels of support to help the resident maintain some level of independence and retain some skills to be more self sufficient in aspects of everyday living. Residents are encouraged to pursue their own interests and hobbies and are supported to do so;gardening,listening to music, shopping,art,cookery,reading.Residents also Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: enjoy meals out at local pubs,Indian restaurants,Antiques fayres,books,card playing and going for walks,shopping,watching television,theatre trips and whatever is of interest to the resident. Comments include:Social support. Encourages social time when person is in a low mood. I feel social activities and outings are always an issue regardless of the residential service. People wanting to go out but no one to support.Pembroke offer either 1,1 support or a group of three who have formed a friendship go out. Some residents said they would like to go out more often. Within the home residents bedrooms are equipped with their own televisions,radios, books,pictures and whatever is of interest to the resident. Residents care plans and case records detail any family involvement. Conversation with residents also provided evidence that residents are encouraged to maintain contact with family and friends, if they wish to do so, with staff providing any support that may be required. Menus for the home are devized at Head Office but residents are consulted regularly by the cook to check about their food likes and dislikes to localize the menu.Cooked breakfasts are available each day.No menus were on display to inform residents of daily meals being served. Special diets are catered for. Care Homes for Adults (18-65 years) Page 16 of 30 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. There are good arrangements in place to ensure that residents health and social care needs are met. Evidence: Three care plans and case records were inspected. The daily records detailed the care and support required for different needs. They reflected the changing needs of service users as they became more dependent. The home respects the wishes of an individual when dealing with their increased dependency. Comments include:Privacy and dignity issues are built into the homes policies and procedures and staff training. All personal care and medical examination/treatment is carried out in private. Service users have moving and handling needs. Service users need help with personal care tasks, such as bathing and dressing. Privacy and dignity are respected at all times. Records showed when residents had seen health professionals e.g doctors,community nurses,psychiatrists,psychologists. Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: Residents are referred for specialist health care if appropriate. Records also showed when residents had seen opticians and dentists. Staff who have completed training administer medication. A sample of medication records was examined and they were found to be in order. Clear directions were recorded and each dose of medication was signed for, or a code entered to verify the reason not given. No resident administers their own medication currently. A system could be put in place to oversee the medication of residents if they should retain and administer their own medication. The environment is equipped with aids and adaptations for the needs of residents. Comments include:Individual care plans work well. General care has been very good. All his other care needs are maximsed. Liaison with health and social services. All needs are met as far as I am aware. Care Homes for Adults (18-65 years) Page 18 of 30 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 does have a clear,user friendly complaints and protection system to ensure residents views are listened to and acted upon. Evidence: There is a complaints procedure that includes what complainants should do if they are not happy with the homes investigation and response which includes how to complain as required by the Care Home Regulations 2001. A localized procedure is available. The home keeps a record of complaints but this was not available at the time of inspection. The home has a Whistle Blowing policy and Vulnerable Adults procedures. Staff have received training about Protection of Vulnerable Adults and Prevention of Abuse. Residents can deposit money for safe keeping in the homes safe and records are kept of accounts. Comments include:No complaints. Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: Feedback is always clear and effective. Communication with a variety of agencies is very good, also the teamwork ethic is very strong at Pembroke. I am normally contacted by the home manager to inform me of any new issues concerning my service user. Contact with the home is of a good standard, when they believe the need arises. Care Homes for Adults (18-65 years) Page 20 of 30 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 home provides a comfortable and safe environment for those living there and all areas are well maintained ,clean,tidy and free from offensive odours. Evidence: There is a programme of redecoration and improvement around the home. The home was clean, well decorated and well maintained. Since the last inspection there has been a major change in the resident category of care and the home has undergone major structural change and has been refurbished. The home has an appropriate amount of sitting, recreational and dining space. There are enough rooms for a variety of activities to take place. Residents can see visitors in private in their own rooms. Furnishings and fittings were domestic in design and in good condition. Lighting was bright and domestic in design. Residents bedrooms have opening windows. The rooms were centrally heated. All bedrooms were personalized according to individual taste. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: There was emergency lighting throughout the home. The home was clean and free from offensive odours. The laundry facilities are well organised. The washing machines have the specified programme to meet disinfection standards. Comments include:The home is kept clean, a fairly new home very pleasant and well furnished. Nice lounges with televisions. Care Homes for Adults (18-65 years) Page 22 of 30 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. There are enough staff who have been properly trained and supported to meet the needs of residents living in the home. Evidence: Examination of staff rosters and discussion with the person in charge showed that the numbers of staff are as follows: 8.00am- 8:00pm 3 - 4 staff members 8:00pm- 8:00am 2 staff members. These numbers do not include the manager. Other members of staff are employed for cooking,maintenance and cleaning the home. There are currently two staffing vacancies in the home which are being filled. Staff stated that they enjoyed working in the home and were observed to be kind, caring and respectful to residents. There is a good level of staff training. 73 of staff have achieved National Vocational Qualifications at levels 2 and 26 are studying or have applied to study for this Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: qualification. 40 of staff members have achieved level 3 and 6 have applied to study at this level. Staff and the training records showed that they also receive training or advice in other areas such as equality and diversity,infection control,food hygiene,safe handling of medication,safe guarding,health and safety awareness,first aid and moving and handling.Staff have received developmental training to ensure they can meet all the needs of the residents :Huntingtons Disease,Schizophrenia,diabetes,mental capacity,alcohol dependency,manic depression,person centred care,nutrition,activities,challenging behaviour and the brain. Staff receive regular supervision. Staff files were not available to inspect on the day of inspection to check the recruitment and vetting procedures for the home but discussion took place with the operational manager about the availability of records when the manager was not on the premises. Comments include:Staff appear to meet really complex needs to a high standard of care. The staff are very helpful and caring. Residents can be very challenging and difficult to work with but staff have persisted and coped very well. Staff supportive. I am very happy with the care provided. Staff help the residents to live as they choose within their ability. My experience of this home is that senior care staff do have the right skills and experience and that new staff are receiving appropriate training. The staff are always friendly and helpful and are usually very busy. It appears staff have the skills but I have not had the opportunity to fully observe. Meets the needs of the residents in a friendly,but professional manner. Care Homes for Adults (18-65 years) Page 24 of 30 Care Homes for Adults (18-65 years) Page 25 of 30 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. Residents and staff benefit from the ethos,leadership and management approach of the home which encourages the involvement of residents and staff and ensures that the health,safety and welfare of residents are promoted and protected. Evidence: The manager has the appropriate qualifications, experience and management skills necessary to manage the service. Comments include: I have found the manager is always prepared to listen to any concerns or issues and act on this. Residents living at the home appear to like living there. Comments include: Provides a friendly home for all people who are at risk in the community. It is just like one happy family. Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: The home is alright the way it is. The atmosphere is relaxed and friendly and like a proper house and not a home. The health ,safety and welfare of residents are promoted and protected. There is a health and safety policy and a range of associated procedures. The staff receive training in health and safety and safe working practices fire safety, moving and handling, first aid, food hygiene, and infection control. Servicing and maintenance agreements are in place for facilities and equipment. Records as required by the Care Homes Regulations were well documented and completed. All fire safety checks, tests and instructions to staff are conducted at the required frequency and recorded. Water storage tanks, gas and electrics are checked annually. Care Homes for Adults (18-65 years) Page 27 of 30 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 28 of 30 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 1 22 22 Th complaints log must be available at the time of inspection. Regulation 26/10/2008 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 1 17 Menus should be on display to inform residents of the food available at meal times. Care Homes for Adults (18-65 years) Page 29 of 30 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 30 of 30 - 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!