Care Home: Pennefather Court

What the care home does well The home has information available to people who are considering moving to the home in the form of a statement of purpose and service users guide. The manager visits them before they move to assess their needs and ensure that they can be met. People are invited to stay at the home for a trial period to give them the opportunity to decide whether they would like to move there. The initial assessment takes into account peoples individual needs and their faith and cultural wishes. People are supported to remain independent and to make choices about their lives. Residents said they were happy in the home saying ` I am looked after well`. People`s healthcare needs are met and they are registered with local general practitioners and see a range of healthcare professionals including a dentist. There are complaints, whistle blowing and safeguarding policies and procedures in place. Residents said that they knew who to speak to if they had a concern and how to make a formal complaint if necessary. Resident`s accommodation is on the ground floor and there is good access to the home and around the home for people who use a wheelchair. Residents are encouraged to personalise their rooms and most had chosen to do. Their rooms reflected their personality and hobbies. One resident said `this is my space`. There is a full staff team providing continuity for residents. One resident said that `they look after us very well; it is good to be here`. There is an active training programme and staff are supported to undertake training to give them the skills and knowledge they need to support vulnerable people. Recruitment procedures are thorough and should protect residents from unsuitable carers. The home is well managed by an experienced manager. Sanctuary Care has quality assurance systems in place which take account of people`s views. There are health and safety procedures in place and regular maintenance and safety checks on equipment and services are undertaken. What has improved since the last inspection? The plans of care have improved. They have been rewritten with the residents and are up to date and clearly show how people would like to be cared for. They focus on peoples` abilities and how people can be supported to maintain their independence. Medication management has improved and controlled drugs are now recorded in a controlled drug register and checked regularly to minimise the risk of error or theft. The staff rotas have been reviewed to give residents dedicated 1:1 time with a carer which can be used for outings of resident`s choice. There are two members of staff on duty at night which gives residents the choice as to when they go to bed and to go out in the evening if they wish. The uneven paving to the patio area has been replaced giving easier and safer access for service users who use a wheelchair or who are unsteady walking. What the care home could do better: People are rightly encouraged to take responsibility for their own medicines if they wish. The home must however ensure that this is done safely and ensure care plans and risk assessments are updated to show this. Staff should not put medicines in a dosette box for residents. This should be done by the pharmacist to minimise the risk of a mistake being made. The home should ensure that peoples` care plans accurately reflect their healthcare needs to ensure staff know of these and that residents healthcare needs are met. Key inspection report Care homes for adults (18-65 years) Name: Address: Pennefather Court Croft Road Aylesbury Bucks HP21 7RA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Chris Sidwell     Date: 0 5 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Adults (18-65 years) Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Pennefather Court Croft Road Aylesbury Bucks HP21 7RA 01296484810 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): caroline.rush@sanctuary-housing.co.uk www.sanctuary-care.co.uk Sanctuary Care Ltd The registered provider is responsible for running the service care home 14 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users to be accommodated is 14 The registered person may provide the following category of service only: Care home only(PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Physical disability (PD) Date of last inspection Brief description of the care home Pennefather Court is a care home providing personal care and accommodation for fourteen residents with a physical disability. Sanctuary Care owns the home. The home is located in Aylesbury in a quiet cul-de-sac close to shops, pubs the post office and other amenities. Public transport is easily accessible. The home was opened in 1989 and consists of a two-storey building. The ground level Care Homes for Adults (18-65 years) Page 4 of 25 Over 65 0 14 1 7 0 9 2 0 0 8 Brief description of the care home accommodates residents and all bedrooms are single occupancy. Two of the bedrooms have en suite facilities. There is a patio area, which is easily accessible by residents. Care Homes for Adults (18-65 years) Page 5 of 25 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 inspection was conducted over three days and included a review of the information we hold about the service and an unannounced visit to the home of five hours on the 5th August 2009. The key standards for adult services were assessed. Information received about the home since the last inspection was taken into account in the planning of the visit. The manager completed an annual quality assurance assessment (AQAA) in which she described the way in which the home ensures that the views of people who use the service are included in what they do, the way they ensure equality and diversity is respected, what they do well, the evidence to show it and their plans for improvement. This was completed in full and returned on time. Questionnaires were sent to the home for distribution to residents, staff and visiting professionals. Twelve residents, seven members of staff and three healthcare professionals returned these. Residents were spoken to on the day of the unannounced visit. Discussions took place with the manager, deputy manager, the administrator, care and ancillary staff and some records were examined. Feedback was given at the end of the visit. Care Homes for Adults (18-65 years) Page 6 of 25 Care practice was observed and the care of three residents was followed through in detail. The environment and accessibility of the home for people with disabilities was checked. The homes approach to equality and diversity was considered throughout. Care Homes for Adults (18-65 years) Page 7 of 25 What the care home does well: What has improved since the last inspection? The plans of care have improved. They have been rewritten with the residents and are up to date and clearly show how people would like to be cared for. They focus on peoples abilities and how people can be supported to maintain their independence. Medication management has improved and controlled drugs are now recorded in a controlled drug register and checked regularly to minimise the risk of error or theft. The staff rotas have been reviewed to give residents dedicated 1:1 time with a carer which can be used for outings of residents choice. There are two members of staff on duty at night which gives residents the choice as to when they go to bed and to go out in the evening if they wish. The uneven paving to the patio area has been replaced giving easier and safer access for service users who use a wheelchair or who are unsteady walking. Care Homes for Adults (18-65 years) Page 8 of 25 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 25 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 25 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. Residents diverse needs and wishes are identified and agreed with them before they move to the home to ensure they can be met. Evidence: No one has moved to the home since the last inspection. The manager described the way in which peoples needs and wishes are assessed before they move to the home. There is a comprehensive assessment process in place to give residents the information they need and the opportunity to decide whether they would like to move to the home. They are visited by the manager or her deputy and an assessment is carried out. The documentation used identifies prospective residents care needs and their cultural and faith wishes. They are then invited to stay at the home for a period of six to eight weeks for further assessment and for them to decide whether they wish to move to the home on a permanent basis. At the end of this time a meeting is held with the prospective resident, family and care manager and a decision is made. Care Homes for Adults (18-65 years) Page 11 of 25 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. People have an up to date plan of care which they have been involved in making. They are supported to remain independent and to make choices about their lives. Evidence: The home has worked with residents to review everyones care plan since the last inspection. The care plans are written in a person centred way and were clear and up to date. They have been reviewed regularly and focused on the goals and aspirations of individuals. Risk assessments had been undertaken to enable people to lead as independent a lifestyle as possible. Many of these however were generic in nature and work is being undertaken to ensure people have personalised risk assessments which reflect their activities and challenges. Some were personalised and described how people could be supported to be independent in everyday activities, for instance making drinks using the kettle tipper. The new care plans focused on peoples abilities and how these could be maintained. Staff support residents to be independent and to make decisions about their lives, in Care Homes for Adults (18-65 years) Page 12 of 25 Evidence: conjunction with their families and care manager. The care plans showed that people had a choice as to whether they had a male or female carer. Residents said that staff respect their individuality. A number of residents manage their own financial affairs. The home can offer safe keeping facilities for small amounts of money for residents. Where this is undertaken records are kept and receipts given. The amounts held are regularly audited by an external auditor. Care Homes for Adults (18-65 years) Page 13 of 25 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 are actively supported to live an independent lifestyle and to be a part of the local community. The standard of food in the home is good and mealtimes are a sociable occasion. Evidence: Care staff have specific time allocated to support residents in an activity of their choice. Residents and staff said this has been a successful initiative which residents enjoyed. It enables residents who need support to go out on a regular basis on an activity of their choice. In addition residents are members of the local community and some regularly attend the local arts centre and are supported to go to a local church if they wish. The atmosphere in the home is relaxed and residents were engaged in their own pursuits. There are a number of different places to sit and residents have personalised their rooms with their own belongings and hobbies. One residents said this is my space. Care Homes for Adults (18-65 years) Page 14 of 25 Evidence: The chef provides a varied menu and service users have a choice of main course. Service users choose a light lunch, which may be sandwiches, salad or a snack on toast. The main meal is in the evening. Service users said they enjoyed the meals, that they were varied and that they were able to influence the menu. Care Homes for Adults (18-65 years) Page 15 of 25 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. In general people health and personal care needs are met. There is room for further improvement in medication management. Evidence: The care of three residents was followed through. Their care plans showed that they were offered individual support which focused on peoples abilities and what they wished to do for themselves. Residents were involved in drawing up their care plans and evaluating them on a monthly basis. The evaluations showed achievements over the last month and goals for the next month. The care plans were up to date. They showed that people had a choice as to who worked with them and that they could have a carer of the same gender if they wished. Those who returned the questionnaires said that staff always or usually listened to what they say. In general peoples health care needs were recorded and the care plans showed that they saw a general practitioner regularly and other members of the healthcare team such as district nurses, dentists and speech and language therapists. Care Homes for Adults (18-65 years) Page 16 of 25 Evidence: The management of medication has improved since the last inspection. There are policies and procedures in place and staff have had medication training. They confirmed that medication was not administered covertly. Records of medication received, administered and destroyed were kept. A controlled drug register has now been purchased and controlled drugs were recorded correctly. There were some discrepancies between the medication care plans and the general care plans which should be addressed. One person was prescribed medication to control epilepsy although his epilepsy was not recorded as a health issue in the general care plan. Another person was recorded as needing his medication administered whereas he was self administering his medication. The staff were putting his medication into a dosette box. This is known as secondary dispensing and is not recommended. This should be discussed with the pharmacist and a pharmacy dispensed dosette box obtained. It is good practice to support people to self administer their medication but this should be done safely and the risk of error reduced. There is guidance on our website about medication administration and secondary dispensing, www.cqc.org.uk. Care Homes for Adults (18-65 years) Page 17 of 25 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. Peoples concerns are addressed and there are safeguarding policies and procedures in place to protect them from harm. Evidence: The home has complaints policies and procedures in place. These are made available to residents and everyone who returned the surveys said that they knew who to speak to if they had a concern and how to make a formal complaint. The home said that they had received two complaints in the last year, which had been investigated and action taken to address the concerns. There are safeguarding and whistle blowing policies and procedures in place. Staff have training in safeguarding vulnerable people and said that they would have no hesitation in reporting any concerns. The manager said that she would be attending the Local Authority train the trainer course to lead the training in the home. The manager said in the Annual Quality Assurance Assessment (AQAA) that she has made two safeguarding referrals to the local authority which is the lead agency in these matters. These have been investigated and appropriate action taken by the home. Care Homes for Adults (18-65 years) Page 18 of 25 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 is well maintained and is accessible for people with disabilities. They are able to decorate their rooms as they choose and contribute their views as to how the communal areas should be decorated, preserving peoples individuality and helping them create a place in which they feel at home. Evidence: There is an ongoing refurbishment programme. New curtains and carpets have been bought since the last inspection. Residents rooms are personalised and several have been redecorated recently. The resident chose the colour scheme. The home is on one level and there is space for people who use wheelchairs to move freely. Uneven paving in the garden area has been replaced to make the patio area accessible for people who use wheelchairs or are unsteady walking. There are infection control policies and procedures in place. The laundry is separate from the kitchen area. Protective clothing is available for staff and residents have their own hoist slings. Alcohol hand gel is available to help minimise the risk of cross infection. The home is welcoming, clean and tidy and there were no offensive odours. Care Homes for Adults (18-65 years) Page 19 of 25 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 sufficient staff who have the knowledge and skills to meet residents needs. The recruitment process is thorough protecting residents for unsuitable carers. Evidence: There has been an ongoing recruitment programme since the last inspection. The manager said that the home now had a full complement of staff and that very few agency or bank staff were used. Shift patterns have been changed to allow staff to work with residents on a one to one basis and to support them with outside activities at a time that suits the resident. There are two care staff on duty at night which allows residents greater flexibility as to when they go to bed or if they wish to go out in the evening. Residents said staff and management listened and acted on what they say. Staff said that communication had improved and one member of staff said morale is high. The training records showed that care staff are supported and encouraged to undertake National Vocational Qualifications in Care at level 2 and above. Training programmes to help staff who take responsibility for a shift, act as key workers and lead teams are also offered. Some training in specialist care is offered, for instance caring for a person who has suffered a head injury. This could be developed further to include other care issues such as epilepsy. Care Homes for Adults (18-65 years) Page 20 of 25 Evidence: The recruitment files of two members of staff who had started at the home since the last inspection were checked. The required checks had been undertaken to protect residents from potentially unsuitable staff. There was evidence that the staff members identity had been checked. Criminal Records Bureau disclosures and two references had been sought before the staff member started work. The application form showed the staff members work history and interview records were kept. Care Homes for Adults (18-65 years) Page 21 of 25 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 home is well managed in the interest of residents. Evidence: The home has an experienced, qualified manager who also manages the adjoining supported housing. Sanctuary Care has a quality assurance system which comprises a self audit monthly and a verification audit. There is an annual development plan. An operational manager visits the home on a regular basis and reports of her visits are kept in the home. The last annual service quality audit was undertaken in May 2009 and an action plan is being developed. The home has set up a daily and weekly audit of medication records since the last inspection to ensure that medication is administered safely. Residents views are sought on a day to day basis and through residents and family meetings. There is a comments box in the main entrance and a newsletter is published. The residents said that their views are listened to. There are health and safety policies and procedures in place. Training records show that staff had had training in safe working practices. Sanctuary Care checks the financial and health and safety arrangements in the home on a regular basis. Care Homes for Adults (18-65 years) Page 22 of 25 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 23 of 25 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 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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 © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 25 of 25 - 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!