Care Home: The Headington Care Home

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What the care home does well Service users are fully assessed prior to admission to ensure that their assessed needs can be effectively met by the home. Healthcare needs of service users are well met by a range of healthcare professionals. The recording of all written and verbal complaints are well documented and detailed. What has improved since the last inspection? An additional thirty beds have been registered with us ( the commission), eight of the beds are in a separate unit for adults under the age of sixty five years of age. Elisa Globert has now been registered as the manager of the home. Recruitment of an deputy manager and activity organiser. What the care home could do better: Several areas are identified in the body of the report as needing attention. These included reviewing the care planning documentation to ensure that they reflect a person centred model of care, meaningful activities to be arranged and the need to assist service users with their meals and the presentation of food. Following the inspection we received an action plan detailing what action had been taken to address the concerns raised. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Headington Care Home Roosevelt Drive Headington Oxfordshire OX3 7XR     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: Marie Carvell     Date: 2 6 0 1 2 0 0 9 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. 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. Copies of the National Minimum Standards – Care Homes for Older People 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 Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: The Headington Care Home Roosevelt Drive Headington Oxfordshire OX3 7XR 01865760075 01865760093 the.headington@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Four Seasons (H2) Ltd Name of registered manager (if applicable) Miss Ma Elisa Globert Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 60. 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: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD). Date of last inspection Brief description of the care home The home is situated within the grounds of the Churchill Hospital in Headington, Oxford. The building was purpose built less than ten years ago and twenty two bedrooms are situated on the ground floor. There is a separate eight bed unit for adults under the age of sixty five years. The unit has its own sitting room and dining area. Accommodation is in single en-suite rooms, and is arranged around a central courtyard garden. There are two dining rooms, two sitting rooms, a conservatory, Care Homes for Older People Page 4 of 27 care home 60 Over 65 60 60 0 0 Brief description of the care home therapy room and a family room in the main part of the home. Assisted bathrooms are also provided. The laundry and kitchen services are also situated on the premises. Landscaped parking is provided to the front. The range of fees for this home is 624.00 to 850.00 pounds per week. There are additional charges for hairdressing, chiropody (none diabetic service users), newspapers and toiletries. Care Homes for Older People Page 5 of 27 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection of this service was completed in January 2008. This inspection of the service was an unannounced Key Inspection. We arrived at the service at 9.50am and was in the service until 5.50pm. It was a thorough look at how well the service is doing. It took into account detailed information provided by the manager, Elisa Globert in November 2008 and any other information that we have received about the service since the last inspection. Two service users returned completed surveys. We looked at how well the service was meeting the standards set by the government and have in this report made judgements about the standards of the service. We toured the premises, examined a sample of records required to be kept in the home, including the case tracking of service user files and spent time talking to service users Care Homes for Older People Page 6 of 27 individually and in groups. We spent time with the manager, staff on duty and three relatives. In addition we observed how the care was being delivered to service users and joined service users in one communal dining room for the midday meal. At the last inspection one requirement and one good practice recommendation were made, these have been complied with and are referred to in the body of the report. Feedback was given to the manager, during and at the end of the inspection. 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.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 Older People Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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 fully assessed prior to admission to ensure that their needs can be effectively met by the home. Evidence: Service users are admitted to the home following a full assessment of need, to ensure that the home can effectively meet their needs. The assessment is carried out by the manager or a senior member of staff using the organisations Care and Health Assessment Profile ( CHAP). No service users are admitted before registering with a local GP or before the home receives relevant information from health and social care professionals. The home does not provide intermediate care. Care Homes for Older People Page 10 of 27 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. Care planning processes need to be reviewed to ensure that they reflect a person centred model of care. The healthcare needs of service users are well met by a range of healthcare professionals. Medication administration is well organised. Service users are treated with dignity and respect. Service users can be assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. Evidence: Care plans are drawn up from the pre admission assessment, agreed and signed by Care Homes for Older People Page 11 of 27 Evidence: the service user and representative, as appropriate. Information regarding health and personal care is well documented. However, the manager accepts that care plans do not consistently reflect a person centred care approach and in March 2009, all registered nurses ( RNs) and care assistants are to be trained in Dementia Care Mapping and person centred care planning as the home is commencing an Dementia Accreditation programme. Following the inspection we received a written action plan from the manager, Elisa Globert confirming that a revision on all service user care plans to ensure that they reflect a more person centred care approach and that training will commence in February 2009 for all RNs and key workers to ensure that there is a consistency of the service users care plan. This will include lifestyle choices, health, emotional and psychological needs, life history, comfort, occupation and inclusion. Appropriate risk assessments are in place and other healthcare professionals are involved, as necessary. The recording of risk reduction measures are well documented. The medical needs of service users are provided by several GP practices. From the evidence seen in service user records and in discussion with staff on duty and relatives, the healthcare needs of service users are well met. Two surveys were received from service users. One stated that they always received the medical support needed and one stated usually they receive the medical support needed. A comment included I chose to keep my Xs own GP. Medication is administered by the RNs on duty. Medication storage, administration and recording appear to be well organised and the manager undertakes monthly medication audits. Time was spent with service users in communal areas of the home. Staff were observed to interact with service users in a respectful and appropriate manner and address service users by their preferred name and title. During the inspection it was noted that one service user was wearing slippers that were far too big, resulting in the service user, having to shuffle. This was pointed out to the manager and dealt with immediately. Two surveys completed by service users indicated that usually they receive the care and support needed. Comments included Some of the staff need more training, which I think is soon to be put into place, There arent enough carers. As far as I know people are being interviewed, but the numbers of carers remains the same, three new ones, but three have left. It was observed that many service users and relatives have a good relationship with the nursing and care staff. Service users able to express an opinion said that staff were very kind. Recently bereaved relatives, described the care and attention provided in the days Care Homes for Older People Page 12 of 27 Evidence: leading up to their relatives demise as excellent. Not only was a member of staff present at all times, but that they, as relatives felt supported and sensitively cared for and commented that nothing was too much trouble and staff made time in their busy schedule to sit and listen. As in many other care homes, there is a wide range of racial, ethnic and faith backgrounds represented within the staff group compared with the current service users. From discussion with the manager and staff on duty, we consider that the home is able to provide a service to meet the needs of individual service users of various religious, racial or cultural needs. However, there are indications that service users sometimes find that some staff cannot communicate satisfactorily because English is not their first language. Care Homes for Older People Page 13 of 27 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. Arrangements are being put into place to provide a range of meaningful activities to meet the needs of the service users. Staff should be able to offer service users assistance in eating their meals when necessary. Food needs to be presented in an attractive and appealing manner. Evidence: At the last inspection, the manager acknowledged that the daily activities in the home were insufficient to meet the emotional and social needs of the service users. Two surveys were received from service users, one service user stated that usually there were activities arranged by the home that they could take part in, and the second survey stated that sometimes there were activities arranged by the home that they could take part in. Comments made included Very sporadic as there is at present no proper entertainment post, There are some activities or concerts, but not an activities person. The music therapist is excellent. Recently a well qualified and experienced person has been appointed as an activities organiser, working four days per week and it is understood that a second activity organiser is in the process of being recruited. The activity organiser was able to demonstrate how he is planning to Care Homes for Older People Page 14 of 27 Evidence: provide meaningful and enjoyable activities and interests for all service users. An enthusiastic music therapist, provides sessions in the home for four half days per week and these are well attended. The home is able to hire transport for outings etc and a range of outings are being arranged. Many of the service users have friends and family who are able to visit on a regular basis. Regular family support meetings take place, these are well attended, and the manager attends each meeting. Religious ministers visit the home on a regular basis and transport arrangements could be made for service users to attend local places of worship, if requested. Routines in the home are flexible, such as being able to choose how to spend their day, when to get up in the mornings and when to go to bed. We were able to join service users in one of the two communal dining rooms for the midday meal. Two care staff were assisting service users eat their meal, whilst the RN was administering medication. The mealtime could not be described as relaxed or congenial. The meals of lasagne or vegetarian stuffed aubergine, were not attractively presented. Several service users require a pureed diet. It was observed that the whole meal was liquidised together, which gave the food an unfortunate appearance. We were informed, by staff on duty that this was the accepted way of pureed food being served in the home. There were no condiments, cutlery, clothes on the tables or napkins, which gave an unwelcoming feel. One care assistant refused to answer questions about mealtimes when asked, later telling the manager that he/she didnt want to get involved. At the last inspection the manager was asked to consider introducing protected mealtimes in the home, to ensure that nursing staff are available to monitor meal times and assist as necessary. Following the inspection we received an action plan from the manager , Elisa Globert confirming that protective mealtimes were to be introduced immediately, to ensure that service users are given attention and supervision during mealtimes, that RNs will supervise and be present during mealtimes so as to be able to attend and act in the event of a service user needing medical attention, RNs will complete medication rounds before or after mealtimes, to allow them free time to supervise mealtimes. In addition the action plan confirmed that all pureed meals will be served separately and not be mixed, this is with immediate effect and all care staff will be trained on the presentation of meals. This will be completed by March 2009. Both surveys completed by service user confirmed that they usually liked the meals at the home. Comments made included Too much cream and not enough fruit , The food is quite good, but sometimes a bit odd . Care Homes for Older People Page 15 of 27 Care Homes for Older People Page 16 of 27 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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 can be confident that any concerns or complaints will be listened to, taken seriously and acted upon. The recording of complaints are well documented and detailed. Policies and procedures are in place to protect service users from possible abuse. Evidence: There is a complaints procedure displayed in the entrance hall of the hall. All service users/representatives are given a copy. At the last inspection a requirement was made that all complaints received by the home, received verbally or in writing must be recorded in line with the homes own complaints procedure. In the last twelve months the home has received twenty two complaints, ninety nine per cent were resolved within twenty eight days and one complaint was upheld. Complaints were seen to be appropriately recorded with action taken and outcomes recorded.Following the last inspection, a good practice recommendation was made that all staff received training in dealing with and recording complaints. The manager confirmed that this has taken place. Service users spoken to were aware of the complaints procedure and said that they would ask their relatives to deal with complaints or speak to a member of staff. Both surveys completed by service users confirmed that they know how to make a complaint. Care Homes for Older People Page 17 of 27 Evidence: Since the last inspection we have not received any information regarding complaints about this service. All staff receive training in the homes policies and procedures for protecting service users from possible abuse and the homes whistle blowing policy. Training is provided to staff during their induction and then updated on a regular basis. The home has a copy of the Oxfordshire Safeguarding Adults procedures. One safeguarding adults referral has been made in the last twelve months and one safeguarding adults investigation has taken place. No referrals have been made for inclusion on the Protection of Vulnerable Adults list (POVA). Care Homes for Older People Page 18 of 27 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, 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. 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 safe, well maintained and spacious accommodation for service users. The layout and location of the home is suitable for its stated purpose. Service users expressed their satisfaction of the premises, especially their bedrooms. The home was found to be clean, well maintained and free from unpleasant smells. Evidence: Since the last inspection, an additional thirty beds have been registered with us ( the commission), twenty two beds on the ground floor and an separate eight bed unit for service users under the age of sixty five years of age. At the time of this inspection this unit was not in use. The home is purpose built and is suitable for its stated purpose. The home is spacious, although the dining rooms appear to be cramped for the number of service users. Attention has been given to making the home comfortable and welcoming. Corridors are designed for service users to walk around safely. Pictures and items of general interest are displayed on walls throughout the home. The manager confirmed that this is being developed further. Service users expressed their appreciation of their bedrooms and being able to personalise their bedrooms. One surveys completed by a service user, confirmed that the home was always fresh and clean and a second survey stated that usually the Care Homes for Older People Page 19 of 27 Evidence: home was fresh and clean. All areas of the home were seen to be clean, well maintained and free from unpleasant smells. From discussion with the housekeeping staff on duty, it was evident that they take pride in maintaining high standards of cleanliness throughout the home. Care Homes for Older People Page 20 of 27 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. Staff recruitment procedures are robust and protect service users from harm. Staffing levels are adequate to meet the needs of service users. Staff are well trained. Evidence: From discussion with the manager, staff on duty, examination of duty rosters and observation of staff routines, there appears to be adequate levels of nursing and care staff on duty supported by an activity organiser and a team of ancillary and administrative staff. Since the last inspection twenty three members of staff have resigned for a variety of reasons, when possible the manager undertakes an exit interview. Most staff vacancies have been filled, and currently there are vacancies for a two full time RNs. Vacant posts for an activity organiser, RNs, care and housekeeping staff have recently been recruited and are awaiting the outcome of police checks. Care staff are encouraged to undertake National Vocational Qualification ( NVQ) training. Seven care staff have completed NVQ at levels II or III, six care staff are currently undertaking the training at levels II or III and four care staff have been registered to commence NVQ level II within the next few months. All newly recruited staff complete an induction programme that meets Skills for Care standards. Each member of staff has a training and development programme. Training is well Care Homes for Older People Page 21 of 27 Evidence: organised in the home with all staff completing mandatory training as well as specialist training, as appropriate, to meet the needs of service users. Nursing staff are encouraged to undertake continous professional development . All mandatory training is updated as appropriate. From a sample of staff personnel files it was evident that the home has robust recruitment procedures in place. Two senior staff conduct all interviews and the process is recorded. Staff spoken to expressed their satisfaction of working in the home, felt valued and well supported. Staff said that morale had improved in the home. Communication systems in the home are well organised, with staff handovers taking place at the start of each shift. Regular staff meetings take place and minutes of these meetings were available for examination. Care Homes for Older People Page 22 of 27 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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 benefit from a well managed home. Evidence: Since the last inspection, Elisa Globert has been registered with us as the registered manager of the home. She is a well qualified manager, with both nursing and management qualifications. The manager is supported by a deputy manager. This post has recently become vacant, following a long period of the sickness of the previous post holder. In discussion with service users, relatives and staff on duty, all expressed the view that the home was well managed and run in the best interests of the service user. One survey completed by a service user stated that the manager is extremely helpful. Staff described the manager as having high standards , there is an open door policy and helpful and usually available, if I want to discuss something Care Homes for Older People Page 23 of 27 Evidence: Procedures are in place for dealing with service users monies, financial records are well maintained. Since the last inspection all nursing staff have received supervisory training and each RN has a number of care staff, who they have supervisory responsibility for. Following the inspection we received an action plan from the manager confirmed that the new deputy manager, once appointed will have responsibility for monitoring and overseeing the consistency and frequency of all formal supervision. The manager will continue to supervise all Heads of Departments. Policies and procedures are in place and are reviewed on a regular basis. The home has an annual business and development plan in place. It was noted during the inspection that the home did not have a contingency plan for in the event of major disruption to the service, such as lack of power, heating or water. Following the inspection we received a copy of the policy that is to be put into place. Reports written by a provider representative, following a monthly visit to the home, were available for examination. Regular audits take place and are undertaken by either the manager, senior nursing staff or member of senior management of the company. A sample of record relating to health, safety and welfare were examined and found to be well maintained and up to date. Quality assurance processes are robust and it was evidence that the views of service users, representatives and other stakeholders are sought on a regular basis. Care Homes for Older People Page 24 of 27 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 Older People Page 25 of 27 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 Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or 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) 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 Older People Page 27 of 27 - 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!