Inspection on 30/12/08 for Barna House

This is the latest available inspection report for this service, carried out on 30th December 2008.

CSCI found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Barna House 27/02/06

Barna House 26/09/05

Barna House 22/02/05

Barna House 21/06/04

Barna House 16/03/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Barna House 60 Clarendon Avenue Leamington Spa Warwickshire CV32 4SA     The quality rating for this care home is:   three star excellent 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: Suzette Farrelly     Date: 3 0 1 2 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 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 28 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Barna House 60 Clarendon Avenue Leamington Spa Warwickshire CV32 4SA 01926421186 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Eibhlin Agnes ThorpeSmith,Mr B Thorpe-Smith care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Barna House is a large converted town house providing domestic, homely accommodation for up to 12 older people. Nursing care is not provided at this Home. Service users have assess to community health services such as GPs, district nurses and other professionals. There are 10 single rooms, 3 of which have en-suite toilets, and 1 double room, the home also has 2 bathrooms and a large lounge/dining room. There is a patio area at the rear with raised flowerbeds, planted pots and hanging baskets. The home is located close to the town centre of Leamington Spa and is within easy reach of shops, churches, parks and doctors surgeries. Street parking for up to two hours is available in addition to pay car parks within a short distance. Bus stops are near by and the railway station is about a mile and a half away. 0 0 Over 65 1 11 Care Homes for Older People Page 4 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent 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: An unannounced visit was undertaken at this service to establish that the previous quality rating of 2 Star - a service that provides good outcomes for those living there has been sustained or improved. We collected information before attending the inspection such as notification from the home, concerns and complaints and feedback from those who use the service. During the visit we spent time with the people who live there and discussed with them their experience of living at this home. We observed how staff work with each other and those they care for. We read a variety of records to confirm that the home is well orgaised and run to the benifit of those using the home. Care Homes for Older People Page 5 of 28 We case Tracked two people, this involves reading their care records, discussing their needs with the person and the staff, checking that equipment needed is available and safe to use. We also checked records related to staff employment and support and records for quality assurance and manageing the service. What the care home does well: What has improved since the last inspection? What they could do better: There have been no requirments made at this inspection. The manager is aware that improvments can be made in a variety of areas. The way medication is transfered to the dining room needs to be considered to ensure that this is safe at all times. To improve the information that is recorded about the activities of each person, this will ensure that changes are recognised and will assist in evaluating if the activities are useful and meet the needs of each person. Up to date information about who to contact if there is an allegation or suspicion of abuse should be made available to all staff, this will ensure that appropriate action can be taken by anyone living or working at the home. Care Homes for Older People Page 7 of 28 Liquid soap and paper hand towels should be made available in the laundry so that staff can wash their hands when leaving the room. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 28 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 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them 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. Each person can be confident that they will have a full assessment to ensure that their neds can be met by the home before admission. Evidence: The home has had no new admissions since the last Key Inspection in 2007. They have a vacancy but this has not yet been filled. Paperwork available and discussion with the manager told us that full assessment before admission to the home is taken seriously. Areas such as health care needs and social needs are considered along with the individuals ability to fit in with the current group of people living at the home. The manager also told us that for those people who receive social service funding, admission would not be agreed untill a full assessment and care plan had been Care Homes for Older People Page 10 of 28 Evidence: received and an agreement to the needs required. There is an up to date Statement of Purpose and Guide that are available and give information about the home, its facilities and what can be expected from living at this home. The manager discussed how this could be improved and is committed to changing the format using more pictures and involving the people who live there in the redesign. The last key inspection report and Annual Service Review are available in the reception area along with the Concerns, Complaints and Comment books. The present Registration Certificate is also available and is up to date. Relatives and those using the service are encouraged to voice their opinions and to be actively involved in the home. Care Homes for Older People Page 11 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person can be confident that their care needs will be met by caring and sensitive staff. Medication management is robust and ensures that each person is safe. Evidence: On arrival to the home five people were sitting in the lounge, it was warm, cosy and homely. All the people looked well cared for, dressed appropriately and were awake and alert. Two people told us that they had a Really nice Christmas and that The staff are really good and care for us well. Two people were case tracked this involves reading the care records, talking to the staff and the people involved where possible and checking their medication. It was found that the written information available was clear and concise and gave all the information needed by the care staff to meet their needs. The care plans stated in plain English what the need was and how this should be managed. Risk assessments are also available for all areas that may cause a problem such as falls, nutrition and Care Homes for Older People Page 12 of 28 Evidence: the development of broken skin due to prolonged pressure. The care plans are evaluated on a monthly basis or more often if needed and changes are made to the care plans if there is a change in the need of the person. Each month a full review is completed and the resident and their relative are asked if they would like to participate in this process. All relative have been sent a letter inviting them to this session, some have agreed to participate, and others have sent comments to the home. The monthly review is signed by either the resident or their relative where possible. Staff spoken to were able to tell us the care needs of the people in the home and were up to date with those who were unwell or required more care. The staff were attentive and spent time with each person as needed. The manager ensures that all the people living there receive visits from other professionals as needed and this is clearly recorded in the care records. During this inspection the GP was called for a person who has been unwell and was not responding to treatment, admission to hospital was organised in a sensitive and caring manner. One relative spoken with told us that the manager and her staff keep the family informed of any changes and are always available to discuss care and other needs as they arise. They also told us that the care is excellent and that when they leave they are confident that all their relatives needs will be met to a high standard. The medication was checked. The deputy manager has control of this area and told us how the medication was administered and how the audits were carried out. The medication is stored in a suitable cupboard and the the senior person in charge of the shift keeps the keys. Each person has a separate Medication Administration Record (MAR) that has all the medication prescribed written and staff sign when this is adminsitered. There were no gaps and any codes used were explained. Hand written prescriptions should be signed by two people to minimise the risk of mistakes. There are no controlled drugs at this time, storage is available and meets with present legislation and the home have a suitable book to record controlled drugs when this required. They have recently changed their chemist and now use Boots who have assisted them to make changes to the process and they supply a better quality of service. We were told that Boots will carryout an assessment of their medication processes in 2009 and that this will assist the home to ensure that they continue to handle medication properly and to make improvements. Care Homes for Older People Page 13 of 28 Evidence: Medication is taken from the cupboard and put onto a large tray, which is then taken upstairs to administer to each person separately. This is not safe practice, if an emergency occurred the medication may have to be left unattended. The manager told us that she would discuss alternatives with Boots and change the system. No one self medicates at this time. There is a Homely medication policy and the GP has signed to state that he is happy with this. It is good practice to ensure that a list of Homely Medication is signed for each person to ensure that there are no reasons that the over the counter medicines would interact with medication already prescribed. The manager told us that she would discuss this with each GP and make the necessary changes. Four people who live here and one relative told us that the dignity and respect of each person was always taken into account. Observation told us that staff respond to each person as an individual and respect their wishes and ensure that their privacy is maintained. Care Homes for Older People Page 14 of 28 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. The people who live at Barna House can be confident that their social needs are met and that they are helped to maintain the relationships with friendss and family. Evidence: The home has recently employed an Activity Organiser who was working in a voluntary capacity. The decision was made as this persons input has increased the positive relationship between the people that live there, has encouraged more activities and relatives are now more involved. The Activity Organiser told us that she really enjoyed her role and like working with each person to find what they enjoyed, she also told us that she recognised that some of the people were happy to observe and not participate. One person told us that they enjoy the activities and another person told us that they like the Wednesday Movie Afternoon where they watch films they enjoy and eat pop-corn and cakes. Outside activities are organised, such as visiting the local park in the summer and one person likes to visit the local supermarket, which they will do with staff when they go shopping. Care Homes for Older People Page 15 of 28 Evidence: One person who normally refused all activities has been encouraged to find something they like. This has been achieved and the person concerned is delight as is her family. There are photo albums and photographs on the walls showing the Christmas festivities and other activities throughout the year such as Birthday parties, planting flowers and dancing. Time was spent with the cook and examining the kitchen. The kitchen was clean, well organised and had a good stock of fresh and non-perishable foods. There is a three week menu, the cook told us that they do not always stick to this menu and it was seen that some changes had been made. Each person is told what is available for dinner and asked if they would like anything different. The cook told us that for the past few weeks due to an outbreak of Winter Flu the people living there have not had a good appetite and she has tried to encourage them to eat by offering different foods such as soup. The meals are served in the dining room, which is part of the open plan lounge. The tables are laid with table-clothes and place mats. It is bright, cheerful and homely. The mid-day meal was gammon and chips and all the people seen in the dining room enjoyed their meal. Three people told us that the food was lovely and that they always had enough to eat. Each person has a nutritional assessment and one person, who had some difficulties with their diet, has a clear plan to state how this is managed. The cook was also aware of this. Each person is weighed monthly, it was noted that some people refuse from time to time and this was discussed and it was suggested that upper arm measurements are used to determine changes in weight. The home has been awarded the Gold Star Award for Food Hygiene from Environmental health in 2007 and told that they would not receive a further visit for a couple of years. There are drinks and snacks available on request and at regular intervals throughout the day. The staff have access to the kitchen and food at all times and the people who live there are encouraged to drink plenty of fluids at all times to maintain their well being. There is an open policy for visiting and relatives are always made welcome and included in the lives of those who live there. One relative stated in the survey sent by the home - We come and go as we please, its like visiting mum at home and another Care Homes for Older People Page 16 of 28 Evidence: stated We are extremely happy with the care at Barna. One relative spoken to told us that they visit regularly unannounced and are always made welcome. They also told us that the manager and her staff always include them in the care and daily life of their relative and that they feel secure and safe that the care for both the physical and social needs are always met. Care Homes for Older People Page 17 of 28 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. The people who live at Barna House can be confident that their concerns and complaints will be taken seriously and that are staff are aware of their responsibility to keep them safe from harm. Evidence: The home has a clear complaints policy and process, which is available in the reception area. There is also a book for the people who live there, the relatives and staff to record any comments or complaints that they have. The manager discussed her proactive style of dealing with minor concerns that are raised, stating that any daily issues raised are dealt with immediately and this prevents issues turning in to major complaints. A relative told us that they have never had any reason to complain but felt assured that if they did the manager would deal with it in an appropriate manner. One person who lives at the home told us she could tell any of the staff if she was unhappy or had any concerns, but she told us she was completely happy and staff responded to her needs quickly and always with a smile. There is a suitable safeguarding policy available. Staff received training in 2006 and the manager is organising up dated training for the beginning of 2009. When Care Homes for Older People Page 18 of 28 Evidence: discussing the process the manager and deputy were aware of their responsibility in relation to safeguarding, however, they were unsure of the number that they would need to ring to inform Social Services. This was discussed and the manager is committed to ensuring that this information is available for all staff. The home managers small amounts of personal monies for the people who live there. This was seen and found to be robust and correct protecting each person from financial abuse. Employment process ensures that staff employed are suitable to work with vulnerable adults. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, 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. Each person can be confident that they live in a home that is comfortable, safe and meets their individual needs, making this experience pleasent and pleasing. Evidence: The home is clean, tidy, well organised and free from unpleasant smells. The lounge and dining area are pleasant and homely and meet the needs of the people living there. There are two stair lifts available to the upper floors. The bedrooms on the mezzanine area have a few steps and those who occupy these rooms must be able to use these stairs. The corridors are narrow but enable wheel chair access if needed. Most of the people living at the home are mobile with aids and assistance. Five bedrooms were looked at and each was individually furnished some with the persons own furniture. Family picture, paintings and other personal items were visible making the room a personal place for each individual. There is a handyman available who carries out basic repairs and maintains the decor of Care Homes for Older People Page 20 of 28 Evidence: the home. The manager also has access to an electrician and plumber for more specialist jobs around the home. There is a programme of refurbishment and items are replaced, as they are needed. The laundry is small but organised and has a new washing machine with sluicing facility and new tumble drier. There were no paper hand towels or liquid soap in this area to ensure that staff can wash their hands before leaving this area. The manager assured us that this would be addressed immediately. Aprons and gloves are always available for staff when needed and there is proper disposal of incontinence products. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent 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. The people who live at Barna House can be confident that they are cared for by well trained staff and that there are always enough staff avaialble to meet their needs. Evidence: There are presently eleven people living at Barna House, the manager told us that due to the Winter Flu the dependency level has increased as a number of the people living there have been unwell. Generally the dependency is low to medium with some individuals able to manage most of their own care. From discussion with the manager and staff and observation it was confirmed that there are enough staff available to meet the needs of the people living at Barna House. Each day the manager or deputy with 2 carers and the activity organiser are available to address the needs of each person. There is also a cook and cleaner available. In the evening there are two carers and at night one carer is awake while another sleeps in. One relative told us that they are satisfied that the staff are dedicated and know what they are doing. Training information told us that approximately 75 of the care staff have completed the National Vocational Training (NVQ) at Level 2 and/or 3 in care, this ensures that the staff have sufficient knowledge and understanding to care for the Care Homes for Older People Page 22 of 28 Evidence: needs of each person. The staff have also attended other training related to their job such as Food and Hygiene, Dementia Care and Safeguarding. The manager told us that up dated Moving and Handling Training is organised for January 2009. One recently employed staff members file was looked at. This told us that the management ensure that all checks are carried out and to demonstrate that the person is fit to work with vulnerable people before employment. All new staff commence the Skills for Care Induction Standards after the initial settling in period. All staff receive formal supervision every two months, at this time areas of work, training and progress are discussed. One relative stated in the survey from the home It is a well run home, with proper routine and various activities and another stated All the staff are dedicated. Care Homes for Older People Page 23 of 28 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. This is a well run service that considers the views of those who use the service and include staff, relatives and the people who live there is the daily running of the home. Evidence: The manager has worked at Barna House for more than seven years and has a good relationship with the people who live there, the staff, relatives and other professionals. She continues to improve her knowledge and has completed her National Vocational Qualification Level 4 in Care this year and has almost completed the Leadership and Management Qualification. This home is well managed and this is noted through the organisation and management of areas such as care planning, daily routines and care given to each person, staff knowledge and recognition of their individual roles. All staff receive formal supervision six times a year and the manager and deputy manager work along side the staff on a daily basis and offer informal supervision. Care Homes for Older People Page 24 of 28 Evidence: There is a quality assurance system in place. The manager ensures that various areas of the service are checked on a yearly basis and changes are made where required. Staff and relatives are surveyed and discussion takes place to create incentives and to make changes to improve the service. From the last survey changes made included new equipment for the kitchen, employment of the activity organiser and some changes to the general environment. Also the manager has recently invited all relatives to attend the monthly review of the care provided to their relatives. Some relatives have taken this opportunity and others have sent information to the service. The home manages personal monies for most of the people living there. Each person has individual records stating the amount of money that comes in and what it is used for. Receipts are available for all money spent. The receipt from the hairdresser contains all the names of those people who had their hair done that day. It is suggested that each person has an individual receipt to maintain Data Protection. The manager agreed to make this change. The home has contracts in place to ensure that all equipment is tested and is fit to be used. The management also ensure that weekly checks are carried out on the fire system, and any faults are reported immediately. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 4 9 9 12 18 An assessment of how medication is transported should be undertaken and a safer process developed. Two peeple should sign all hand written prescriptions to minimise the risk of mistakes. Records of daily activities for each person should be more detailed and describe the activity and their participation. Up to date information about contacting Social Services in the event of a suspicion or actual abuse should be made available to all staff. Liquid soap and paper hand towels should be made available in the laundry room so that staff can wash their hands before leaving this area. 5 26 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (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 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!