Random inspection report
Care homes for older people
Name: Address: Beechwood Lodge 148 Barnhorn Road Bexhill-on-Sea East Sussex TN39 4QL zero star poor service 29/10/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Michele Etherton Date: 1 4 0 4 2 0 1 0 Information about the care home
Name of care home: Address: Beechwood Lodge 148 Barnhorn Road Bexhill-on-Sea East Sussex TN39 4QL 01424844989 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Robert Jempson Type of registration: Number of places registered: Conditions of registration: Category(ies) : Beechwood Lodge Limited care home 20 Number of places (if applicable): Under 65 Over 65 0 old age, not falling within any other category Conditions of registration: 0 Service users must be older people aged sixty-five (65) years or over on admission. The maximum number of service users to be accommodated is twenty (20). Date of last inspection Brief description of the care home Beechwood Lodge is a care home registered to accommodate a maximum of 20 older people. The premises are situated in a residential area of East Sussex near to Little Common and just over a mile from Bexhill-on-Sea. The Home is close to local shops and amenities and the coast is less than a mile away. Accommodation comprises of twelve single bedrooms and four double bedrooms, all of which have en-suite facilities. Bedrooms are located on two floors. There is a shaft lift to enable service users ease
Care Homes for Older People Page 2 of 18 2 9 1 0 2 0 0 9 Brief description of the care home of access to each floor. In addition there are two bathrooms and six toilets. The Home has two lounges, a billiard room and a dining room to provide communal space. There are well maintained rear gardens and car parking facilities at the front of the property.The current fees range from £460 - £590 per week. There are no extra charges made, except for personal items such as clothing and toiletries etc.Potential new service users can obtain information relating to the home by word of mouth, CQC inspection reports, care managers and placing authorities, contacting the home direct and Social Services. Care Homes for Older People Page 3 of 18 What we found:
A random inspection of this service has been undertaken to assess progress made towards compliance with outstanding requirements some of which are long standing. Our inspection of this service has involved the assessment of AQAA information submitted recently by the home and also the findings from an unannounced site visit conducted on 14th April 2010 between 9:30 a.m and 15:30 p.m. During our site visit we were able to examine a range of documentation and records and speak with the registered provider/manager and the deputy manager to assess improvements made and highlight where shortfalls remain. The recent AQAA received by the commission was received within the designated timescale, completion of this information has marginally improved. It would benefit from greater detail to illustrate the day to day operation of the home, and also a fuller reflection on how previous identified shortfalls have been addressed. These improvements have been discussed with the registered Provider/manager. We examined the files of all present residents and found the majority to contain confirmations signed by residents or their relatives that Statement Of Purpose, user guide and terms and conditions information had been received, however, existing copies of these documents are out of date with agency addresses etc in need of changing. The provider has indicated within AQAA information the aspiration to update the Statement of purpose and user guide and make this more personal and user friendly this is still to be developed we therefore consider the requirement in regard to ensuring residents receive copies to have been only partly met. The user guide is also out of date again providing inaccurate contact details for the commission. A draft copy of the terms and conditions information is not provided although the guide makes reference to this information being available from the registered provider, we consider prospective e residents should have a opportunity to see a draft terms and conditions document to inform their decision to accept a place or not. The service has met an outstanding requirement by ensuring that each resident now has a revised and personalised plan of care this is not the case for those people who return from time to time as respite residents, and we have discussed the importance of staff being provided with updated care plan information for respite clients to ensure they understand any changes in need and delivery of support. We found that overall new care plans are very informative for staff, enabling them to support residents effectively in line with their preferences, all support plans have been viewed, some in more detail than others Some of the files we looked at hi lighted a need for additional information to be added or clarified to better inform staff and we have brought this to the attention of the provider and deputy manager. Log entries are being well maintained, each resident now has their own daily log book. These tell us that for several residents who experience disturbed nights the home is
Care Homes for Older People Page 4 of 18 undertaking monitoring of the level of nighttime activity for these residents, and whilst this is good practice, it is unclear, what or who this information is being collected for and this needs clarity within the relevant care plans. Care plans viewed indicate the majority of residents are being supported and encouraged to maintain a level of independence, any support offered by staff is managed sensitively to not appear intrusive, and this is valued by the residents. It is important with the introduction of the new care plans that the content of files is standardised to bring consistency to the type and range of information collected and recorded by staff. We noted several serious incidents where residents had fallen and staff had acted appropriately to ensure they received appropriate interventions by attendance at A&E, however, the registered provider/manager had failed to inform the Commission of these significant events in keeping with reporting responsibilities under Regulation 37 of the Care Homes Regualtions 2001. A health report plan has also been developed for each resident. We are satisfied that the service has implemented a review system for updating care plan information, however this had not been updated for march 2010 and we discussed the importance with the provider and deputy of maintaining reviewing frequencies. One health plan we viewed recorded that the BMI index is low and the resident is at risk of malnutrition, guidance has been developed for staff in regard to issues of underweight and the relevant health report states that the BMI Should be recorded monthly owing to the level of risk. Examination of records and discussion with the deputy manager indicates this is still to be implemented. In regard to the same resident we found care plan information still lacks clarity as to whom is responsible for ensuring air mattress pressures are maintained appropriately for this resident. We noted a body chart used to record injuries sustained by one resident in hospital, this would be considered good practise if staff are routinely using this visual recording aid for all such events both internal and external to the home, which they are not. A range of risk assessments are now in place for every resident and we consider the outstanding requirement to be met, however through our discussion with the deputy manager and examination of documentation we noted that whilst care staff have an awareness of other possible risks some residents may be subject to i.e.poor nutrition, skin breakdown, or continence issues; formal risk assessments have not been devised to inform staff practise and ensure that all appropriate risk reduction measures are in place. We have discussed with the deputy manager the importance of including these. Consent information in regard to the locking of the front door, medication, hourly checks, room keys etc have been introduced but are not used consistently across the resident group and this needs to be standardised to avoid confusion or omissions of information. Detailed Guidelines have been developed to inform staff of how to work with individual residents in some areas of need. Examination of documentation indicates that the service management have a clear understanding of the limitations of the service and where changes in need can no longer be supported within the service discussions with relatives and social services ensures
Care Homes for Older People Page 5 of 18 alternatives are sought. Examination of self administration assessments for medication, medication records, daily log entries and discussion with the deputy manager highlights that there remain shortfalls within the medication administration arrangements, and these could compromise resident safety. A Register of administering staff is being maintained. Receipt of medications into the home are being appropriately recorded onto the medication administration records (MAR). During our examination of records we noted that two residents had not been administered a single weekly dose of medication, we found no reference to this mistake within daily log information on the relevant days or actions taken by staff as a result of these incidents, in accordance with policy and procedure, the registered provider/manager was unaware of these omissions although they had occurred a week previous to our visit. The commission has not been notified about this incident, and investigation into the causes of the errors is still to be implemented. Some care plans viewed contained self administration of medications assessments and yet log entries for the same residents indicate they are having their medications administered by staff. We have discussed these anomalies with the deputy manager who advises that in such cases residents are usually administering only some of their medication, the present arrangements therefore need to be made much clearer within care plan information. Issues of safe storage for self medicating individuals has not been addressed, we have confirmed from staff that some non self medicating residents still have prescribed creams left in their rooms, this remains a risk to the health and safety of those residents who may have a degree of confusion that causes them to touch medication that is not theirs if they are entering other residents rooms. There are still no PRN guidelines for staff to follow to aid consistency in administration. Generally we found Medication sheets to be completed reasonably well. Handwritten changes are being signed for but not dated. We have discussed the importance of handwritten comments added to MAR records by Pharmacy staff to be highlighted and consultation with the relevant pharmacy staff to ensure these are signed for. In view of some of the shortfalls that remain in the medication arrangements within the home we do not at this time consider the outstanding requirement to be met. A previous recommendation for the home to obtain royal pharmaceutical society guidance for care homes has not been achieved although the deputy indicated she had discussed this with the homes pharmacy, we have further suggested a drug reference book for staff to enable recognition of oral medications more readily and enable them to better understand their purpose and side effects. The new AQAA informs us that two complaints have been received and resolved within a 28 day period. Survey feedback from residents indicates they find the provider and staff approachable and would feel comfortable raising issues if needed, the complaints procedure has been revised and is displayed on the notice board, its content has been discussed with staff thereby meeting a previously outstanding requirement. Updated
Care Homes for Older People Page 6 of 18 versions of the complaints procedure need to be made available to residents in any pre printed information about the home provided to existing and prospective residents. The provider now has obtained a copy of locally agreed protocols for the management of safeguarding issues by lead agencies and this is accessible to staff, he has also developed a laminated flowchart for staff reference explaining the identification and processing of a safeguarding issue and this is on display within the office for staff to refer to. Staff have completed adult safeguarding training and a further refresher course is booked with an external training provider for June 2010. There have been improvements also in the completion of all mandatory training by staff including health and safety. Risk information and guidelines have been developed to inform staff practise. Whilst we accept that the provider has met the outstanding requirement for staff to be trained in the literal sense there are sufficient shortfalls still within the management of medication, staff recruitment, induction and supervision that may continue to compromise resident safety. General risk information is still to be updated and made available to staff. The internal appearance of the home remains comfortable and pleasant providing a clean homely atmosphere for residents with no unpleasant odours. We have not on this occasion assessed the premises, only the outstanding requirement. We found no evidence that general risk assessments for the home environment have been updated at this time and this requirement therefore remains unmet. A previous recommendation that periodic assessment of the premises by a suitably qualified OT or other has not been acted upon at this time. The Registered provider/manager was not initially present at the home when we visited on 14th April, although he was able to join us shortly afterwards. During our visit we established that the home is still to establish a key work system which remains under consideration. There are currently only twelve residents two of whom are currently in hospital, although some residents have experienced changes in need log entries and survey feedback does not indicate any concerns from either staff or residents in regard to current staffing levels at this time. Apart from a cleaner there are currently no other ancillary staff to undertake cooking, laundry or maintenance works and these roles are covered by care staff and the provider. Resident and relative survey feedback did highlight a need for additional activities and if actioned will impact on current staffing levels and availability of staff, therefore staffing levels should remain under review. We are advised by AQAA information submitted in march 2010 that 6 out of 8 care staff have NVQ2 or above this, exceeding the requirement of 50 . Some of the newer staff are being registered for NVQ courses. The AQAA informs us that there is a recruitment procedure in place and when we last assessed records we found these to be better organised and information more easily accessible ,albeit a significant amount of individual recruitment information remains missing, e.g. references, lack of interview records, ensuring gaps in employment are
Care Homes for Older People Page 7 of 18 clarified and reasons for leaving previous care roles verified. On this occasion we examined three staff files, one from an existing staff member and two new employees. We found that the file for the longer serving staff member contained an application form, 2 references which were in keeping with those referees given on the application form,CRB information and POVA 1ST. No identification was noted within the file, and no evidence of interview, checks on employment gaps, or verification of reasons for leaving previous care role. A copy of Terms & Conditions is in place but no Job description for the position held. A record of mandatory training attended with appropriate certificates has been noted. We looked at recruitment files for two new staff to ascertain whether improvements to recruitment practise has been sustained. We noted in respect of one new staff member their recruitment file contains no application form with no employment history, health statement or the ability to assess whether references obtained are from the most recent and relevant employers. We also noted that a previous CRB was for a different service and not transportable, although the registered provider insists that a new CRB has been applied for we could find no evidence that the new CRB or ISA check have been applied for. There is a job description for the current role and a letter of appointment when appointed previously and briefly by the home. A signed supervision contract in respect of a previous appointment at the home has not been updated. ID was found to be in place. We found no evidence that formal supervisions are being conducted at this time. Training indicates that this staff member is still to complete the majority of mandatory training. We examined recruitment information for a 2nd new member of staff, the file contained , personal details information, an application form, two references viewed indicated no link to previous and last employers. A medical statement is in place. A job description is also provided for the role they are undertaking. A CRB has been obtained but no evidence of an ISA check being returned although evidence is in place that indicates this may have been applied for, the provider has indicated this may not have been filed appropriately upon its return. A Supervision contract was found to be in place but no evidence of any recorded supervisions since the staff member commenced work at the home in November 2009. We found some evidence of ID although nothing with a home address on. Current photos of staff are not in evidence. As we are advised that the provider has appointed a new member of staff to take over the management of the home, who is to commence work on 1st May 2010. We have asked to see the recruitment file for this individual. The registered provider was able to provide us with a CV only. We found no evidence of application form or interview records. We found no evidence that gaps in employment history have been explored and reasons for leaving previous care roles have been verified. We are assured by the registered provider that he has sought references and CRB and ISA checks have been applied for, but we were provided with no evidence that these applications have been made, neither has any copies of ID been obtained or a statement as to the appointed staff members health. We are concerned that our examination of staff records has provided evidence of the continued failure in compliance by the registered provider with regulation 19 of the Care
Care Homes for Older People Page 8 of 18 Homes Regulations 2001, and to ensure that a robust procedure for the recruitment of new staff including the new manager has been implemented and adhered to, this requirement remains unmet. The provider has satisfied a previous requirement by establishing a training programme for staff to ensure mandatory training is kept updated, but is unable to evidence that new staff are being provided with a satisfactory induction to the care home and their role in keeping with Skills for Care Induction standards. A completed AQAA has been received from the service, this was returned within timescale although the AQAA would benefit from additional information which we have discussed with the registered provider we are satisfied that the service has now met this requirement. Examination of documentation indicates that whilst the home has established a system of surveying the views of relatives and residents, there is no mechanism at this time for the analysis of survey feedback or satisfactory systems to measure quality of service delivery, the provider is still to produce an annual report of quality assurance findings. In discussion with the provider we are assured that he has identified a quality assurance tool to monitor service quality, but, as this is still to be implemented the requirement remains outstanding. We are assured that financial accounts for the service for the 2007/2008 period have now been signed off although these were not available to view, however the registered provider is still to develop a financial and business plan and this remains an outstanding requirement. The registered person/manager is on site most days and speaks with staff and residents routinely these informal discussions are not recorded and there is no established monitoring by the registered provider of documentation and records, he has identified documentation to formally record these visits but has yet to implement them, and this requirement therefore remains outstanding. During our site visit to the home we were given full access to records and documentation and are satisfied that although there are significant gaps in some information within staff files this is because the information has not been obtained and is not because it is being kept elsewhere. We are satisfied therefore, that the majority of records were accessible and the home has met an outstanding requirement in regard to this. When we reviewed daily log entries and other documentation including medication records we noted at least four events which should have been notified to the Commission under regulation 37 of the Cares Homes Regulations 2001, these include a medication error, the death of a resident and two injuries sustained by residents at the home requiring hospital treatment one of which is serious. This therefore remains an outstanding requirement. As a result of our site visit we have assessed the home as having met seven of the sixteen outstanding requirements. What the care home does well:
Care Homes for Older People Page 9 of 18 The service provides residents with a spacious, clean and comfortable environment. Residents enjoy the quality of the furnishings and appearance of the home and its homelike atmosphere. The home is well located close to public transport and within a short distance of shops. It is generally accessible. The health support needs of residents are well met with evidence that appropriate interventions are sought and that links with health care professionals are good. Residents enjoy a varied and nutritious diet that takes account of their own preferences and affords them opportunities to choose from more than one option. Continuity within the staff team means that residents benefit from a familiar group of experienced staff who has been provided with updated knowledge and skills to better safeguard residents. The service respects the right of residents to be individual, to maintain a level of independence and privacy without intrusion of staff, where residents require or actively request support this is provided sensitively in keeping with the preference of the resident concerned. What they could do better:
Feedback from residents and relatives continues to reflect a positive view of the service and a belief that residents receive good outcomes, our inspection has also identified improved compliance in some areas meaning that six of the outstanding requirements have been met. When we visited the service in October 2009 we were satisfied that the registered provider had ensured that all existing residents had received Statement of Purpose and user guide information, however, we identified the need for this information to be updated to ensure prospective and existing residents have access to accurate information. To date the registered provider/manager has failed to update this information and as a consequence residents are not provided with accurate information about accessing the Commission, staffing structure information is aspirational rather than accurate and user guide information does not provide prospective residents with a copy of terms and conditions of residence to inform their decision making. The AQAA informs us that updating of this documentation is an area the provider wishes to address in the future. The registered Provider has failed to update and make available general environmental risk information, this informs staff and ensures that measures are in place to minimise environmental risks to residents, this is also an outstanding requirement of the Health and safety officer from the EHO. The registered provider has failed to provide oversight of the arrangements for the storage, administration and recording of medication, and was unaware until we hi lighted it that medication errors had occurred for two residents. The registered provider has failed to ensure that residents are safeguarded by the implementation of a robust recruitment procedure, and marginal improvements to the
Care Homes for Older People Page 10 of 18 recruitment procedure noted at the last inspection have not been sustained by ensuring all required documentation is in place for new staff. Although staff complete supervision contracts there is no evidence from the three files viewed that staff are in receipt of regular recorded supervision or that monitoring of staff competency and performance is being undertaken routinely to drive up service quality. New staff are provided with a cursory induction to the home, this lacks substance to enable the registered provider/manager to undertake an assessment of their competency or ensure they have sufficient knowledge and skills to support residents effectively and safely in keeping with the Nationally recognised Skills for Care Common Induction Standards. The registered provider/manager is still to develop and implement a business and financial plan, and provide a copy of this information to the Commission, some financial accounts have now been completed but those for 2008/2009 remain outstanding. We have reminded the registered Provider of the need to ensure that the Commission is kept informed and provided with the information requested as it becomes available. Our examination of records indicates that there have been at least four significant events happen at the home that have not been notified to the Commission, guidelines and procedures make clear to staff that the Commission must be notified but the registered provider/manager has not ensured that this happens. The registered provider/manager as the sole director of Beechwood Lodge Ltd is required to undertake formal visits to the home and to record the outcome of these visits, the registered provider is aware of this responsibility and has sought an appropriate recording tool to undertake this activity, this is still to be implemented. The registered provider/manager is undertaking to survey relatives and residents but is still to implement a mechanism for analysing their feedback and incorporating this into service development plans, no system currently exists for the registered provider to routinely monitor and report on service quality. As a result of these outstanding requirements a code B notice has been issued, and the Commission may decide to take further enforcement action as a result. We have indicated previously our concerns that the Registered provider does not have the necessary skills, leadership, or qualifications to undertake the management of the home on a day to day basis or effect sustained improvement, and this is evident from the continued shortfalls in key areas of service delivery and practise that directly impact on the safety and well being of residents. . 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 2. Care Homes for Older People Page 11 of 18 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 1 5 That all residents are provided with an up to date and amended copy of the Service user Guide and Statement of Purpose That all residents are provided with an up to date and amended copy of the Service user Guide and Statement of Purpose 30/06/2009 2 9 13 All care staff administering 30/06/2009 medication must receive certificated training to evidence they have achieve the appropriate competency to do so safely. Residents who self medicate should be provided with secure and fixed storage facilities within their own rooms. Administering staff must adhere to the medication policy and procedure to ensure safe practice in administration All care staff administering medication must receive certificated training to evidence they have achieve the appropriate competency to do so safely. Residents who self medicate should be provided with secure and Care Homes for Older People Page 12 of 18 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action fixed storage facilities within their own rooms. Administering staff must adhere to the medication policy and procedure to ensure safe practice in administration 3 19 13 That staff have ready access 30/06/2009 to and are made aware of the homes general risk assessments. That staff have ready access to and are made aware of the homes general risk assessments. 4 29 19 That staff recruitment 30/06/2009 procedures are robust and ensure that recruitment practice must comply with the Care Homes Regulations 2001. (This is an outstanding Requirement from the inspection in April and October 2006, June 2007, February 2008 and in June 2008) That staff recruitment procedures are robust and ensure that recruitment practice must comply with the Care Homes Regulations 2001. (This is an outstanding Requirement from the inspection in April and October 2006, June 2007, February 2008 and in June 2008) 5 30 18 A suitable induction and foundation programmes 30/06/2009 Care Homes for Older People Page 13 of 18 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action must be implemented to enable staff development. (This is an outstanding Requirement from the inspection in April and October 2006, June 2007, February 2008 and in June 2008) A suitable induction and foundation programmes must be implemented to enable staff development. (This has remained an outstanding Requirement, which has been repeated from the last seven previous inspections.) 6 33 26 The Registered Person as a 01/12/2009 representative of an organisation must undertake visits to the care home in accordance with this regulation at least once per month, and shall interview with their consent and in private a sample of residents and care staff as necessary to form a opinion of the standard of care provided in the home, carry out an inspection of the home and prepare a written report on the conduct of the home which must be made available to the Commission. The Registered Person as a representative of an organisation must undertake visits to the care home in accordance with this
Care Homes for Older People Page 14 of 18 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action regulation at least once per month, and shall interview with their consent and in private a sample of residents and care staff as necessary to form a opinion of the standard of care provided in the home, carry out an inspection of the home and prepare a written report on the conduct of the home which must be made available to the Commission. 7 33 24 The registered person must 30/06/2009 be able to demonstrate how the home provides a good quality service for residents and the measures necessary to improve the quality and delivery of the service provided in the home. (This is an outstanding Requirement from the inspection in June 2007) The registered person must be able to demonstrate how the home provides a good quality service for residents and the measures necessary to improve the quality and delivery of the service provided in the home. (This is an outstanding Requirement from the inspection in June 2007) 8 34 25 That a financial and business 30/06/2009 plan is sent to the CSCI and is made available for future inspections. That a financial and business
Care Homes for Older People Page 15 of 18 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action plan is sent to the CSCI and is made available for future inspections. 9 38 27 The Registered person shall 01/12/2009 give notice to the Commission without delay of the occurrence of the death, illness, and other significant events made clear within this regulation, and any notification made orally in accordance with this regulation shall be confirmed in writing. The Registered person shall give notice to the Commission without delay of the occurrence of the death, illness, and other significant events made clear within this regulation, and any notification made orally in accordance with this regulation shall be confirmed in writing. Care Homes for Older People Page 16 of 18 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, 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 17 of 18 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 18 of 18 - 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!
