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Inspection on 14/05/09 for Bulwer Lytton House

Also see our care home review for Bulwer Lytton House for more information

This is the latest available inspection report for this service, carried out on 14th May 2009.

CQC found this care home to be providing an Good 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents live in a homely and clean environment which meet their care needs. They appeared well dressed and well cared for. Some were observed participating in a group activity, called Reminisence, that was held before lunchtime and they seemed happy and relaxed. The residents have access to all the communal areas of the home. Many of the residents enjoy their walks in the secure communal courtyard and garden around the six bungalows. Some were seen walking about in the garden at different times throughout the day. Staff were vigilant to ensure that the residents were safe in the garden throughout. The managers and staff show enthusiasm in their work and have demonstrated their skills and knowledge about the people in their care. The duty managers on site were seen supporting the care workers in the respective bungalows. Team working was evident. Members of staff interacted well with the residents and readily assisted those residents who needed help. Both residents and visitors spoken to give positive feedback about the care and service provided. Comments received from residents and relatives included: "The staff are very kind and helpful." "The staff are very good." "I like my bedroom. It is cleaned every day." "The food is good." "I have no complaints. The staff are very good." "The care is excellent." "They are wonderful staff." "My (resident) is well cared for. I am very happy indeed. Such wonderful and caring staff. Nothing is too much trouble. The staff always give service with a smile." "The staff are wonderful to (the resident) and also to the visitors. We are always made welcome." "The residents are treated with respect."

What has improved since the last inspection?

All the statutory requirements made in the last inspection report have been met. Since the last inspection all the written care plans are in person-centred format to reflect the person-centred care provided. This ensures that those who are looking afterthe residents have the required information to deliver the personal and healthcare needs of the people living in the home. Since the last inspection, the activities have improved with more choices, increased one-to one activities and increased hours allocated to group activities.

What the care home could do better:

It was noted that the handwritten notes on the Medication Administration Record (MAR) charts were not signed or dated by the author. In order to ensure that medicines are administered safely, and to enable case tracking of written information, it is important that all handwritten notes on the MAR charts are signed and dated. It was noted that in the small bungalows, where one care worker is allocated per shift, some of the residents may not be given one-to one activities or be supervised appropriately. Since the inspection, the home manager has revised the staff duty rota to ensure that there are at least two care workers during peak periods in each of the smaller bungalows (namely 2, 3, 5 and 6) to the benefit of the residents who have dementia and to ensure that these residents are supervised at all times.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bulwer Lytton House Lytton Fields Knebworth Hertfordshire SG3 6DW     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: Yoke-Lan Jackson     Date: 1 4 0 5 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 26 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 26 Information about the care home Name of care home: Address: Bulwer Lytton House Lytton Fields Knebworth Hertfordshire SG3 6DW 01438818000 01438818006 Bulwer@quantumcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Quantum Care Limited care home 56 Number of places (if applicable): Under 65 Over 65 56 56 56 56 dementia learning disability old age, not falling within any other category physical disability Additional conditions: OP-56, DE(E)-56, LD(E)-56, PD(E)-56 Date of last inspection Brief description of the care home 0 0 0 0 Bulwer Lytton House is a purpose built home accommodating up to 56 elderly people and comprises six bungalows grouped around a separate administration and reception area. Each bungalow is self-contained and has its own paved sitting out area. Most of the bungalows are linked by covered walkways, and one bungalow has been considerably extended to provide sixteen places for mentally frail older people. The administrative centre is also of bungalow construction and contains the reception, offices, laundry and main kitchen. There is also a large activity area that is used for communal functions. Bungalow 1 provides 8 intermediate beds for older people coming from hospital before returning to their own homes, and the service works in partnership with staff from Lister Hospital. The home is located in the centre of Care Homes for Older People Page 4 of 26 Brief description of the care home Knebworth, close to the main line railway station. The home charges £437.78 to £585.00 per week. Information about the home and the service it offers is contained in the Statement of Purpose and Service Users Guide. A copy of these and the most recent CQC inspection report are available in the home. Care Homes for Older People Page 5 of 26 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: This unannounced inspection was carried out on 14/05/2009. The service was last inspected in April 2008. The registered manager and the duty managers were present. There are currently 56 people in residence. The inspection included a tour of the premises. Time was also spent observing how the staff interacted with the residents. Staff, residents and visitors were spoken to and key documents were examined. The inspection ended with a thorough discussion with the registered manager and the duty managers. Information received by us included the Annual Quality and Assurance Assessment (AQAA) which providers of registered services are required to complete. The AQAA Care Homes for Older People Page 6 of 26 focuses on how the outcomes are being met for the people using the service and also provides us with statistical data. What the care home does well: What has improved since the last inspection? All the statutory requirements made in the last inspection report have been met. Since the last inspection all the written care plans are in person-centred format to reflect the person-centred care provided. This ensures that those who are looking after Care Homes for Older People Page 8 of 26 the residents have the required information to deliver the personal and healthcare needs of the people living in the home. Since the last inspection, the activities have improved with more choices, increased one-to one activities and increased hours allocated to group activities. 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 9 of 26 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 10 of 26 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. Prospective clients can be assured that a thorough pre-admission assessment will be carried out before they are admitted to ensure that the home can meet all their care needs. People who are admitted for intermediate care can be assured that they will be assisted to maximise their independence before they return to their own home. Evidence: The pre-admission documents for two recent admissions were examined and they showed that a thorough pre-admission assessment was carried out prior to their admission to ensure that all their personal, healthcare and social care needs can be met. The service includes an eight-bedded bungalow, used as a rehabilitation unit for intermediate care. The residents recently discharged from the hospital seemed settled in their daily routine. On the day of the site visit, it was noted that the physiotherapist, Care Homes for Older People Page 11 of 26 Evidence: the occupational therapist and the nurse from the hospital rehabilitation unit team were busy assisting some of the residents involved in the rehabilitation programme. One resident said I feel good and I am going home tomorrow. People admitted to this unit stay on for at least 4-6 weeks until they are ready to go back to their own home. Care Homes for Older People Page 12 of 26 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. People who use the service can be assured that they will be treated with respect and they will receive personal care and support in the way they prefer and require. They are safeguarded by the homes Medication Policy and Procedure. Evidence: Each resident has a written care plan, which forms the basis of the care to be delivered. The manager said that all the care plans are currently being revised to reflect the person-centred care provided. This ensures that care staff have the required information to deliver the personal and healthcare needs of the people living in the home. The key worker for each resident writes the person-centred care plan which is then audited by the duty manager assigned to oversee the relevant bungalows. The care plans for two recent admissions were examined and they were found to be detailed and informative. Appropriate risk assessment documents were seen in the care plan folder. The daily handwritten information reflected any change in the Care Homes for Older People Page 13 of 26 Evidence: personal or healthcare needs of those residents. At the end of each month, the handwritten information which identified a specific change in the care needs of the resident is then documented as the reviewed plan of care. However, it was noted that the handwritten notes are sometimes not signed and dated. This is important for case tracking purposes. The manager has remedied this issue since the site visit. Each resident has a regular annual review of their care needs that involves all parties including the next of kin and the relevant social worker from the funding social services. The home manager said that she will be reviewing the care needs of a resident in the coming weeks with relatives involvement to ensure that the home is able to meet all the residents care needs. All the residents have access to healthcare if required. Each of the residents is registered with a general practitioner of their choice and residents have access to other specialist professionals including the district nurse, occupational health therapist, physiotherapist and chiropodist according to their care needs. A trained member of staff administers the medication. Medication for all six bungalows are stored in locked cabinets and trolleys within an air-conditioned room. There is also a controlled drug cupboard which was attached to the wall. All the controlled drugs in use were properly documented and were found to be correctly recorded. The Medication Administration Record (MAR) Charts were examined and no gaps were found. One of the duty managers is currently reviewing all the repeat prescriptions with the doctor to ensure that all stock medication is appropriately returned to the supplying pharmacy when not in use on a monthly basis rather than being carried forward in order to avoid medication errors. It was noted that the handwritten notes on the MAR charts were not signed or dated by the author. In order to ensure that medicines are administered safely, and to enable case tracking of written information, it is important that all handwritten notes on the MAR charts are signed and dated. Care Homes for Older People Page 14 of 26 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. People who use the service can be assured that they will be given the opportunity to make everyday choices, including their recreational activities and menu, and that their preferences and requests will be respected. They will be encouraged to maintain links with their friends and families and they will be encouraged to have a healthy diet. Evidence: Residents are consulted on all aspects of life in the home and, for those who are able to, the staff encourage them to make their own decisions and to get involved in the daily routine in the home. During the site visit, it was noted that both management and staff gave one-to-one attention to individuals as they walk about in the communal areas. Lunchtime was observed to be unhurried. Members of staff were readily available to assist those residents who needed some help. It was noted that the residents seemed to enjoy their hot lunch of chicken cottage pie and vegetables. The duty manager said that all residents have a choice of menu and hot meals are always provided at lunchtime. The chef ensures that the meals provided are nutritious and balanced. The chef deals with the menu and has a one-to-one consultation with each resident. The Care Homes for Older People Page 15 of 26 Evidence: main meal of the day was provided from the central kitchen at the home and delivered to each bungalow in a heated trolley. In the intermediate rehabilitation unit, residents are served their main meals but they are all supported to get their own breakfast and during teatime once they had been assessed by an Occupational Therapist to be safe to do so. The home has recently employed an additional activity co-ordinator. On the day of the site visit, the activity co-ordinator held a reminiscence session in the activity room before lunch. Those residents who participated seemed to enjoy themselves, chatting and laughing away. The duty manager said that before the group session, all the residents in each of the bungalows are reminded of the time of the activity, and those who wish to participate are assisted to the activity room. The activity lounge includes a bar for residents of all the bungalows to meet for happy hour on a Sunday evening. Other indoor group activities include music and movement, dog therapy, knitting club, aromatherapy massage, church services, a floristry workshop and line dancing. Every two weeks the staff organise a party dance night for all residents to get together in Bungalow 4. Party snacks and drinks including sherry are available. Members of staff interviewed said that residents usually have a great time during dance night. Particular consideration is also given to residents with other cognitive impairments, those with visual, hearing or dual sensory impairments and those with physical disabilities. There are also outdoor group activities especially in the summer months. Some residents are taken out to the local shops and the local pub for a meal. Visitors are welcome at all reasonable times. Two visitors were present before lunchtime in one of the bungalows and a resident was observed to be taken out during tea-time by a relative. The visitors spoken to gave very positive reports about the service and the care provided. Care Homes for Older People Page 16 of 26 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. People who use the service can be assured that the service has a robust Complaints Policy and Procedure and people can be assured that their complaints will be listened to and that any concerns raised will be investigated and appropriate action taken. Evidence: The home manager confirmed that any concerns raised by residents, their relatives or representatives are dealt with promptly and effectively. There is a monthly residents meeting where minutes are taken and the management listen and make appropriate changes as requested to the benefit of the residents. Since the inspection, the management team have had a meeting with the relatives of a resident to resolve issues raised by the relatives and the outcome has been very positive for all parties concerned. All members of staff have had training on the protection of the vulnerable, Abuse Awareness and Whistle-Blowing Policy. The home follows the joint agency Safeguarding Procedures of Hertfordshire County Council Adult Care Services. There have been no safeguarding issues since the last inspection. The home is not involved in the financial affairs of the service users. However, the management assist them with their personal allowances. Individual accounts are kept, together with receipts, and the accounting records were found to be accurate. Care Homes for Older People Page 17 of 26 Care Homes for Older People Page 18 of 26 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. People who use the service can be assured that they live in a homely, comfortable, safe and well maintained environment and they have access to all communal spaces and facilities. Evidence: The home is clean, tidy and well maintained. There is an ongoing maintenance programme. The bedrooms examined appeared clean and tidy and there were personalised items on display. Each bedroom door is lockable and there is a master key in case of emergencies. The home has an attractive courtyard which is well designed with raised areas that are accessible to wheelchair users and lower areas with attractive flowerbeds. There is a space for barbecues and there are garden furniture and seating areas for residents and their visitors to enjoy fresh air in pleasant and attractive surroundings. On the day of the site visit, there were some residents having their daily walk about in the courtyard. Members of staff have knowledge of the residents from the various bungalows who often spend the day in the courtyard and all the staff make sure that food and drinks are offered to them routinely and staff also ensure the residents safety. Care Homes for Older People Page 19 of 26 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. People who use the service can be assured that the home has an effective staff team who will support them and can be confident that they will be safeguarded by the homes robust recruitment policy and procedure. Evidence: Since the last inspection, the home has recruited some new care workers and an additional activity co-ordinator. The staff files examined evidenced proper recruitment processes had been followed. The files were all kept up to date with training records. The Criminal Record Bureau (CRB) and the Protection of Vulnerable Adults (POVA) checks were done and the certificates were checked and found to be satisfactory. Members of staff interviewed confirmed that they have had a period of induction training. The management encourages staff to undertake professional development in addition to mandatory training. There is a rolling training programme and all new staff have induction training that is in line with the Skills for Care guidelines. Some of the duty managers and senior care workers are NVQ assessors and dementia champions. The management confirmed that some of the care workers had recently completed an advanced course in dementia care organised by the provider, Quantum Care. Other training includes medication, safeguarding issues and infection control. Care Homes for Older People Page 20 of 26 Evidence: During the site visit it was noted that in bungalows 1 and 4 where there were more care workers present, the residents seemed alert and happy with smiles on their faces. Some were observed chatting to the members of staff, who interacted well with the residents. It was noted that in bungalows 2 and 3, where there was only one care staff on duty, the residents were observed sitting in the lounge with very little stimulation as the care staff was busy with daily chores and personal care. Routinely there is an additional care worker assigned to assist as a floater among the 4 small bungalows, (namely 2, 3, 5 and 6). The duty managers on the day help out where needed and whenever they can. This arrangement meant that these residents may not be supervised at all times and they may not have the one-to-one activity if the care worker is busy elsewhere. Since the inspection, the home manager has revised the staff duty rota to ensure that there are at least two care workers per shift in each of the smaller bungalows (namely 2, 3, 4 and 5) to the benefit of the residents who have dementia and to ensure that these residents are supervised at all times. Care Homes for Older People Page 21 of 26 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. People who use the service can be assured that the standards of administration and management of the service have been well-maintained and improved to support their interests and that their health and safety are promoted and protected. Evidence: The standards of administration and management of the service are well maintained. The provider has updated all its policy and procedures to comply with current legislation and the servicing records have been kept up to date. The Registration Certificate and the Liability Insurance Certificate are on display in the entrance hall. Since the inspection, the management has addressed the shortfalls in staffing levels to ensure residents in the smaller bungalows are appropriately supervised and their social care needs enhanced. The manager has also developed a care practice learning set to ensure that all members of staff discuss practice issues relevant to maintain the quality of care for the residents. Care Homes for Older People Page 22 of 26 Evidence: Both management and staff handle confidential information in accordance with the Data Protection Act 1998. On the day of the site visit it was noted that all the documents and care plans were kept in locked cabinets in the administrative office. The home has an annual quality assurance and monitoring system that includes survey questionnaires for residents, relatives, staff and others. Information received is collated and analysed and an annual audit report is produced. The provider carries out a regular audit and a monthly visit in accordance with legislation. The Annual Quality Assurance Assessment (AQAA) forms issued by the Commission were received on time for this inspection. The information provided was satisfactory and they were included in this report. Care Homes for Older People Page 23 of 26 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 24 of 26 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 9 It is recommended that all handwritten notes be signed and dated by the author to enable case tracking of written information and to ensure that medicines are administered safely and appropriately. It is recommended that each of the bungalows, namely 2, 3, 5 and 6, have at least two care workers during peak periods. 2 27 Care Homes for Older People Page 25 of 26 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 26 of 26 - 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. 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