Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Chorlton Place Nursing Home 290 Wilbraham Road Chorlton Manchester M16 8LT 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: Geraldine Blow
Date: 1 4 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home
Name of care home: Address: Chorlton Place Nursing Home 290 Wilbraham Road Chorlton Manchester M16 8LT 01618820102 01618606685 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) : Southern Cross Healthcare Services Ltd care home 48 Number of places (if applicable): Under 65 Over 65 48 old age, not falling within any other category Additional conditions: 0 Registration is subject to compliance with the minimum nursing staffing levels indicated in the Notice previously served in accordance with Section 25 (3) of the Registered Homes Act 1984 issued on 3 June 2001. The maximum number of service users requiring nursing care shall be 45. The maximum number of service users requiring personal care only shall be 3. The service should,at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Date of last inspection Brief description of the care home Chorlton Place Nursing Home provides accommodation for 48 older people. The premises are owned by Nursing Home Properties (NHP) PLC and are leased to Southern Cross Healthcare Limited. The home is located in the Chorlton area of Manchester close to main public transport routes, local shops, public houses and other social and recreational amenities. Parking Care Homes for Older People
Page 4 of 27 Brief description of the care home facilities are available to the front and rear of the property. The home is a three storey purpose-built building set in its own well-maintained grounds. Bedroom accommodation for residents is provided on the first 2 floors and the third floor is used as office space, which includes the companys divisional offices. The home offers accommodation in 48 single, en-suite bedrooms. Each floor has 2 lounges, a dining room and 2 small seating areas. The charges for fees range from £388.31 to £568 per week. There are additional charges for magazines, papers, hairdressing and Chiropody. Care Homes for Older People Page 5 of 27 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is two stars. This means the people who use this service experience good quality outcomes. This visit was undertaken by two inspectors as part of a key inspection, which includes an analysis of any information received by us (the Care Quality Commission) in relation to this home prior to our visit. We also looked at other information we had about the home. Before the visit the home manager was asked to complete an Annual Quality Assurance Assessment (AQAA) to provide up to date information. The AQAA is a self assessment that focuses on how well outcomes are being met for people living at the home. it also gives us some Care Homes for Older People
Page 6 of 27 numerical information about the home. We sent our questionnaires out to people who live in the home, their families and staff in order to find out their views. The visit was unannounced and took place over the course of 8 hours on Wednesday 24th June 2009. During the course of our visit we spent time talking to residents, the manager and 2 members of staff to find out their views of the home. Time was spent examining maintenance records and the residents and staff files. A tour of the building was also carried out. There was evidence to show that the unit managers and staff continued to work hard to develop and improve the service. Health and Safety checks take place to make sure people are kept safe and good records are kept of these. References to our,we and us relate to the Care Quality Commission. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our findings
Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were given enough information about the home and had an assessment of their care needs before moving in. This is to make sure the home can meet their care needs. Evidence: We saw that they produced a glossy brochure. This gave enough information to people thinking about moving into the home. They also have a more detailed statement of purpose that gives more information about the services and staff at the home. This means that people are given all the information they need about the home to make a decision about moving in. The brochure explained what services the home offered. The brochure advises people that there will be an allocated carer to help them settle into the home. We spoke to people living at the home. One person told us they gave me some papers but I gave
Care Homes for Older People Page 10 of 27 Evidence: those to my son. They told us that people are invited to visit the home and stay for a meal. This helps people to see what it will be like living at the home. One person told us I came with my son to look around another person told us someone stayed with us and we looked around. The manager told us that before admission to the home people have an assessment of their care needs. The assessments are carried out by a care manager. The home also carry out a pre-admission assessment. This is to make sure that they can meet peoples needs. We saw copies of the completed assessments in peoples care plans. We spoke to people living at the home. One person told us I remember someone coming to speak to me before I moved here. The assessments were fully completed and included a short dementia care assessment. We saw that on some peoples care plan a separate more detailed dementia assessment had been completed. The information in the assessment documents were then used to write a plan of care for the person. This home does not provide intermediate care facilities. Care Homes for Older People Page 11 of 27 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and social care needs had been identified and people were safeguarded by the homes medication systems. Evidence: We looked at a sample of peoples care plans. We saw that they gave details about peoples preferences. For example what name the person preferred to be called and the time they like to get up and go to bed. We saw that one care plan identified that the person preferred to known by their middle name. We saw that the care plans were person-centered and easy to follow. We saw that regular reviews were carried out and where necessary amendments to care plans were made. The care plans we saw gave detailed information about what help people needed. We saw that the care plan told staff how they needed to help people. We saw that care plans had been signed and dated to show when they were written and who wrote
Care Homes for Older People Page 12 of 27 Evidence: them. We saw that any changes to the care plans were signed and dated. This means that staff can assess how often peoples needs change and if they need a referral to other health care professionals. We saw that some people had been assessed as needing a hoist to help with transfers. We saw that the type of hoist and sling was recorded. This means that staff know exactly what equipment should be used and minimises any risk to the person. We saw that nutritional assessments had been carried out. This is done to make sure that the person has the right type of food. For example a soft diet for people who have difficulty swallowing or a sugar free diet for people who are diabetic. We saw that regular reviews of the care plans were being carried out. This means that when peoples needs change this is identified and a new care plan put in place. This makes sure that the person receives the right level of support. The manager told us that they also carry out a regular audit of the care plans to make sure they all meet the required standard. We saw risk assessments and care plans were in place for one person using a bucket chair. This detailed why the chair was used and what the risks to the person were. We looked at the way they manage peoples medication. We saw that they kept a record of any medication received into the home. They had lockable trolleys to store peoples medication and a system of recording the disposal of unused medication. We saw that they had developed a system of recording medication that was prescribed to be taken when needed. We saw that they recorded when the medication was given and why it was given. Some people living at the home are unable to tell staff when they are in pain and need medication. We saw that they have a record of how to identify if those people are in pain. This means that staff know if a person is known to rub or tap their head it is an indicator that they may be in pain. Being aware of how different people communicate that they are in pain prompts staff to ask if they need medication. We also saw that where people are prescribed creams and lotions they have a body map on the medication administration sheets. This is a drawing of the outline of a body. A mark is put onto the body map and is used to indicate where the cream should be applied. This reduces the risk of mistakes. Care Homes for Older People Page 13 of 27 Evidence: We looked at the medication administration record sheets. We saw that there were no gaps in recording. We checked the records against the numbers of tablets in the blister packs and saw that the records tallied with the number of tablets. This means that medication was being given to people as it was prescribed by the GP. We saw that people living at the home were registered with a local GP and had access to other health care professionals such as opticians and dentists. One person living at the home told us they give me my tablets when I need them. Another said if I dont feel well and I need to see the Dr they will fetch him. We saw that staff and residents had a good relationship. We saw that staff approached people with respect, encouraged choice and helped to maintain peoples dignity. We saw staff knocking on peoples bedroom doors and waiting to be invited in. We saw that staff responded to peoples needs in a sensitive way. One person told us the staff are very good another person told us if I need help I press the buzzer and they come quickly there are no quibbles and yes they are all kind and very very nice. Care Homes for Older People Page 14 of 27 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were a range of activities on offer and people were offered a varied and balanced diet with mealtimes being a sociable and enjoyable experience. Evidence: They told us that all meals are prepared in the main kitchen on the second floor. The meal was transported to the dining rooms in a heated trolley. This means that the cooked food temperature is maintained and people can enjoy a hot meal. The meal on the day of our visit was grilled pork chops or cheese and potato pie with broccoli and Swede, with rice pudding or yogurt for sweet. The evening meal was chicken casserole or cauliflower gratin. We saw that the menus are based on a Nutmeg menu planning system. This is system where balanced menus are developed based on the nutritional value of each meal. The nutritional values of meals are identified by a bar chart that is displayed next to the menus in the hallway. We spoke to people living at the home who told us we get a full cooked breakfast as
Care Homes for Older People Page 15 of 27 Evidence: well and they always come and ask us what we want each mealtime. Another person told us I prefer to have sandwiches I find them easier to manage, I do have other meals but I like sandwiches. We heard the chef checking by asking this person if they still wanted sandwiches and not a hot meal. There was a full time activity organiser. We saw an activity board in the hallway on each floor. Planned activities included board games, musical bingo, shopping, 121 discussions, film shows arts and crafts and exercises. We saw a scrap book with photographs of recent activities. This included a football match between Chorlton Place and another care home in the area. One person living at the home asked have they told you about the football game, it was hilarious we such a good laugh. We saw that residents made good use of the large enclosed gardens and patio area. Another told us there is always something going on. People living at the home told us that there were no restrictions on visiting. One person told us my son can come anytime even if it is late they dont mind. Care Homes for Older People Page 16 of 27 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were policies and procedures in place to safeguard people from harm and people are encouraged to express any concerns. Evidence: We saw that they had received eight complaints since the last inspection. We saw that they kept a record of all complaints. The record included detail of the complaint, the investigation and the outcome. This means that they have a clear and detailed record of how they responded to the complaint. They told us that they use any complaints or concerns as a way of reviewing practice and improving the service. We spoke to people living at the home. They told us that they were confident that any concerns would be taken seriously and acted upon. One person told us I dont have any complaints but I would tell the girls or the manager. We saw that the manager had a weekly surgery. This means that every Thursday the manager works late and is available to meet with and talk to visitors. The manager told us that she did this so that people can express any concerns directly to her. We saw that risk assessments were carried out during the care planning process. This means that they do all they can to keep people safe. Care Homes for Older People Page 17 of 27 Evidence: We spoke to several members of staff. They told us that they had received training in relation to safeguarding vulnerable people. We asked staff what they would do if they witnessed poor care practice. They told us I would make sure the person concerned was safe and then I would immediately tell the manager. They also told us if I was concerned about the managers practice I would phone the contact centre, I have the telephone number in my pocket. This means that staff are aware of the local authority safeguarding procedures. Care Homes for Older People Page 18 of 27 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, comfortable and well-maintained environment. Evidence: We saw that the home was clean, tidy and well-maintained. Lounges and bedrooms were bright and airy with views over the gardens. One person told us I love my room even though the road here is busy I cant hear the traffic and I like to watch people passing by. The dining rooms were bright and spacious. This means that people are able to enjoy their meals in a relaxed and comfortable atmosphere. People were seen reading, watching television, listening to the radio or relaxing in lounges. One person told us I have got my own television and I can watch it whenever I want to. We saw a sample of bedrooms. We saw that people had brought some of their own belongings from home. This means that people were surrounded by familiar things. One person told us I have brought my photographs and some of my ornaments with me. Care Homes for Older People Page 19 of 27 Evidence: We saw that a number of bedrooms had been redecorated. They told us that a major programme of refurbishment was about to start. This means that carpets and furniture will be replaced and all areas of the home will be redecorated. Access to the first floor was via a passenger lift. This means that people were able to come and go as they please. We saw people moving freely around the building. One person told us there are no strict rules here I can have a wander around and sit in the hallway. The laundry was located on the second floor. This means that soiled linen and dirty clothing were not moved around or stored close to the areas where people live. We saw that there were enough toilet and bathrooms around the home for people to use. We saw that they were close to lounges and dining rooms. This means that people did not have to walk too far to use the toilet. We saw that they had a variety of bathing facilities. This means that people could choose whether to have a shower or bath. It also means that where people needed help to get into and out of the bath the correct aids were provided. We saw that protective clothing such as latex gloves and plastic aprons were provided. We saw that liquid soap and paper towels were provided in all toilets and bathrooms. We saw sanitising hand gel was available throughout the home. We saw staff using the gel to cleanse their hands. This means that they take care to reduce the risks of infection. We saw that they had the appropriate aids and adaptations available to assist in moving people safely. These included manual hoists and adapted bathing facilities. We saw that staff were given manual handling training as part of the induction process. This means that they knew the correct way to operate equipment. We saw that there were large well-maintained gardens with a number of seating areas. People living at the home told us that they liked to sit in the garden in the nice weather. One person told us we had a football match in the garden the other week. Care Homes for Older People Page 20 of 27 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home were protected by the homes recruitment and selection processes. Evidence: We saw a sample of staff files. We saw that each person has to fill in an application form. We saw that they have to give two references so that the manager can check their suitability for the job with previous employers. We saw that they had a Criminal Records Bureau (CRB) check and that a check against the Protection of Vulnerable Adults list (POVA) had been made before staff started work. This is to make sure that all staff are safe to work with vulnerable people. We saw that they checked peoples identity. This is to make sure that people were who they said they were and that they were entitled to work in the UK. We saw that where documents had been copied the copies were signed and dated to show that the originals had been seen. This shows that they carry out thorough checks before they employ new staff. We saw that staff have a twelve week induction period where they were expected to read the policies and procedures and shadow existing staff.
Care Homes for Older People Page 21 of 27 Evidence: We saw that they had a training plan that identifies which courses staff have attended. This means that they can identify when training updates are needed. They told us that the organisation has its own training section. The home has a large training room on the second floor. The manager told us that they have access to training provided by Manchester City Council and that this training takes place in the homes training rooms. We spoke to staff who told us that they had received training in how to identify and report abuse. This means that staff know how to keep people safe. We saw that aids and adaptations were provided to assist in moving people safely. These included manual hoists and adapted bathing facilities. We saw that staff were given manual handling training as part of the induction process. This means that they knew the correct way to operate equipment. We saw that staff have received training in safeguarding, first aid and basic food hygiene. This means that they have the skills and knowledge needed to carry out their role. On the day of our visit we saw that there were enough staff on duty to meet peoples care needs. We saw staff received training. They told us that eight care staff had NVQ level 2 and that a further six staff were registered to start the course. The manager told us that one member of staff has NVQ at levels 2 and 3. We saw that staff meetings take place every three months or sooner if the manager needs to pass on any new information. We saw that minutes were kept of the staff meetings and are available for staff to read at the nurses station. This means that any staff who were not able to go to the meetings were kept informed. The manager told us that supervision is carried out on a three monthly basis. One member of staff told us I have a one to one meeting with my manager to discuss my practice and any problems I may have. Another member of staff told us I can speak to the manager whenever I need to she is very accessible. Care Homes for Older People Page 22 of 27 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed in the best interests of the people who live there. Evidence: We spoke to staff who told us that the manager was always available to offer support and advice. One member of staff told us I can always go to the manager and ask her questions if I am not sure about something. We saw that supervision was taking place on a regular basis. We spoke to some of the staff. One member of staff told us I have a one to one meeting with the manager about four times a year and I can speak to her at anytime. We saw that the manager carries out monthly audits of the care plans and medication systems. This means that any errors or gaps in recording are identified and discussed with the staff. In addition the operations manager visits the home and carries out systems audits every two months and provides feedback to the manager.
Care Homes for Older People Page 23 of 27 Evidence: We saw that they had systems in place for managing peoples finances. We saw that people had individual accounts. The accounts were interest bearing and we saw that interest was added to accounts on a regular basis. We saw that they have a quality assurance system in place to get peoples views about the care they receive. They told us that questionnaires were sent out to people with an interest in the home. There was a questionnaire form in the foyer asking what people thought the did well, what has improved and what they could do better. They told us they use the comments to make improvements to the service. The manager also holds a late surgery at the home on a Thursday evening. This is so that relatives can discuss any issues thy may have about their relatives care. The manager told us that this is popular and means that any concerns can be addressed quickly. The manager has a number of years experience in running a care service. We saw that the manager has the registered managers award. This means that they have the skills, knowledge and experience needed to run a care service. The manager told us that she has completed the a mentoring course at Manchester Metropolitan University. This means that she can support and mentor student nurses. The manager also told us that she had attended various seminars and training days with the Primary Care Trust including diabetes care. The manager told us that Manchester City Council hold training courses in the home. This is because they have a large training room and means that staff have access to a wide range of training. They told us in the Annual Quality Assurance Assessment (AQAA) that maintenance records were up to date. This means that the home is safe for people to live in. We saw the certificate of registration and the public liability insurance certificate were displayed in the main hallway. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!