Inspection on 14/12/09 for Garth House

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

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Garth House 01/06/06

Garth House 15/12/05

Garth House 18/07/05

Garth House 29/11/04

Garth House 05/08/04

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Garth House Tower Hill Road Dorking Surrey RH4 2AY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Sally Hall     Date: 1 4 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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: Garth House Tower Hill Road Dorking Surrey RH4 2AY 01306880511 01306877640 garthhouse@caringhomes.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Assured Healthcare Ltd care home 42 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 42 The registered person may provide the following category of service only: Care home with nursing - Nto service users of the following gender:Eitherwhose primary care needs on admission to the home are within the following categories:Dementia - DEOld age, not falling within any other category - OP Date of last inspection Brief description of the care home Garth House is a registered care home providing residential and nursing care for up to forty-two older people. It is now part of the Caring Homes group. The company operates numerous homes across the United Kingdom. The home offers nursing, palliative and convalescent care as well as long and short term care. There are some exceptions that allow provision of services to people between the age of sixty and sixty-five who have significant physical disabilities or whose mental capacity is failing. The home is within walking distance of Dorking Town centre. Originally an elegant three story Victorian Manor House, Garth House was converted for use as a Care Homes for Older People Page 4 of 27 42 0 Over 65 0 42 Brief description of the care home nursing home some fifty years ago. Further extensions were added in the 1990s. Caring homes Ltd took over the management of the home two years ago. Garth House has plenty of communal space; there is a good-sized sitting room, a small quiet area, a large garden room and two dining areas. Most of the bedrooms are for single occupancy and have ensuite facilities. Outside there is well-maintained garden to the side and rear of the home. There is a car parking area at the front of the home. The weekly fees, vary depending on the room and care needs. Further information about the homes fees can be obtained directly from the home. Additional charges are made for items such as private physiotherapy, personal newspapers and personal telephone calls. 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: We agreed and explained the inspection process with the registered Manager at the start of the inspection. The focus of the inspection was to assess Garth House in accordance with the Care Home Regulations 2001 and the National Minimum Standards for Older People. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. We used a varied method of gathering evidence to complete this inspection, preinspection information such as the previous report and discussion and correspondence with the registered provider was used in the planning process to support the inspector to explore any issues of concern and verify practice and service provision. The home had completed an AQAA an annual quality assurance assessment questionnaire, which was received prior the site visit to the home. This provided us with information relating Care Homes for Older People Page 6 of 27 to what the home considers it does well, what they could do better, what has improved within the last 12 months and their plans for improvement. Survey questionnaires were also sent to the home prior to the inspection for distribution to service users, staff and other health professionals, comments from these have been included in the report. Documentation and records were read. Time was spent reading of written policies and procedures, reviewing care plans and records kept within the home. Other areas viewed included risk assessments, pre-admission assessments, staff rota, training records and recruitment records. We identified five people who use the service for case tracking, speaking with one of them whilst assessing the available information held in the home pertaining to the care provision for them. In addition the Inspector met with the other People who use the service and their family, which gave her a good opportunity to observe the quality of care being provided by the home and understand the impact the care provision has on their quality of life. Care Homes for Older People Page 7 of 27 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are given sufficient information by the home to make an informed choice about whether the home is right for them. Service users can feel confident that it offered placement at the home following the assessment process staff will have the skills and knowledge to meet their needs. Evidence: The registered manager confirmed that before any new service user is admitted to the home on a trial period they are assessed. This was supported by the evidence seen on two new service user individual files. A comprehensive assessment is recorded during the assessment process, with a summary of their main needs also recorded. A service user and visiting family members confirmed that the assessment had taken place prior to a place being offered at the home. They also confirmed that they were given information about the home and what the fees include was fully explained. Care Homes for Older People Page 10 of 27 Evidence: The registered manager confirmed that only if as a result of the assessment it can be shown that staff are able to meet the needs of the proposed service user is a place offered. The service user is admitted to the home for a trial period, during this time the assessment is ongoing. If at the end of this period the service user wishes to stay, and the staff can meet their individual needs will the placement become permanent. 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. Service users benefit from being competently assessed and supported with regard to their health and personal care needs. They can be confident all their needs are recorded on care plans and risk assessments which are kept under review and include their wishes and preferences. However the lack sufficient information in the daily records kept regarding service users could leave them at risk. Evidence: Four service user files were sampled, and they included service users who require varying levels of care needs. The files evidenced that service users have a recorded plan of care for staff to follow. Service users and family spoken with confirm that they had been part of the care planning process. It was also evident that information gathered during the pre-assessment process had been used to formulate the plan of care. The plans of care included clinical nursing tasks, these along with the other elements of care were clearly written. This enabled staff to have a good understanding of their responsibilities in providing care in a way that meets the service users wishes and preferences. The care plans had been reviewed regularly the manager confirmed Care Homes for Older People Page 12 of 27 Evidence: although current most have been written recently as the care plan documentation has been changed to ensure they are person centred. The lack of information contained in the daily records was of concern as evidence was found that monitoring request by the visiting GP had not been documented for example. Most service users daily records said the same thing washed and dressed and taken to the lounge They did not give an indication of the care they receive, or the work staff do to motivate service users. A lack of follow up information in these records could leave service users at risk, this was discussed with the registered manager and the registered responsible individual and they agreed to return to the former style of daily recording, including all relevant information. On the files sampled evidence were seen of risk assessments. These had been undertaken for each individual service user where risks had been identified a risk assessment had been completed. In most cases these had been reviewed, however staff do need to be vigilant and ensure all risk assessments are reviewed in a timely way. Medication is currently being given by the qualified nurse on duty, and medication is taken to service users using a medication trolley. The manager confirmed that currently none of the service uses self-medicates. A small audit of medication was undertaken and all medication was found to be correct. The protocols for giving PRN (as and when necessary) medication were seen on file and clear photographs were also available for each service user for easy identification. The medication trolley is kept securely and the home has appropriate storage for controlled medication. Controlled medication that was checked was found to be correct. The home has a medication policy and procedure in place which staff are following. The staff nurse stated that medication monitoring takes place weekly, evidence of this was also seen. It was evident form my observations and from talking with service users that staff treat service users with respect and they feel there privacy and dignity is protected. One service users spoken to said they liked the way staff have a joke with them but are careful not to offend. The family spoken to said that they visit regularly and they always observe treating all service users with respect, and they said they keep there dignity in tact. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from being supported to make choices and have a wide range of activities available to them. Service users can feel confident that they are offered choice within a well balanced menu and will supported to eat their food where necessary. Evidence: People who live in the home are supported to live their lives as they choose. Routines are flexible. Restrictions are kept to a minimum within a risk management framework. There is a variety of activities on offer such as art and craft, card games, knitting, crosswords and exercise, which they may choose to take part in if they wish. There is an activity coordinator employed in the home. On the day of inspection the lead activity co-ordinator described her role, and described the different activities (including outings) service users have a choice of. Individual records are currently not being kept of all activities undertaken or refused by service users. It was recommended that this be recorded in future so the home can make sure all service users have access to activities which suit them. Visiting family spoken to said they try always to come at the end of the week as they like to join in with the exercise session. A relative commented that the home is always welcoming to visitors and that staff and Care Homes for Older People Page 14 of 27 Evidence: management are helpful. The home takes particular care to ensure that food is nutritious and takes account of specialist dietary needs. Meals are often the highlight of the day for service users, therefore the choice offered on the menu and alternatives which are available are important. The majority of the meals are home made from fresh ingredients, and at lunch time there is a three course meal offered. The dining room is well laid out with tables attractively set, although service users can choose to take their meals in their rooms. Currently the home only records the meal eaten, no record was seen of the amount eaten, important as some service users have been identified at not eating enough and the risk assessment and care plan asks for the amount eaten to be recorded. Care Homes for Older People Page 15 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. The home has an effective complaints system in place and service users can be confident their complaints will be taken seriously. Service users are protected by adult safeguarding policies and procedures, staff training and a robust recruitment system. Evidence: The complaints and compliments file was seen, all complaints have been dealt within the time scale, and compliments very positive particularly about end of life care. Service users family spoken with or surveyed confirmed that they know how to complain but they said they had never had to do so. They also said that if they had to complain then they believed the management would take their concerns seriously. The registered manager stated that complaints help the home improve the service it offers The home has a policy and procedure on the safeguarding of vulnerable adults. The home is aware of the safeguarding protocols of the local authority and their responsibility. The home has been subject of one referral to safeguarding itself and worked with social services to ensure the best outcome for the service user. Evidence was seen that staff attend Safeguarding training (adult protection) and the registered manager was aware this needs to be updated three yearly although the organisation likes to refresh the training yearly. The staff files sample showed that the home has a robust recruitment procedure to Care Homes for Older People Page 16 of 27 Evidence: further protect service users. Care Homes for Older People Page 17 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. Service users benefit from living in a home that provides a safe and homely environment. Having a variety of accommodation to suit each service user with comfortable indoor and well tended outdoor communal areas. Evidence: The home has been extended and restored over the years, and combines the original architectural features of the building with newer modern rooms. The home is a comfortable environment for service users, which is decorated and generally well maintained. However, some carpets are now waiting to be replaced and refurbishment has been planned. In two areas a slight odour was noticed, the registered manager stated that one of the rooms was awaiting new flooring. The home has beautiful landscaped gardens which are well tended and even in winter gave a lot of interest. Many of the rooms have views over the gardens. There is an air-conditioned garden room, with direct access to a large patio area and the garden. All parts of the garden are wheelchair accessible however there are some steep slops in places. There are also plenty of sitting areas in the home with pleasant views over the gardens. Some bedrooms were viewed, all those occupied had been personalised. They were clean and comfortable and specialised equipment was evident in some rooms where Care Homes for Older People Page 18 of 27 Evidence: needed. The home has assisted bathrooms and appropriate equipment, such as hoists, for safe moving and handling. The toilet aids that needed attention as per the previous inspection report have now been replaced as the paint work was chipped and posed an infection control risk. Suitable hand cleaning liquid over and above soap was available for staff, service users and visitors around the home, and staff had access to gloves, aprons etc for use when needed. Care Homes for Older People Page 19 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. Service users can feel confident that their care, social and emotional needs will be met by care and nursing staff in sufficient numbers who have the skills, knowledge and training to those needs. Service users can be confident that they will be protected by the homes robust recruitment policy and procedure. Evidence: The ratios of care staff to service users are determined according to the assessed needs of service users. Observations made during the inspection of the number of staff available in the home gave us the opinion that sufficient care staff were on duty to support service users to meet their personal needs and take all reasonable steps to ensure their health and safety at this time. Staff spoken to confirmed that rotas are covered when staff are absent. Service users families talked with also confirmed that there seemed to be sufficient staff on duty when they visit. Feedback from surveys confirmed that service users are generally well supported with their needs. The manager stated that staffing is constantly kept under review, the home is not full currently and daily there is two qualified nurses and six care staff on duty plus ancillary staff. The home employs ancillary staff who work as cleaners, laundry, cooks, etc. Thus allowing care staff the time to meet the needs of service users. The staff training records indicated undertaken training. Individual and group staff training needs had been identified. From documentary evidence seen the standard of staff training was good overall with the large majority of staff completing basic courses. Care Homes for Older People Page 20 of 27 Evidence: The home also provides courses in other areas of care such as communication, dementia, Parkinsons, stroke, challenging behaviour, diabetes, end of life, falls in the older person, and palliative care, to ensure the staff have the skills and understanding to met the service users needs. The homes staff have achieved an NVQ (National Vocational Qualification) Level 2 or above in care or an equivalent qualification for more than 50 of care staff the registered manager confirmed. Staff training is ongoing and further training is booked. The manager confirmed that the home has a development programme for all new staff, which meets Sector Skills councils workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. The staff files sampled showed that the home undertakes a recruitment procedure including submission of an application form detailing all previous work history, requests proof of identity and copies of qualification certificates, seeks two written references, and confirms work status. The homes recruitment files evidenced all qualified Nurses working within the home are currently registered with the Nursing and Midwifery Council. It was evidenced that all staff have a current CRB and POVA (Protection of Vulnerable Adults) check. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can be confident that the registered manager has the necessary qualification skills and experience to run the home in a way that promotes their quality of life. They can also be confident that their views and opinions effect how the home is run. Evidence: The registered manager is a qualified nurse who has extensive relevant experience in public and private health care sectors. She was head of nurse education at a Hospital before taking up the post as manager at Garth House. She holds diplomas in education and higher education and the Registered Managers Award (RMA). She is also a student nurse assessor. The management of the home has made a number of improvements since the previous inspection. With all of the shortfalls identified at the previous inspection have been actioned. The registered manager having made sure that care plans have Care Homes for Older People Page 22 of 27 Evidence: become more person centred has given her commitment to making sure the daily records documentation in the service users files is improved to reflect the high standard of care being provided. Quality assurance was discussed and the views and opinions of many of the service users are sought where capacity allows. They or their family confirmed a great deal of satisfaction in living within the home and felt confident that the staff and management valued their views and opinions. The manager confirmed that the home does undertake quality assurance by means of asking service users/families to complete questionnaires. There are also meetings held throughout the year when views are sought form service users, staff and visitors. Regulation 26 visit (Statutory documented visits by the provider to monitor standards within the home) are taking place monthly, and reports completed at each visit were seen. The visits assess the quality of care within the home and ensure that it is meeting with the required National Minimum Standards. Policies and procedures required in the home are in place and have been reviewed in a timely way. The registered manager explained that the organisation treat the policies and procedures as living documents which are kept under continual review by a dedicated team to ensure they meet any changes in legislation or good practice. The home does not hold any service users money, the bills incurred by service users for things like hair dressing is paid by the home if the service users do not have there own money. Then the person responsible for the service users finances is then invoiced monthly. The home has a maintenance person who takes care of the day to day things, the organisation also has a maintenance team that undertake larger maintenance tasks. Care Homes for Older People Page 23 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 24 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 1 7 12 The registered manager must ensure that the care/nursing care provided by staff is recorded together with monitoring information on a regular basis. To ensure staff and others have the information they need regarding service users care or information to assess individuals, staff need to record the care they provided for service users, the progress of any monitoring staff are undertaking and any refusals made by the service users, on a daily basis 30/01/2010 Care Homes for Older People Page 25 of 27 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 12 make sure that activities including when offered and refused are recorded for each individual service user. Care Homes for Older People Page 26 of 27 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. Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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. 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