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Inspection on 19/03/10 for Guysfield Residential Home

Also see our care home review for Guysfield Residential Home for more information

This is the latest available inspection report for this service, carried out on 19th March 2010.

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. They appeared well dressed and well cared for. Some were observed chatting among themselves in the lounge and the majority participated in a group activity (bingo) organised by staff before lunchtime. Members of staff interacted well with the residents and residents who have dementia seemed to gain extra stimulation as they mixed and chatted with non dementia residents. The standards of administration and management of the service have improved since the last inspection. The members of staff carried on their work smoothly, and team working was evident during the site visit. Staff have the skills and knowledge to care for the residents. There is a rolling training programme for staff to ensure that they are able to care for the residents appropriately. The premises are well maintained, including the attractive and spacious grounds and garden. Residents have access to the grounds when the weather permits and there is garden furniture and seating on the patio for residents and their visitors. The following comments were received from the residents and stakeholders in a recent survey conducted by us: "The carers help me. I am pleased with the care." "The carers are very good." "I am fine. No complaints." "The care staff do an excellent job." "The staff work well together to ensure the residents are on the whole happy." "The meals are of a high standard." "The food is very good." "We always have a glass of wine with our meals. The food is good." "They look after us well"

What has improved since the last inspection?

The general administration and management of the service have improved to a good standard. Since the last inspection, the home has a more stable workforce and the deployment of agency workers has been reduced to a bare minimum. As a result of listening to residents and their relatives, positive changes have been made to improve the environment, facilities and recreational activities.

What the care home could do better:

It would benefit both residents and supporting care staff if the care plans were consistently maintained and kept up to date. Since the inspection, the management has updated the written care plans to reflect specific changes in healthcare conditions such as pressure sores. This will ensure that those who are looking after the residents have the required information to deliver not only the personal and social care needs but also the healthcare needs of the people living in the home. The regional manager confirmed that the management team and senior care workers have had retraining on the recenly introduced written care plan.

Key inspection report Care homes for older people Name: Address: Guysfield Residential Home Willian Road Willian Letchworth Hertfordshire SG6 2AB     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: Yoke-Lan Jackson     Date: 1 9 0 3 2 0 1 0 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 26 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Guysfield Residential Home Willian Road Willian Letchworth Hertfordshire SG6 2AB 01462684441 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): guysfield@caringhomes.org Guysfield House Ltd Name of registered manager (if applicable) Mrs Stephenie Mary Cole Type of registration: Number of places registered: care home 51 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Guysfield was originally a large Victorian house, subsequently sympathetically converted and extended to provide residential care for elderly people. It is situated in the quiet village of Willian, within a few minutes walk of village amenities and about two miles from Letchworth town centre. There is ample car parking space to the front of the property and a large garden to the sides. 0 6 0 4 2 0 0 9 0 0 Over 65 8 51 The accommodation comprises forty-eight single bedrooms and one double bedroom, all with en suite sink and toilet facilities, located on three floors. There are two Care Homes for Older People Page 4 of 26 Brief description of the care home passenger lifts, which serve all three floors. Three lounges, a large central conservatory and two dining rooms are on the ground floor, as well as the main kitchen, the laundry facilities and the managers office. The home charges £438 to £625 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 service had a key inspection in April 2009. This unannounced key inspection was carried out on 19/04/2010. The home manager and the regional area manager were both present. There were 46 people in residence with 2 currently in hospital. The inspection commenced with observation of how staff interacted with the residents in the main lounge as well as observing the activity session and the lunchtime staff interaction with residents. Both staff and residents were spoken to and key documents were examined. The inspection ended with a thorough discussion with the management team. Survey questionnaires were sent to the residents and relatives and their responses and other information received by us were reviewed. This included the Annual Quality and Assurance Assessment (AQAA) which providers of registered services are required to complete annually. The AQAA focuses on how the outcomes are being met for the Care Homes for Older People Page 6 of 26 people using the service and also provides us with statistical data. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? The general administration and management of the service have improved to a good standard. Since the last inspection, the home has a more stable workforce and the deployment of agency workers has been reduced to a bare minimum. As a result of listening to residents and their relatives, positive changes have been Care Homes for Older People Page 8 of 26 made to improve the environment, facilities and recreational 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 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 residents have the information they need to make an informed choice and they 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. Evidence: The pre-admission documents for three residents 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 home will not admit a prospective client whose care needs cannot be met. Likewise an alternative placement will be sought for a resident whose care needs cannot be met in the home. One of the residents whose care needs could not be met was recently transferred to another home. Care Homes for Older People Page 11 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 dignity 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. The home now uses the person-centred care plan issued by the provider. The manager confirmed that since the last inspection specific conditions such as dementia, Parkinsons disease and diabetes have been reflected in the residents care plans. Relevant risk assessments were seen in the care plans examined. However, one of the care plans has not been updated to reflect the grade 3 pressure sore that has since developed in the resident. Detailed information was seen in the nursing file, including pain relief. The district nurse has been visiting the resident on alternate days. The homes nutritional protocol was followed and there are food intake and fluid intake charts for this resident. Since the inspection, the residents care plan has been updated to reflect this specific condition. This will ensure that those who are looking Care Homes for Older People Page 12 of 26 Evidence: after the resident have the required information to deliver not only the personal and social care needs but also the residents healthcare needs. The regional manager has since confirmed that the management team and all senior care workers have been retrained in regards to using the recently introduced written care plan. The way these care plans are being audited has also been improved to ensure consistency in updating to reflect the changes in the care needs of individuals. The service has no specific areas designated to care for those residents with dementia and all the residents have access to all the communal areas. During the site visit, it was noted that members of staff interacted well with the residents and readily assisted those residents who needed help. The staff seemed to have a good knowledge of the residents conditions and their likes and dislikes, and delivered care and support accordingly. Residents who have dementia seemed to gain extra stimulation as they mixed and chatted with non dementia residents. All the residents observed have smiles on their faces and all were observed to enjoy the activity sessions together. Members of staff lend a helping hand during the bingo activity sessions. Staff were gentle and soft spoken in their approach to each resident. It was particularly pleasing to observe the kind response from a member of staff to a resident who needed immediate help with personal care during the activity session. The individual was treated with respect and dignity. The resident seemed at ease to ask for assistance. Each of the residents is registered with a general practitioner of their choice and residents have access to other healthcare professionals, including the district nurse, chiropodist and dentist according to their care needs. The manager confirmed that one of the residents who is prone to falls has been referred to the Falls clinic of the local NHS hospital via their own doctor. A trained member of staff administers the medication. All medicines that are in use are stored in drug trolleys. There is a drug trolley that is used by the night staff. All the trolleys are securely attached to the wall when not in use. The controlled drug cupboard is attached to the wall in the corridor outside the office. All the controlled drugs in use were accurately administered and recorded. The Medication Adminstration Record Charts examined were accurately recorded and kept up to date. The manager confirmed that arrangements have been made to change to another local pharmacy in the next few weeks. There are plans to construct a clinical room for the storage of all medicines. The assistant manager regularly audits the storage and administration of medication to ensure that staff follow the homes medication policy and procedures and that medication is administered in accordance with legislation. A medication error was Care Homes for Older People Page 13 of 26 Evidence: made by a supplying pharmacist and the issue was addressed appropriately by the pharmacist, the General Practitioner. The resident was not unduly affected. The management has since reminded staff to be extra vigilant and has ensured that staff follow the homes procedure when receiving medicines from the pharmacy. 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 and their preferences and requests, including recreational and social interests, and choice of menu will be respected. They will be encouraged to maintain links with their friends and families. Evidence: On the morning of the site visit most of the residents were in the main lounge resting after having breakfast. A few residents were observed chatting among themselves. It was noted that the activity co-ordinator and four members of staff were interacting well with the residents who were offered drinks every thirty minutes. Those residents who appeared sleepy were encouraged to drink and when the group activity was in session, all the residents were encouraged to participate. The daily activity programme was on display on the noticeboard in each communal areas. The service has two activity co-ordinators. Some of the residents in the lounge have dementia. Members of staff were observed assisting individuals who needed some help with the bingo game. At least 15 residents took part during the 3 sessions of bingo. Three of the residents who won prizes have dementia. They chose their prizes from a selection tray. All the residents seemed to Care Homes for Older People Page 15 of 26 Evidence: enjoy themselves, so much so that the bingo session was extended to just before lunchtime. In the second lounge, members of staff assisted those who were interested in reading. There are braille and talking books available for those with sight or hearing impairment. Lunchtime was unhurried. There was a choice of hot meals of either fish and chips or burgers and chips. Some residents were given both as they preferred. Most of the residents have their meals in the dining room and those spoken to said that they enjoyed their meals and the dessert of hot pie and custard. Members of staff assisted those who needed help during mealtimes. A member of staff spoken to said that there were six residents who had their meals served to them in their own bedrooms. The daily menu was on display on each of the tables in the dining room. There is one-toone consultation with each resident about their preferred choice of menu. The residents spoken with gave positive feedback about the meals provided. A resident commented, There is a good selection on the menu and the meals are very good. Residents are able to choose whom they wish to see and they can have visitors in their own bedrooms. There were no visitors present before lunchtime but some were present around teatime. 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 their views will be listened to and any concerns raised will be taken seriously and prompt action taken to improve the service. They can be assured that the service has a robust complaints policy and procedure and that they will be protected from abuse. Evidence: There is a residents meeting every six weeks and minutes are taken at these meetings. Residents may raise their concerns and any issue raised is addressed promptly by the manager. There have been three verbal complaints since the last inspection and these were dealt with appropriately in accordance with the homes robust complaints policy and procedure. All members of staff are given training on the protection of the vulnerable, abuse awareness and the Whistle-Blowing Policy. The home follows the Hertfordshire County Council Joint Safeguarding Procedure and currently there is a safeguarding issue that is being investigated. Staff have training on the Mental Capacity Act 2005 and the Deprivation of Liberty safeguards to ensure that staff have an awareness of the assessment of capacity and that decision-making for a resident is being undertaken in a way that complies with legislation. This ensures that people living in the home are not deprived of their liberty without authorisation. The management confirmed that there have been Care Homes for Older People Page 17 of 26 Evidence: no cases subjected to Deprivation of Liberty authorisation. 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 will live in a homely, comfortable and safe environment and they will have access to all communal areas and facilities. Evidence: On the day of the site visit, the home appeared clean and tidy. The service has a maintenance person who ensures that the premises and the garden are well maintained. There is a rolling maintenance programme. The dining room has been refurbished. Most of the old furniture has been replaced. The conservatory which is used as a main lounge has a modern settee and armchairs which have been arranged to produce a more homely atmosphere. Residents spoken to said that they are happy to be in the conservatory and that they are satisfied with their bedrooms which have personalised items on display. Since the last inspection, the repeated test for legionnelle bacteria in the water system has continued and the result finally became negative on the last two occasions since August 2009. The home continues to engage the services of a specialist firm to help maintain the system and regular testing will continue to ensure the safety of residents and staff. 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 they will be protected by the homes robust recruitment policy and procedures and they can be assured that staff have relevant training so that residents care needs can be appropriately met. Evidence: On the day of the inspection site visit, the home was well supported by staff. There were two assistant managers, one senior care worker, seven care support workers and an activity care co-ordinator. They were supported by an administrator and domestic and kitchen staff. The home was smoothly run and the residents seemed well cared for. The home manager who was on annual leave came specially for the unannounced inspection. The staff files examined evidenced proper recruitment processes. The files were all kept up to date. The home manager said that all new members of staff commence working with supervision after they have had POVA First ( Protection of Vulnerable Adults) checks. Once the Criminal Bureau (CRB) checks and clearance were made the new recruits then carry on working without supervision and are then able to attend to residents personal care needs. The manager confirmed that the service has finally established a stable core group of experienced care staff and that staff turnover has been reduced since the last Care Homes for Older People Page 20 of 26 Evidence: inspection. The deployment of agency workers has also been reduced as more permanent staff have been recruited. Members of staff spoken to confirmed that they have a period of induction training. The home follows the Skills for Care induction programme. There is a rolling training programme for all members of staff, who are encouraged to attain NVQ qualifications. This ensures that members of staff maintain their skills and competency to meet the needs of those who use the service. The management receive support from the providers training department. Recent training includes Equality and Diversity, Safeguarding, Dementia, Care Planning and Medication. One of the assistant managers is attending the A1 Assessor course and the other is attending the Home Manager Leadership course. Arrangements have been made for all care staff to attend further dementia training in May and June 2010. 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 home is run in their best interests and they can be assured that their health, safety and welfare are promoted and protected. Evidence: The standards of administration and management of the service have improved since the last inspection to a good standard. On the morning of the site visit, the home was smoothly managed by the assistant managers. Team working was evident and members of staff interacted well with the residents who seemed well cared for. The home manager who was on annual leave came shortly afterwards in view of the unannounced inspection. The regional manager arrived during lunchtime to give support. Proper accounting records are kept and well maintained for residents personal allowances. Receipts are kept for all purchases. There is a regular audit by the provider who carries out a monthly visit in compliance with regulations. There is also Care Homes for Older People Page 22 of 26 Evidence: an annual quality assurance and monitoring survey. This includes written questionnaire feedback from residents, relatives and others. The audit documents were readily available for inspection. The manager comfirmed that relatives have been complimentary as reflected in the letters and thank you cards received about the care their loved ones had received whilst living in the home. The service has achieved the Hospitality Assured Award for the year. The management promote equality and diversity. All members of staff are trained to ensure they follow the homes policy and procedures on equality and diversity issues and they are aware of the Mental Capacity Act 2005 and the Deprivation of Liberty safeguards. The home manager confirmed that there have been no cases subject to Deprivation of Liberty authorisation. The Annual Quality Assurance Assessment (AQAA) forms issued by the Commission were received on time for this inspection. The information provided was detailed and has been 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 Care Homes for Older People Page 25 of 26 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 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. 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!