Inspection on 24/06/09 for Home Meadow

This is the latest available inspection report for this service, carried out on 24th June 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Home Meadow 24/07/07

Home Meadow 28/07/06

Home Meadow 14/10/05

Home Meadow 17/06/05

Home Meadow 18/10/04

Home Meadow 24/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Home Meadow Comberton Road Toft Cambridgeshire CB23 7RY     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: Shirley Christopher     Date: 2 4 0 6 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 29 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 29 Information about the care home Name of care home: Address: Home Meadow Comberton Road Toft Cambridgeshire CB23 7RY 01223263282 01223264201 admin@homemeadow.healthcarehomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Home Meadow Limited care home 42 Number of places (if applicable): Under 65 Over 65 0 42 dementia old age, not falling within any other category Additional conditions: Minimum staffing at night must be 3 staff Date of last inspection Brief description of the care home 42 0 Home Meadow is situated in the village of Toft approximately seven miles from the centre of Cambridge. There is a public house in the village and a shop that provides a wide range of services including a post office. A limited bus service operates between Toft and Cambridge. The building is single storey and is divided into five flats. Each flat accommodates between five and eight people. Two of the flats are for people who have dementia and another flat accommodates short stay residents. Each flat has a bathroom with WC, a further WC, a kitchenette, and a lounge/dining area and between five and eight single bedrooms. The home has a day centre with a large lounge and service users in the home use this for communal gatherings when the day centre is not in use. The home has well maintained gardens. Fees for the service vary. They are between 620 to 640 with ensuite for the residential beds or 640 to 680 with ensuite for dementia care A copy of the CQC inspection report Care Homes for Older People Page 4 of 29 Brief description of the care home is available on request. Care Homes for Older People Page 5 of 29 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, The Quality Care Commission carried out an unannounced inspection to the home on the 24 June 2009. We were joined by an expert by experience, who had spent most of her working life in higher education and social work. She is still actively involved in social care after her retirement. She was able to give a valuable insight into the first hand experiences of people living at the home. She spent time talking with people, observing care practices and joined residents for lunch. We spent some time looking at records the home are required to keep including: Resident and staff records, maintenance and servicing records, record of complaints and audits completed by the home and other external agencies. We spoke to staff, and residents. We spent some time on the individual units and also joined residents for Care Homes for Older People Page 6 of 29 lunch. Before the planned inspection we asked the manager to complete a detailed audit of the service using a form known as the AQAA, Annual Quality Assurance Assessment. We asked for this to be returned by a specific time. This was completed and returned on time. It was well completed and gave us lots of information about what the home are doing well and where they have identified improvements. The AQAA is a legal document that all registered services are required to complete annually. It is a self evaluation tool which provides us with numerical data and written information about how the home are meeting National minimum standards. We did not send out surveys in time for this inspection, but have followed this up and have sent surveys out. We received a number back and these commented favorably on most aspects of the home and daily life. One relative expressed concern about the cleanliness of the home, but this was not identifed by anyone else. 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 29 Care Homes for Older People Page 9 of 29 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 29 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. Residents can be assured that the home are able to meet their needs and that their needs will be fully assessed and kept under review. Evidence: Whilst we were at the home a couple were being shown round. They were looking for a home for their relative. They commented on how lovely the home was and expressed an interest in their relative moving in. They were told the home was fully occupied and there is also a waiting list. The couple commented on the previous inspection report and questioned the rating, stating the home was better than adequate. The manager has worked hard to improve standards in the home. Potential residents have the opportunity to look round and stay for the day if they wish. Realistically it is often relatives that choose the home on the residents behalf. We asked how the home would enable potential residents to be involved in the decision to move there. The manager said the home were going to prepare a home video for prospective residents which Care Homes for Older People Page 11 of 29 Evidence: would give them a insight in to life in the home. Other information such as the statement of purpose and service user guide are readily available. The home has also introduced an induction checklist for new residents which means that staff spend time with residents on admission familiarizing them and their relatives with the home. Preadmission assessments are completed before a resident moves in and information is kept updated. We saw evidence that the home are able to meet specialist needs. Staff have received training in dementia and other specialist areas. See the staffing section for more details. The home work in conjunction with other agencies to meet specialist need and this is recorded on residents records. Care Homes for Older People Page 12 of 29 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. The registered person promotes the residents health, personal and social care needs through good care plans and regular reviews of residents needs. Residents can expect staff to know how to meet their needs. Evidence: The manager stated that the care plans had been reviewed and there was a new format in place. She stated that when residents come in for a period of respite care, the care plans are updated from any previous stay. We asked to look at two care plans for residents in the respite care unit and looked at one care plan for a permanent resident. The first file included a detailed pre admission assessment. It was written in a person centered way and included a social history, family circumstances, and interests. There was no care plan for their night needs and they told us that they were unable to sleep well at night. It would of been useful to record their usual nightly routine which may assist staff in promoting a good nights rest. There was no risk assessment in place relating to the prevention of falls. This person had underlying physical disabilities and physical impairment which may make them more prone to Care Homes for Older People Page 13 of 29 Evidence: falls. A recent fall was recorded on their file. It stated that they may need assistance with mobility but did not state what assistance. The second file included a pre admission assessment. There was also a check list, which demonstrated that the home had spent time familiarizing the resident with the daily routines of the home to help them settle in. The information was satisfactory but again there was no night care plan. The pre-admission assessment indicated that they were restless at night. However the daily records kept by the home indicated that they were sleeping well throughout the night. There were alot of entries of them refusing their food. We sat and observed a meal at lunch time. They refused their main course and was offered an alternative which was also refused. The home offer residents a choice of menu. There was nothing in their care plan about maintaining their weight or their preferred dietary needs. The care plan also referred to them as having limited communication. We spent a considerable period of time with them and found them to be very expressive and using alot of non verbal communication. This should be reflected in the care plan. We discussed this with the manager during our feedback and she immediately ratified this. This resident joined in the afternoon activities playing the keyboard. Staff did not know that they were able to do this, but the home were building up a social profile for residents to ensure their social needs could be met. The care plan for the permanent resident was very much improved. It was easy to read, well organized, regularly reviewed and included good social information. It was written in the first person. There was no care plan for their mental health. We noted that information was very easily accessible and well organized. Separate health care files are kept where both the doctor and the district nurse record visits and any treatment given. The records provided us with evidence that residents health care needs were being met. There was also evidence that medication reviews are carried out regularly and the home access other specialist services when a need is identified. The expert by experience commented on the practices of the home and felt there had been a shift, based on evidence from the last report from a task led to resident focused culture. She felt that the home worked hard to keep residents mobile. Staff took residents out for a walk around the grounds and gardens. We looked at the homes medication policy and procedure and were satisfied that the home has adequate systems in place for the safe storage and administration of medication. The home complete a monthly, internal audit of medication. Only Senior staff who have received the appropriate training are able to administer the medication. Staff competency is tested every three months. Medication records were supplemented Care Homes for Older People Page 14 of 29 Evidence: with information about the medications and when they should be administered. This relates to medication which is given when necessary, such as pain relief. We saw care plans in place for residents taking medication which requires special instructions to be followed. We saw evidence that residents medication is regularly reviewed and some medication has been decreased or removed altogether. Several people self medicate and the risks have been assessed. To avoid error every medication recording sheet has a photograph of the resident. The home has a signature recording sheet for staff able to give medication. Care Homes for Older People Page 15 of 29 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. Residents can expect the home to meet their social, cultural and recreational needs. Structured activities are available for residents wishing to participate. Evidence: We asked about social activities and were told the home has an activities coordinator and had just recruited a second person. The activities post was for thirty hours a week. The activities for some of the week were displayed on the wall, but the home were waiting for the new person to start. We met a volunteer to the home, who also drives the minibus. The manager stated that they had just started to take a small group of residents out on the minibus. (A recent acquisition.) 4 residents recently went to Wimpole Hall in Cambridgeshire. Staff including one of the domestic staff went. During the day staff were actively engaging with residents and several staff joined residents for lunch. In the afternoon there was some music, with a chap playing the keyboard. One of the residents was able to join in being an accomplished player himself. This was previously unknown to the home as his life history was incomplete. Residents can order a daily paper and there is a mobile library. The home produce a newsletter every couple of months. The expert by experience stressed the importance Care Homes for Older People Page 16 of 29 Evidence: of local people, local knowledge and local networks. The manager stated that they were going to put pictures up of recent social events and areas of local interest. We asked about local community groups and the manager said they have lots of people coming to the home on work experience. The home has a church service every three weeks. The home has a safe, enclosed garden. The home employs a gardener who will involve residents if they are interested. One lady spoken to had a keen interest in gardening but because of a stroke was no longer able to manage. This was discussed with the manager and she had said they were going to introduce window boxes which she may be able to help with. On this inspection we used an expert by experience who had a keen interest in the day centre which was viewed as an invaluable resource to the local community. Recently the day centre was under threat of closure and some people thought this was due to plans to expand the home. The manager explained the real reason for proposed closure was that numbers had dropped. A campaign to keep it open was successful and attendance had increased. The day centre is not currently used by people living at the home. The only exception to this is local residents attending the day centre, might also come in for a period of respite care. The expert by experience discussed the importance of place and locality and felt that both staff and residents were local to the area and knew the history of the area and had strong networks. An example was a lady attending the respite care unit knew one of the residents in the home and were reintroduced after many years of not seeing each other. The home has lots of visitors and this was observed on the day of inspection. A couple came to look round the home and they were made welcome. The home has a number of volunteers and regular visits from the hairdresser and chiropodist. The day centre and respite care centre adds to the busyness of the home. We observed care practices and staff were courteous and offered choices in daily routines. The homes practices are flexible. One example of this was some residents are up and dressed early whilst other residents were still in bed just before lunch time. This was recorded in their care plan as their preferred choice. The menus were much improved. They are displayed on the table and residents have a choice of two main dishes,other choices can be made. The menus are planned in a four week cycle and take into account the season. The manager stated that residents are consulted when reviewing the menus. She said she is planning to design a pictorial menu to assist residents in making a choice. Staff joined residents in the respite care unit for lunch and food was served hot and appropriate support was given. Snacks and Care Homes for Older People Page 17 of 29 Evidence: drinks were offered throughout the day. At breakfast time residents can choose a cooked breakfast. Each unit has a kitchenette so light drinks and snacks can be prepared by the staff. We spoke to the kitchen staff who confirmed that they had adequate budgets for food and were able to use local suppliers for their fruit, vegetables and meat. They confirmed that regular snacks were available including home made cakes and fresh fruit. Equipment was regularly maintained, but one of the fridges needed replacing and was not holding its temperature very well. Care Homes for Older People Page 18 of 29 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 adequate systems in place to ensure unsuitable people are not employed at the home. Evidence: We discussed adult protection and complaints with the manager. The homes information is easily accessible for all staff and there is alot of information for residents and visitors about the home and how to contact other agencies if they need further information, or if they are unhappy with their care. The home has good staff recruitment procedures and ensure all staff are properly vetted before offering them employment. This is an important safeguard. The home have had a number of complaints, mainly to do with the threatened closure of the day centre. Complaints were properly recorded and responded to appropriately. There have been no recorded adult protection issues since the last inspection. All staff receive training in adult protection, or safeguarding as it is now referred to. One person we spoke to stated she had been roughly handled by a member of staff, whilst being assisted with personal care. They were not able to identify the staff member of give any further details. This was discussed with the manager who said she would speak to them. Care Homes for Older People Page 19 of 29 Evidence: Residents spoken to knew who the management team were and felt able to raise concerns. One resident told us staff could get cross with difficult residents. This was raised as a concern with the manager. Care Homes for Older People Page 20 of 29 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. The environment is well maintained and is cleaned to a high standard. Evidence: The environment was well maintained and cleaned to a high standard. The home have four domestic staff who work very efficiently. One member of the domestic team was spoken to and showed a good understanding of infection control and had received all the appropriate training. He had been able to go out with residents and care staff to the recent social outing to Wimpole Hall. We looked round the home and did not identify any hazards or obstacles. The home is purpose built, light and airy. Temperatures were being maintained at an appropriate level despite it being a hot day. There is a safe, enclosed garden and the home has a designated gardener. There are plans to create sensory areas. Plans to extend the dementia care unit by knocking down an internal wall are still under review and consultation. The manager stated that some areas of the home have been painted. Residents were Care Homes for Older People Page 21 of 29 Evidence: consulted about colour schemes and sutle tones to stimulate visual senses have been chosen. Care Homes for Older People Page 22 of 29 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. The home has thorough staff recruitment procedures. Staff can expect to be properly supported through a detailed induction programme and regular support and supervision. Evidence: The home was fully staffed at the time of inspection and the manager reported a low staff turn over. She stated that they had not used agency staff for over six weeks. The home was adequately staffed with five staff working in the units. One person in the office, the manager and deputy manager. They had sufficient domestic staff who also worked over the weekend. The cook and kitchen assistant, the laundry lady and maintenance person were in the home. The home had an activities coordinator and a volunteer who also drove the mini bus. Rotas showed adequate staffing levels were being maintained. We looked at four staff files and these showed that staff were only employed after rigorous employment checks had been carried out. We saw evidence of regular staff supervision and a good induction for new staff, who were expected to complete a five day formal induction and then work through a book called passport for care. They also completed a probationary period with reviews of their performance during this time. Care Homes for Older People Page 23 of 29 Evidence: There was a staff training matrix on the wall and most training was up to date or planned for the near future with training taking place every month. Specialist training was being provided. Care staff had recently completed a six week training course in dementia care. This was provided by the community mental health team. The manager is going on to do a professional development course in dementia studies. Training in managing challenging behavior, palliative care, nutrition and the mental capacity act had also been completed. We spoke to a number of staff and the feedback received was generally positive. Staff felt there had been alot of changes which were mostly for the better. One staff member expressed concern about the increased dependency levels of residents and the uneven distribution of work load between the different units. The respite care unit had a number of permanent residents there, but the dependency levels could easily fluctuate in this unit depending on which residents were in. Care Homes for Older People Page 24 of 29 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 well managed and run in the interest of residents. The home conducts regular audits to identify where they do well and where they need to improve. Evidence: The registered manager was appointed in November 2007 and appointed both an assistant manager and a deputy manager. They have worked hard to improve standards at the home. Most noticeably the home is fully occupied, there is a waiting list and there are no staff vacancies. The home is well organized and run very efficiently in the interest of the residents. The manager is very enthusiastic and has alot of ideas about how to continue to develop the service and the staff that work there. We spoke to staff about the home and if there was an inclusive atmosphere. Most staff spoken to felt that the home was a good place to work and the management team were approachable. Examples of where the home had improved were given , such as Care Homes for Older People Page 25 of 29 Evidence: lots of compliments from relatives, improved standards of cleanliness, lots of refurbishment and an open door policy for all staff, residents and visitors alike. We looked at the home accounting procedures for holding residents money. It is a simple system which provides a clear audit trail for residents monies. We checked a couple of residents finances and the balance was correct. We looked at a sample of maintenance and servicing records.The fire policy had been updated in April. Fire maintenance and servicing records were satisfactory. The home complete a monthly health and safety audit. There was a clear record and audit of residents falls. We looked at the quality folder which provided evidence of internal and external audits. The latter carried out by external agencies. The fire authority had made a number of requirements at a previous visit. These had been met. The home had been awarded 4 stars by the environmental health department in 2008. The home are in the process of completing their annual review of the service. They send out questionnaires to residents, staff, relatives and external stakeholders. The results will be analyzed and published. The audit for 2008 was seen and was good. Care Homes for Older People Page 26 of 29 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 27 of 29 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 28 of 29 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 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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