Inspection on 16/04/09 for Kingswood House

This is the latest available inspection report for this service, carried out on 16th April 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kingswood House 30/04/07

Kingswood House 09/06/06

Kingswood House 14/12/05

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth 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: Kingswood House Mays Hill Road Shortlands Bromley Kent BR2 0HY     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: Rosemary Blenkinsopp     Date: 1 6 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Kingswood House Mays Hill Road Shortlands Bromley Kent BR2 0HY 02084600273 02084607836 kingswood.House@shaw.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Shaw Healthcare Ltd care home 39 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: 39 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 26) Dementia, over 65 years of age - Code DE(E) (maximum number of places: 13) Date of last inspection Brief description of the care home Kingswood House is one of 6 homes, which are registered under Shaw Healthcare Ltd. The organisation has a number of residential and nursing homes throughout the UK and has its organisational headquarters in South Wales. Kingswood House is a large Care Homes for Older People Page 4 of 27 Over 65 13 26 0 0 Brief description of the care home purpose built care home situated in a quiet residential area in Shortlands. The home provides twenty-four hour care to a maximum of 39 residents. The home takes in residents in the catagories frail elderly as well as Dementia. In addition it takes residents who require repsite care and those in transitional beds. Residents placed in the home are admitted via the Social Services departments referral and placement system. The home has a Manager, Deputy Manager, support staff and a team of ancillary staff. The fees are £458.17 for the block contract beds purchased through the London Borough of Bromley. Privately funded residents fees are between £600 for frail elderly up to £670.00 for Dementia care beds. The home provides information to residents and relatives in the form of a Service Users Guide and a Statement of Purpose is also available on request from the home. This sets out the type of accommodation and care provided. A copy of the last inspection report is also available on request from the home or the document can be viewed in the main reception area of the home. The home is part of the Shaw rebuilding programme, and this facility is due for closure 2011. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was conducted over a one day period. The manager facilitated the inspection with the help of staff. Periods of observation were undertaken on some of the units. Prior to the inspection the manager had completed the AQAA and forwarded this to the CQC. Twenty comment cards were received including eleven from residents, two from health professionals and seven from staff. The comments made within the comment cards are incorporated into the different sections. During the site visit the inspector met with three relatives, several residents and one Care Manager. Staff were interviewed as part of the site visit. All of the information obtained from the sources identified above has been incorporated Care Homes for Older People Page 6 of 27 into this report. A selection of documents were inspected including care plans staff personnel files as well as health and safety records. Feedback was provided to the manager at the end of the inspection. Other information which has been considered when producing this report and rating, is the information supplied and obtained throughout the year including Regulation 37 reports and complaints. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre-admissions procedures provide residents with the information they require prior to any decision regarding placement being made, to establish whether the service is right for them. Staff have information to ensure they can meet individual residents needs and on which to base an initial care plan. Evidence: The home provides care for residents who are in the category frail elderly and Dementia. The home accepts residents who require respite care as well as those who are in transitional beds. These are for those residents who are waiting or alternative placement perhaps to another care home facility. There are a small number of long term residents living at Kingswood. With such a mix of residents it is important that assessment information is comprehensive. Care Homes for Older People Page 10 of 27 Evidence: Shaw Healthcare provide standard documentation throughout its services. There was evidence from the records that residents had been assessed prior admission usually by the manager. There is a standard pre admission form, which is a tick box format with space for additional comments. The forms seen had been completed and contained information to inform into the decision making process. In addition Social Services assessments had been obtained and in some files correspondence from members of the multi disciplinary team and hospital letters. Residents spoken to said contracts had been issued. The Statement of Purpose and Service Users Guide were available. These will need to be reviewed to reflect the new organisation. 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. Residents can be assured that there needs will be met by staff in the home supported by members of the multi disciplinary team. Care plans are in place, and these provide information for staff to deliver the care. Medications were safely managed which provides protection to residents. Evidence: Care plans were sampled during the inspection of those residents whom we met. In addition the two care plans of those residents included in adult protection investigations were also viewed. One of those was blank and without any information, this is subject to further action, the second did contain some information relating to the allegation, and again this is also under investigation. The remainder of the care plans and supporting risk assessments are set out on standard Shaw Healthcare formats. In general the needs of the residents were outlined with appropriate interventions recorded to address the support and care needed. There were some gaps in psychological care, and this was this was the case Care Homes for Older People Page 12 of 27 Evidence: even when the residents had a diagnosis of Dementia. It is important that if standard care plans are used then these are tailored to met resident individual needs. The care plans and associated risk assessments were in parts a duplication of each other This is time consuming and makes files bulky to read which would deter staff, who have limited time or such. Risk assessments included areas for skin integrity , manual handling self medication as well as others identified through the admission process. One weight chart in a care plan indicated a significant weight loss over the period of one week. It is questionable if these records were accurate, and if they were why further interventions had not been indicated to address this. In the same care plan, the resident had on a previous occasion lost weight and on this occasion interventions to address this were recorded. Respite care plans also must be reflective of the residents condition as this may change between admissions and significantly alter the care they require. Two health care professionals completed comment cards they both made positive comments about the care provided including the following The staff refer to the GPs appropriately but have the skills to take responsibility for problems. A second health professional indicated that residents were always respected and that staff sought advice to manage and improve individual needs. There were records relating to visits made by members of the multidisciplinary team and GP. One staff member was concerned that gloves were located in one are only and not in every bedroom for easy access. This needs to be reviewed to ensure that cross infection measures are appropriate to prevent the spread of infection. In the main the majority of residents indicated in comment cards that their health needs were met one exception was that there was long wait for call bells to be answered. The medication records and storage were inspected. Documentation including medication administration records were maintained in a tidy manner. Photographs of the residents were in place and their allergies recorded. Records were retained for those medications coming into the home and those being disposed of. A list of signatures of the all those who administer medication were on file. Reasons for Care Homes for Older People Page 13 of 27 Evidence: omitting medications were recorded on the reverse of the medication chart. records were well completed. The lunch time medication administration was safely administered by the staff member. Those medications which had a limited self life were dated on opening . Staff should avoid using abbreviations any document particularly medication records The initials NKA , may not be widely known as meaning no known allergies. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The level of activities and interaction provides some residents with stimulation and entertainment although not all residents are suitably engaged, and they demonstrated limited signs of wellbeing. Choices are provided which means residents are enabled to input into their day. Evidence: Within this home there are relatively few residents who are permanent and this in itself makes it difficult with such a transient population to establish preferences around activities. There are also great variations in the levels of physical and mental abilities due to the mix of categories of residents, and this again can be difficult to ensure appropriate activities are organised. The home employs one activities staff member who works with residents . The home has residents of different abilities therefore group activities are not always the best option. During the site visit we saw residents watching TV, some engaging in small group activities as well as conversing with one another and staff. Signs of well being varied - some resident were very animated others mainly sleeping in the lounge chairs. Care Homes for Older People Page 15 of 27 Evidence: Within the comment cards received from residents, the areas which received the most negative comments were those in respect of meals and activities. Seven residents made comments that sometimes activities took part and the food was sometimes what they liked. The lunch was nicely presented and tables laid in preparation for the meal. The lunch was colourful and appetising with good portion sizes observed. Staff assisted residents in an unhurried manner. Juice was offered serviettes and condiments were used . The level of interaction between residents increased and in one case a resident assisted another with her food. Visiting is open at any reasonable time. In the past comments have been received about the wait at the front door particularly at weekends. This is being reviewed to prevent any delay. Relatives were seen to come and go throughout the day. Relatives with whom we met relayed positive comments about the service. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Comprehensive complaints information is provided to residents, relatives and visitors, which provides opportunities to raise issues. Staff demonstrated sufficient knowledge of adult protection procedures, which would afford protection to residents should any incident of this nature occur. Evidence: Shaw Healthcare have comprehensive policies and procedures to cover topics including complaints abuse and whistle blowing. Policies and procedures are available for staff to read and refer to and covered during induction. The Manager operates an open door policy whereby any resident, relative or visitor may speak to her confidentially. There have been two adult protection investigations undertaken within the last months, both relating to the health and welfare of residents. In addition the CQC has received two anonymous complaints regarding residents welfare issues and staffing levels. The two complaints were referred to the provider for investigation. The two adult protection investigations are on going. Four staff interviewed,including an agency worker. They were asked about how to action abuse and how to deal with whistle blowing. All were aware of what action to take should they need to. The level of knowledge varied although staff were aware of Care Homes for Older People Page 17 of 27 Evidence: the need to report such incidents. Staff were aware of whistle blowing and had sufficient information , although more training perhaps giving examples of when it may be used should be included in the on going training. The agency staff stated she had received training on these topics through her agency, whilst staff in the home said that Shaw Healthcare provided regular training on the subject. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with an adequate standard of accommodation. Sufficient equipment in relation to mobility aids and pressure relieving mattresses are provided to meet residents needs. The lift which accesses all floors and specialised equipment all add to benefit residents daily lives. Evidence: Kingswood House is in a residential area of Shortlands. The accommodation at Kingswood is laid out over three floors on three separate units. Each unit has private and communal accommodation. The main kitchen and laundry are on the ground floor, which also comprises the main offices. There is lift access to all floors. Areas were generally clean and tidy. On going efforts are required to maintain the home to its current acceptable level until closure. The home has units located on each floor. All efforts to make individual bedroom areas personal and homely continue. This can be difficult with respite residents and those who are in the home in transitional bedrooms. The sitting areas are maintained in a domestic manner and provide comfortable accommodation. New chairs had be purchased for the ground floor lounge. Care Homes for Older People Page 19 of 27 Evidence: Portable heaters were in use as there had been problems with the system in the home. We were advised that this problem had now been rectified. In the event that portable heater fans are any other equipment is used appropriate risk assessments must be in place. The manager said that environmental risk assessments had been developed. Reality orientation boards are in use in lounge areas to promote residents awareness. Residents with whom we met were satisfied with their accommodation. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are provided in sufficient numbers with an appropriate skill mix to meet the residents needs. Ancillary and administration staff work to support the care staff. Robust recruitment procedures afford protection to residents living in the home. Staff are provided with training and induction to enable them to undertake the work they perform. Evidence: The staff off duty rotas indicated that sufficient staff were employed to meet residents needs, although this was with the use of agency staff. Currently the home has three full time care staff vacancies , a part time team leader day duty as well as a part time night duty team leader. There are also vacancies for a part time kitchen assistant and a domestic. It is envisaged that once Sheila Stead closes, in approximately two months, staff will relocate to this facility , however this is in the interim period having an effect on continuity of care with agency covering vacancies. Within staff comment cards concerns were raised regarding the numbers of staff and one unit particularly was cited as having insufficient staff. The limited number of domestics was also commented upon and especially the weekend cover, when at times only two staff are covering the whole home. The home is spread over a number of floors and this would be an enormous task and must be reviewed. Care Homes for Older People Page 21 of 27 Evidence: One agency staff had worked approximately seven shifts and said that she had received a short induction on her first day and identity checks were made on her arrival. She was wearing a photo photograph identity badge She had received mandatory training through her agency and this included training on abuse and whistle blowing. The chef started 1st April after waiting a considerable length of time for CRB clearance . The lack of a chef had been included as part of a complaint received by CQC. The chef met with us and confirmed induction, and that he had the appropriate qualifications to do the job. He had, in his previous employment worked in this type of facility. One resident made the following comments, Kingswood House gives good to excellent care withe low staff turnover which indicates a happy contented working environment which has a beneficial effect on residents. Included in those comment cards received from staff,comments indicated that good training was provided and induction had been useful when they first commenced employment. Personal files were sampled to check that records relating to recruitment were in place. Recruitment procedures are undertaken through head office. A pro forma form is retained in the personnel file to confirm items such as POVA /CRB clearance and that references have been obtained prior to commencement of employment. At this home, these forms had been signed as evidenced that the checks had been made by a senior person in the company and all recruitment checks were verified and satisfactory. Health questionnaires were on file and completed by the employee. Also in the files were supervision records and where applicable annual appraisals. Supervision records were signed by both parties. Staff training is organised through a computer programme . Prompts are indicated to remind the manager when training is due and if they should become overdue, further reminders are on the spreadsheet . Those staff spoken to by use had a good grasp of mandatory topics including infection control and health and safety. They said that a lot of training was provided by the company. Several had completed NVQ training. Other course which staff had attended related to dealing with dementia, care planning, the Incapacity Act. One team leader was a trained manual handling instructor and received appropriate updates. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager of the home is sufficiently trained and experienced to safely manage the service. She is supported by senior staff in the company and her deputy. Health and safety issues are addressed by regular servicing as well as internal checking and training of staff. The homes quality assurance systems are adequate and include the views of all those who are involved in the service. Evidence: The manager has been in post for some time in this home although had a period of sick leave earlier when her deputy took charge. The deputy has been in post for approximately one year having transferred from another facility in the company. The manager and her deputy have both completed the Registered Managers Award A sample of health and safety records were inspected including those for the annual Care Homes for Older People Page 23 of 27 Evidence: gas appliances, electrical inspections, lift and lifting equipment. Water testing for Legionelle had been conducted July 2008 and was satisfactory. Fire safety records were inspected. Records indicated weekly fire alarm testing and these had taken place a various times of the day. Emergency light tests were recorded weekly. The fire book had a list of fire drills with those staff and residents attending listed. Fire equipment had been serviced recently including extinguishers and fire blankets. In relation to quality assurance there were gaps and omission in areas. The Regulation 26 reports were on site referring to some monthly unannounced visits although gaps were evident. The last annual survey had been conducted December 2008 . These surveys are conducted regularly, where ten residents and ten relatives have questionnaires sent to them. The comments received, are then reported upon and any shortfalls would be reviewed for action. Residents meetings are rarely held due to the transient population . Shaw Healthcare expect each of its homes to have quality monitoring on a quarterly basis. Audits are conducted by the management team included those for infection control, catering and standards of hygiene. This service has not had a recent visit by the Shaw Healthcare quality team. The team conduct internal audits and identify shortfalls which is beneficial for the home in improving standards. Residents finances were checked. Each resident has a transaction sheet and all expenditure has two to confirm they are correct. Receipts are retained and a sample of those checked were found to be correct. Money retained on site is securely stored. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 All residents,including those for temporary care, must have information in place to outline their needs and a care plan to address these. Staff need to work with the information provided in care plan and without such would be unable to deliver the specific care residents need. 30/06/2009 2 12 12 Appropriate activities need to be provided to residents. In order that residents have stimulation to enhance their quality of life 31/07/2009 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 2 8 9 Gloves need to b available where needed and easily accessible to prevent cross infection. Abbreviations used on any document should be avoided Page 26 of 27 Care Homes for Older People Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!