Key inspection report
Care homes for older people
Name: Address: Scarbrough Court Alexandra Way Cramlington Northumberland NE23 6ED The quality rating for this care home is:
three star excellent 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: Janet Thompson
Date: 2 5 0 2 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 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home
Name of care home: Address: Scarbrough Court Alexandra Way Cramlington Northumberland NE23 6ED 01670712215 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: cedden@rmbi.org.uk www.rmbi.org.uk Royal Masonic Benevolent Institution care home 55 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 55 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 category Old Age, not falling within any other category, Code OP - maximum number of places 55 Date of last inspection Brief description of the care home Scarborough Court is registered to provide accommodation for older people who need residential or nursing care. It is built in a local housing development close to the centre of Cramlington. The home is near public transport links and local shops. The home is run by the Royal Masonic Benevolent Institution (RMBI) and mainly provides accommodation for retired Freemasons and their families. Residents who have no connections with the (RMBI) also live at Scarborough Court. Care Homes for Older People
Page 4 of 25 Over 65 55 0 2 0 0 1 2 0 0 9 Brief description of the care home A new home was built in the grounds of the old one in 2008. It is a two storey building with accomodation and communal areas on both floors. There are two full size passenger lifts to help residents move around the home. There are 55 single bedrooms all with en-suite shower and toilet. The accomodation has been planned and built to high specifications and to an excellent standard The registered manager, deputy manager and a strong staff team support residents to be as independent as possible. Fees for the home vary, further information is available from the home. The RMBI has an information pack that is given to people who may wish to move into one of their homes. It contains information about RMBI homes and where they are, eligibility qualifications for admission, an application form, a copy of the complaints policy and information on funding arrangements. Copies of inspection reports are available in the home. Care Homes for Older People Page 5 of 25 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: three star excellent 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 is an overview of what the inspector found during the inspection. The quality rating for this service is three stars. This means the people who use this service experience excellent quality outcomes. We have reviewed our practice when making requirements. Some requirements from previous inspection reports may have been deleted or carried forward to this report as recommendations. This will only happen when it is considered that people who use the service are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Before the visit we looked at information we received since the last visit to the home. This includes how the service dealt with any complaints, changes to how the home is run, the views of people who use the service and the managers views of how well they Care Homes for Older People
Page 6 of 25 care for people. We sent questionnaires to people who use the service and some of the staff at the service. Eight staff and nine service user completed questionnaires were returned to us. The comments contained in the questionnaires have been reflected in the report. An unannounced visit was made on 26 February 2010. During the visit we talked with people who use the service, some staff and the manager. We looked at information about people who use the service and other records which must be kept. We checked that staff had the knowledge, skills and training to meet the needs of the people they care for and we looked around the building to make sure it was clean, safe and comfortable. Following the inspection feedback was given to the manager. Care Homes for Older People Page 7 of 25 What the care home does well: The care and attention given to residents at Scarbrough Court is very good. Residents and their relatives told us that staff were very caring and attentive. In questionnaires and in conversation residents told us that their care needs were met promptly and efficiently. People had good access to health care and all personal care was delivered in private. Care plans were clear and concise. Peoples care needs were properly assessed and good plans were in place to meet those needs. Care plans had been regularly updated. Some work is ongoing to change the format of the plans to make them even more person centred. Medication ordering, administration, storage and disposal was well managed. The home is very well equipped with specialist equipment to meet the needs of frail elderly people and those who are at higher risk due to dementia or physical disability. The home has overhead tracking to enable staff to move highly dependent people. The call system is computerised and works without audible tone, the computer system enables staff to see how quickly calls are answered. There are good social opportunities for people living in the home. There are two activities coordinators, one works on a more one-to-one basis with dependent people, and the other works in more social groups. The range of activities was good and the social life is well supported by the facilities and the environment. Food was very good, residents told us they liked the food and were offered good choices. The dining area was very attractive, the dining experience is similar to that of a Hotel. Residents have recently taken part in a ballot about proposed changes to the time of the main meal and the serving of breakfast. Residents told us that they feel able to complain about the service if needed. Residents said that they feel consulted about the day-to-day running of the home and they receive individualised attention. Complaints are properly recorded and staff have received training in this area. The environment for residents is clean, comfortable and very well maintained. The furniture, fixtures and fittings are of an excellent standard. The home is spacious and suitable for its purpose. Within the large areas smaller spaces have been created and the atmosphere is cosy and homely. The home is well staffed with suitably trained and competent people. Staff told us that they had enough equipment to carry out their job and they received enough instruction and support. We were impressed with the knowledge and enthusiasm of the staff team. Residents and relatives told us that the staff were very good in all areas. People told us that some residents health and emotional well-being had improved due to the care and attention given by staff. Staff described the manager as one of the best they had worked for. Residents and relatives told us that the manager had a high profile within the home, she was always Care Homes for Older People
Page 8 of 25 aware of day-to-day events and responded quickly to any problems. They said the manager set very high standards which were appreciated by all. The management of the home was very good, this was reflected in the high standards seen throughout all sections of this report. Health and safety checks and tests were up to date. Risks to individuals and the environment were assessed and managed within a safety framework. There were no obvious hazards within the home. We spoke to a member of the domestic staff who had an excellent knowledge of the management of hazardous substances and infection control. Residents and other users of the service are regularly consulted. Their views are sought on all aspects of the running of the home. People told us that they feel valued and listened to. Staff receive regular formal supervision. This enables them to contribute to the running of the home and address any individual problems or requests. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 25 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 25 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are properly assessed, taking account of their needs and wishes, so that they can be assured this is a suitable home and receive an individual care service. Evidence: Three pre-admission assessments were seen. They contained enough information to enable staff to assess if they could meet the individual needs of people before admission. Information from other health professionals and carers was included in the assessment. Care Homes for Older People Page 11 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal care that is well planned and takes account of their diverse needs. Evidence: Three care plans were examined and two were case tracked. This means that we spoke to the individual residents or observed their care then matched our observations to what was written in the care plan. Both case tracked care plans did reflect the actual care needed by the residents. Care plans took account of peoples diverse and differing needs. People were supported to achieve independence and meet individual goals. Other health professionals contributed to the planning of care. These contributions were clearly recorded. There was evidence of some very good risk assessments for individual areas of care. All risk assessments were followed up with care plans which had been regularly evaluated. The service is about to introduce a new care plan format which encourages staff to plan in a more person centred way. Currently one or two people have responsibility for care planning, this is about to change so that all staff are involved. This is a positive move as it encourages all staff to remain up-to-date with changes to residents care.
Care Homes for Older People Page 12 of 25 Evidence: The actual care people received appeared to be very good. We spoke to residents who told us that they were well cared for. They said staff responded quickly if they rang the call bell and were attentive to their needs. The nurse call system is electronic, the system enables staff to be alerted without the need for an audible tone. The system also records which room has called and how long the call remained unanswered. We noted that everyone was well dressed and looked clean and cared for. We observed staff supporting residents to wash their hands, clean spectacles and hearing aids. Staff were knowledgeable about individual needs. Residents told us that they could choose their routines, including how their personal care was delivered. Residents said that staff were kind, caring and attentive. Residents wishes in relation to end of life care were recorded. Advanced care plans are currently being introduced for all residents, some of these were completed and were signed by residents and their relatives. Staff showed an understanding of the difficulties faced by residents and relatives regarding end of life care. The subject was handled sensitively and staff showed respect for peoples wishes. Medication ordering, administration, storage and disposal were examined. All medicines were accounted for and all those administered were signed for. Care Homes for Older People Page 13 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to lead a healthy and fulfilling personal lifestyle. This takes account of their wishes and diverse abilities. Evidence: There are two staff members in charge of activities. One activities coordinator works on the nursing unit and one works on the residential unit. Generally more one-to-one activities take place on the nursing unit with more dependent people. This activities coordinator goes around the resident group every morning and spends some time with individuals. Group activities tend to take place in the residential unit, though any residents can attend. Residents are told about activities through a monthly plan, this is given to each person and also displayed on the noticeboard. The activities coordinators support residents to use a range of services within the local community. Residents are encouraged to be in control of their own lives as far as possible. One of the activities coordinators told us that she tries to plan activities that stimulate the physical, intellectual and sensory experience for residents. The activities co-ordinator said that she tries to take some residents out of the home
Care Homes for Older People Page 14 of 25 Evidence: in the homes minibus. She reported that residents enjoy this however, she was aware that this did take her away from the majority of residents left in the home, therefore outings had to be restricted. Relatives told us that they were free to visit at any time, they confirmed that they felt welcome in the home. There are small kitchens on each unit for relatives to use to make drinks or snacks. Relatives told us that they were regularly offered food and drinks by staff when they visited and were treated respectfully at all times. Residents told us they could choose exactly how to spend their day. There was a comfortable, relaxed atmosphere in the home and we observed that residents sat in small groups and communication between them was good. Residents also said they liked the food. We ate the food at the home. It was well presented. The food was hot enough and very tasty. The standard of the cooking was very good. Dining tables were attractively set and the dining experience was more like that of a good hotel. Residents told us that they are consulted about the food, they knew the name of the chefs and are offered a very good degree of choice. Residents currently have three choices of main meal at lunchtime as well as options of light bites. There are three courses at teatime, including one cooked option. Ballot papers have recently been sent to residents seeking their opinion as to whether the main meal should be changed to evening time. They have also been balloted about the breakfast and a proposal for everyone to be served individually in their own rooms. A resident told us that he had completed his Ballot papers and was awaiting the result. Care Homes for Older People Page 15 of 25 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 are protected from harm through thorough policies, procedures and staff training Evidence: Staff follow the homes policies and procedures relating to the management of complaints and allegations of abuse. Staff have been trained in the management of adult safeguarding. Residents are told how to complain through the complaints procedure. Residents spoken to said they would complain if they needed to but none of them had any current complaints. We spoke to three residents who assured us that all small issues were dealt with immediately. They said they could not find anything to complain about because of this. Complaints are properly recorded, we examined the complaints record which showed that complaints are taken seriously and resolved to the satisfaction of the complainants as far as possible. There was not an excessive amount of complaints. Relatives told us that they would feel free to complain if they needed to. They said there was no need to complain because when you asked for something it was provided. Care Homes for Older People Page 16 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a safe comfortable home that is generally pleasant and clean. Evidence: Since the last key inspection of the home residents have moved into an entirely new building. This was purposebuilt with a great deal of planning and input from the manager, staff and residents. The new building provides 55 single bedrooms, all with ensuite shower and toilet. The rooms are spacious and well planned. There are four lounges over two floors and two dining rooms on the ground floor. All communal areas are fitted with a very good standard of furniture. All areas are spacious yet somehow small cosy sitting areas have been created. The atmosphere in the home was relaxed and homely which must have been difficult to achieve in such a big space. The home also has a reflections room which is used for hairdressing, manicures and chiropody. There are small kitchens on both floors for relatives to use. On the first floor there is a roof garden and courtyard which is reportedly well used in good weather. The external grounds have yet to be established but this is progressing. Each residents bedroom is fitted with environment controls and in the nursing unit, each room is fitted with overhead tracking to move residents from bed to shower or toilet. Some of the nursing rooms are fitted with a monitoring system which enables staff to be alerted when people get out of bed. This is only used for people with some element of confusion which renders them at risk of falls if they move unattended. All
Care Homes for Older People Page 17 of 25 Evidence: of the beds are fully adjustable, can be fitted with bedside rails and the nursing beds are able to be profiled to the needs of the individuals. Bathrooms are spacious, well equipped and very well decorated. All areas of the home were very clean, there were no mal odours and everywhere was tidy. The standard of decoration is very high, although staff have been working in the building for a year there was very little damage to the decor. Ancillary areas are well equipped to enable staff to carry out their job. We spoke to one of the ancillary staff and were very impressed with her knowledge of infection control and management of hazardous substances. This staff member described very good working practices to enable the home to be clean and hygienic. She confirmed that the equipment provided for staff was very good, plentiful and readily available. Residents and relatives told us that the home was always clean, warm and comfortable. Residents said that their rooms felt personal as they were able to bring items in with them. We observed that some residents kept their door locked and in all cases staff knocked on doors before entering. Care Homes for Older People Page 18 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported and protected through staff numbers, skill and ability. Evidence: The home was adequately staffed on the day of inspection and enough staff were scheduled to be on duty in the near future. The manager confirmed that over 90 of staff had achieved NVQ level 2 and records confirmed that staff were up to date with essential training. There was a training plan and future training was booked. Staff confirmed that they had done the training required to do their job as well as some developmental training. For example, one senior care assistant has completed a management development programme and is trained as an NVQ assessor. Several staff, such as the cook, cleaner, senior carer and deputy manager have completed an improvement foundation in infection control. There was NVQ training ongoing on the day of inspection and the home has a dedicated training room for staff to use. This is well equipped and was appreciated by the staff. It is evident that the staff training has been relevant and effective due to the good standards of care, cleanliness and management that were demonstrated throughout. Five staff recruitment files were examined. These were for one nurse and four carers
Care Homes for Older People Page 19 of 25 Evidence: on duty that day. All contained good information. Thorough background checks had been carried out before employment. Residents were protected through checking of criminal records information for all employees. Residents and relatives stated that all of the staff work well as a team and as individuals. They said that staff appeared competent and relatives were reassured that people would be looked after well. Residents expressed confidence in the staff team and there appeared to be good relationships all round. Care Homes for Older People Page 20 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are protected through reflective management taking account of the diverse needs of the service. Evidence: The home has an experienced registered manager. She has been assessed as having the competency and skills to run the home. Residents told us that the home seems to run well. Staff appeared to be able to communicate with the manager and regularly sought her advice. The relationship between the manager, staff, residents and relatives appears to be good. Staff and relatives told us that the manager sets high standards within the home, they felt that these standards were realistic and to the benefit of residents living there. Staff said they felt supported by the manager and confident that she would address any issues they might have. The manager has a high profile within the home, people confirmed that they see her on a daily basis and that communication is good. Staff receive formal supervision on a regular basis. This gives them an opportunity to
Care Homes for Older People Page 21 of 25 Evidence: contribute to the running of the home and identify any training needs they might have. The home does operate a quality assurance system. Residents, their relatives and professionals are consulted about the service provided on an annual basis. We looked at the most recent results which were very positive. The results are collated and action plans produced to address any negative comments. Residents are also consulted on a day-to-day basis and through regular meetings, as previously mentioned this has resulted in a recent ballot about food. Servicing and maintenance agreements are in place for facilities and equipment. Risks in the environment and tasks, including safe working practices are assessed and reviewed. All fire safety checks, tests and instructions to staff are conducted at the required frequency and recorded. There were no obvious trip hazards in the home. Fire exits were clear of obstruction and all hazardous fluids locked away. The home does manage monies for some residents. The money is held in a central, nonprofitmaking, account. Individual records are kept for all transactions and receipts are available for expenditure. Monies are regularly checked by the manager and the administrator. Some residents manage their own money and this is encouraged. Care Homes for Older People Page 22 of 25 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 23 of 25 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 24 of 25 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 25 of 25 - 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!