Inspection on 22/09/09 for Shaftesbury House Residential Home

This is the latest available inspection report for this service, carried out on 22nd September 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

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 17/02/2010.

Key inspection report Care homes for older people Name: Address: Shaftesbury House Residential Home 5 Cowper Street Ipswich Suffolk IP4 5JD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Claire Hutton     Date: 2 3 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Shaftesbury House Residential Home 5 Cowper Street Ipswich Suffolk IP4 5JD 01473271987 01473271987 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Sanctuary Care Ltd care home 26 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 uers who can be accommodated is 26. 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 Date of last inspection Brief description of the care home Shaftesbury House is a purpose built care home registered for 25 older people. The home is owned and managed by Sanctuary Care Ltd. The home is situated in Cowper Street, a residential area to the east of Ipswich town centre. The home is laid out over three floors, with some car parking and enclosed private gardens. The environment is pleasant and homely and residents have a choice of communal lounges and dining rooms. The home is situated close to local shops and facilities and a main bus route into town. For more information on fees and a service users guide please contact the home Care Homes for Older People Page 4 of 27 Over 65 26 0 3 0 0 9 2 0 0 8 Brief description of the care home directly. 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: This unannounced inspection took place over eleven hours on two weekdays. This inspection focused on the core standards relating to older people. During this inspection the inspector made a tour of the building, had in depth discussions with the homes manager, met most of the residents and spoke individually with many of them, spoke also with the staff on duty and carried out spot checks on a number of the homes records. The comments in this report reflect the findings made by the inspector during that visit and also take account of information gathered over the past months from the homes manager and by way of pre inspection questionnaires completed by three of the residents, four of their relatives and four staff at the home. This was a positive inspection. The home had a well ordered and homely atmosphere where staff and residents were seen to be interacting positively together. Staff spoken Care Homes for Older People Page 6 of 27 with said morale was good. The residents looked happy and without exception all said that they were well cared for. Comments such as This is a friendly home nothing is too much trouble for the staff were made repeatedly to the inspector. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: The requirements made at the last inspection have all been met. However we did leave an immediate requirement that related to fire safety as one of the previous requirements had only partly been met. The manager responded swiftly and told us that the fire procedure had been revised to have eventual evacuation, equipment purchased and staff training dates set. We believe that this response has ensured that residents are better safeguarded against potential fire hazard than previously. Care Homes for Older People Page 8 of 27 The service should have the most up to date policy and procedure on adult safeguarding from Suffolk Social Services and staff should be made aware of the document. This will ensure that if needed the policy and procedure can be activated without delay. The service should consider how it can develop the risk assessments it has in place relating to medication. Currently there is a clear demarcation as to who has control either the individual or the care home. We would like to see the service develop more to maintain levels of independence based upon individuals capabilities and wishes and put measures in place that allow residents to retain control of their medication for longer. 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 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 10 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. People who use this service will find there is sufficient information available and they can visit. They can expect an assessment of care needs to be completed before moving in. This will enable people to determine if the home can meet their needs. Evidence: Information about this care home is available in the entrance hall. There is a guide to the service provided as well as information about admission to the home, terms and conditions and a sample contract. Additional information is also available on the homes smoking and alcohol policy. We looked for assessments of people at the home in their files, but these had all been archived as they had been developed into care plans. We received assurances from the manager and staff we spoke with that assessments were routinely done and that no one was admitted without staff being aware of their care needs. We did see a sample of the assessment to be completed and this addressed all areas of need when Care Homes for Older People Page 11 of 27 Evidence: completed. Also in files we saw assessments and information provided for people placed by Social Services and from the local hospital. The self-assessment completed told us that prospective residents are encouraged to visit the home and spend time there to help them decide if they want to move in. Also that an in-depth assessment is completed and there is a trail period of 6 weeks. We spoke to residents about how they found this particular home and one resident said we were told it was one of the best homes in Ipswich and my family are all very pleased with it. Three other residents said they had enough information and had a written terms and conditions (contract) Care Homes for Older People Page 12 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. Good care plans are maintained identifying care needs. Residents can be assured that they will have prompt access to medical services whenever these are needed. The homes medication storage and administration system is robust and gives good protection to the residents. Evidence: We examined 4 care plans of people at this home with varying needs. We found that each person had their health, personal and social care needs set out in a plan of care. The files were well organised and contained relevant information about each individual. We found assessments of nutritional needs, manual handling needs, falls and continence. We found that these records were regularly reviewed as staff had indicated on separate assessments any updates. Where one persons nutritional assessment indicated that they were at high risk we also found follow through with a record of their nutritional intake and a record of weight. This record was in a graph format and therefore made it easy for staff to record, but to see the overall weight patterns over a period of time. Care Homes for Older People Page 13 of 27 Evidence: One person had a health care need of diabetes. We found a care plan relating to this. It highlighted the need for GP input in relation to medication reviews and blood testing, regular optician appointments, regular chiropody care, monitoring weight and a supporting diet. We tracked all these elements through by looking a health and care support, talking to the individual resident, care staff and catering staff. We found all these elements of care were being very well met. Care records showed that residents were enabled to appropriately access a full range of health care provision. We spoke with residents and most were satisfied and said how they were able to access the GP when needed, but would like more access to preventative care such as blood pressure monitoring and cholesterol checks. We examined medication practices whilst at the home. We observed staff administering medication and looked at records, storage and staff training. We found that practices were based upon good policies and procedures, staff followed those procedures and told us that they were appropriately trained. All records examined (including controlled drugs) showed good ordering and administering processes in place that meant residents received medication prescribed for them. We looked at examples of when medication had changed and found that the change was double signed by staff and also recorded on the back of the medication administration chart. The storage of medication (including controlled drugs)was good as it was appropriately secure and stored at correct temperatures that were monitored. We saw evidence of regular auditing and checking by managers. Residents are protected by the homes processes and receive medication they require. However the service should consider how it can develop the risk assessments it has in place relating to medication. Currently there is a clear demarcation as to who has control - either the individual or the care home. We would like to see the service develop more to maintain levels of independence based upon individuals capabilities and wishes and put measures in place that allow residents to retain control of their medication for longer. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The diverse social and activity needs of the residents are well supported and enjoyed by all. The residents receive a healthy diet of freshly prepared good quality food, which is provided with good variety. Evidence: The home provides a wide range of activities outings and social events, which are planned to meet individual residents needs and to accommodate their interests and requests. Recent trips included Southwold and Spa Pavillion. Information about these activity programmes is advertised in the homes entrance hallway and also in several locations around the home. One resident who we met who did not like to leave their room had a list of activities for that week just in case they were tempted to join in. The home employs an activities organiser who works several afternoons each week. The range of activities included: Internet cinema show, card making, bingo, quizzes and crosswords. We also saw that individual time was spent with residents accompanying them to choir, knitting and manicures. A number of religious services are held in the home whilst some residents who are able are assisted to attend services in local churches of their choice. Care Homes for Older People Page 15 of 27 Evidence: Without exception the residents comments made to the inspector during this inspection and their comments recorded on the pre-inspection survey questionnaires concerning the food provided by the home were entirely positive. Residents said that they always had sufficient quantity frequent variations were made to the menus following the cooks regular discussions with them concerning preferences. We spoke with the cook and they confirmed that they cater for special diets and regularly discuss preferences with residents. The meals observed by the inspector during the time of this inspection all looked attractive and appetising and residents were seen to take their time and enjoy having a chat in a relaxed manner during their meal times. Comments such as tasty good food. One relative and one resident did comment on the dining room, saying the lay out and amount of noise could be improved. We fed these comments back to the manager and she is looking into the matter, purchasing other furniture that will hopefully make the dining room more accessible and also reduce noise from chair movement. 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. The home has an open culture that allows the residents to express their views and concerns in a safe and understanding environment. The homes complaints policy is clear and freely available. The home has a good understanding of Adult Protection and Whistle Blowing and how these give protection to the residents. Evidence: Information concerning the homes complaints policy and procedures was seen to be freely available in the home. Information gathered from residents and relatives evidenced that they had a good awareness of these. Several residents commented that if they had any reason to complain they would first discuss the problem with a member of staff or the manager because they had confidence that things would be sorted out simply without the need to resort to formal procedures. The records showed that the home has received 4 complaints in the last 12 months and that these have been dealt with promptly and according to the homes policy and procedures. The home is currently investigating a complaint and was able to share their preliminary findings with us. We found that matters are being taken seriously and looked into thoroughly. There has been one incident concerning Safeguarding Adults (Adult Protection) and this related to a small amount of money going missing. This was reported through the correct channels and has been concluded. We spoke to 4 staff and all said they had Care Homes for Older People Page 17 of 27 Evidence: received training in abuse awareness, knew how to raise an alert and the concept of whistle blowing. We also saw information prominently displayed for visitors about alerting any concerns of adult abuse to Social Services. We are confident that the service is aware of how to report safeguarding matters and the manager had a good knowledge, however the most up to date policy and procedure from Suffolk Social Services was not available at the home. The manager agreed to access this promptly and make staff aware. 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 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 to live in a safe, well maintained environment which is clean, pleasant and hygienic and that they have safe, comfortable bedrooms with their own possessions around them. Bathing facilities are set to improve. Evidence: We toured all the communal areas within the home and visited several bedrooms. The home was well maintained, warm throughout and clean. Bedrooms were well furnished and reflected individuals posssessions and choices. Environmentally there are many developments underway and set to happen. Whilst at the premises we saw that the storage heating within the home was being replaced with gas central heating. Such a major undertaking can cause disruption. The process was seen to be managed as well as could be, given the intrusiveness of the work to be done. Once this work is completed there are plans to redecorate the whole home and re-carpet the ground floor area. The dining room is set to get a laminate floor covering and new furniture. The lounge area will get new furniture next year. In our last inspection report we commented upon the bathing facilities within the home and a need to reassess and ensure needs of the resident group were met. We were pleased to see that this reassessment work had been completed and plans were Care Homes for Older People Page 19 of 27 Evidence: underway to change facilities provided. One bathroom will have new facilities before the end of this year and other bathrooms will follow in the next financial year. Since our last inspection there have been problems with the smooth working order of the shaft lift. We were notified about these matters and discussed the current situation with the manager. The shaft lift is now in good working order however, a recent survey of the shaft lift recommends that it should be upgraded or replaced within 2 years. Therefore, there may be further unavoidable disruption. We looked in the laundry room and found good working equipment that ensures the appropriate laundering of clothes. We fed back to the manager the need for a pedal bin in this room and for the floor to be sealed to ensure cleanliness is suitably maintained. We looked at and discussed the security of the premises and found this to be satisfactory. 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. Residents at Shafestbury House are cared for by sufficient numbers of staff who are appropriately recruited and trained. Evidence: We discussed staffing numbers with staff and residents and looked at the roster. The outcome was that people are satisfied with the staffing levels at the moment. This home has used a high number of agency staff in the past months, but this is set to improve with the recruitment drive for permanent staff. There have been 4 new staff recruited and are now working with 5 other staff set to start. We looked at the recruitment records for 3 staff at random and found that all the correct checks to safeguard people were in place. In addition 4 staff surveys told that checks had been completed before they started work at the home. We spoke to 4 staff at the service and received 4 surveys back from staff. Feedback from staff on their induction, training, supervision and developments within the home was positive. Staff told us that moral was improving. One staff member said Changes are happening for the better. Improvements happen on almost a daily basis at the moment. Very positive. All 4 staff spoken with said they had achieved their NVQ in care. Staff spoke of receiving training in manual handling, 1st aid, infection control, health and safety and Care Homes for Older People Page 21 of 27 Evidence: abuse awareness training. The manager confirmed that all team leaders have a current 1st aid certificate. The home also has a running yearly training program in place to ensure staff are kept updated with their practices. Two staff expressed a view that training using DVDs was a lesser quality than if delivered by an individual. 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. Residents and their relatives can be assured a competent, experienced and qualified manager leads the home. The management and administration of the home is based on openness and respect. An effective quality assurance system is in place to ensure peoples views are obtained and incorporated into the running of the home. Evidence: The manager has the required qualifications and experience and is competent to run the home. She has a clear understanding of the key principles and focus of the service and her aim is to improve an increased quality of life for the residents, with a good awareness of the need for equality and an understanding of the diversity needs of the residents. Staff and residents spoken with confirmed that the manager is supportive and approachable. One staff member wrote in their survey We have now an excellent new homes manager, area manager and administrator as well as some new staff. The working environment has improved dramatically over the past few months which has Care Homes for Older People Page 23 of 27 Evidence: had a good and positive effect on all who live at Shaftsbury House. Written comments from relatives also confirmed this and evidenced that the home is run in the best interests of its residents. The home has clear health and safety policies of which staff had a good awareness. Checks are made by the manager to ensure that standards are maintained. A recent example being the environmental audit. Spot checks made of records and policies during this inspection including fire testing, water temperature, chemicals, infection control and risk assessments evidenced that the records are well maintained and that routine checking is carried out. We did find one bath downstairs was on the cool side and registered a temperature of 35 degrees Celsius. The manager agreed to look into this promptly. At the last inspection we made a requirement that the fire risk assessment must be reviewed. We found that this had been reviewed, but we also required an evacuation procedure for the home, equipment provided and staff to be trained to use the equipment whilst following the procedure. We spoke with the maintenance man who had attended a fire marshals training course and had delivered some training around fire to staff, but this did not cover fully our requirement made. Therefore, we left an immediate requirement with the manager repeating the need for evacuation procedures to be in place along with equipment and training for staff. We also notified the local fire services of our concern and know that they will go on to monitor the arrangements put in place. The new manager was swift to respond to our immediate requirement and notified us within days that the procedure had been changed, equipment purchased and staff training dates set. We believe these actions have lessened the potential risk and that residents are safer than they were previously. The home has a current Liability Insurance Certificate and the CQC Registration Certificate was on display. Proper safeguards and recording arrangements are in place to ensure the safety of residents monies kept by the home. The quality monitoring system in place includes the environmental audit, financial audits, food safety, and a number of resident surveys including seeking views on meals, laundry and cleaning, activities and care. We were able to see the outcome of some of these and the responses were positive. The CQC Annual Quality Assurance Assessment(AQAA) form, issued to the home for this inspection, was returned in good time with clear and detailed information. 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 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 18 The service should have the most up to date policy and procedure on adult safeguarding from Suffolk Social Services and staff should be made aware of the document. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!