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Inspection on 07/05/09 for South Wold Nursing Home

Also see our care home review for South Wold Nursing Home for more information

This is the latest available inspection report for this service, carried out on 7th May 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The people live in comfortable accommodation. Each person is encouraged and supported to be independent and take part in meaningful activities. They are also offered choices about what they wish to do and to make decisions about how they spend their lives. Staff communicate well with them and respect their choices and decisions. People living in the home are cared for and supported by a caring, educated and committed team of staff. They are in turn lead by an experienced manager who is also one of the owners and has knowledge about management, the care and support for older people. There is a programme of education and training provided for staff, which ensures that staff know how to care and support the people who live at the home. The staff feel valued by the manager and feel part of a team to improve, help and support the people living in the home.

What has improved since the last inspection?

They have provided new carpets throughout the home as well as flooring in the toilets and dining room which the people told us they liked. They have provided more special beds which make it more comfortable for people in bed and safer for staff when attending to these people, bringing the total to 5. They have also provided more alternating pressure mattresses. They have replaced the fridge and microwave in the kitchen. They have also provided a new washing machine which has improved the way clothes are washed.

What the care home could do better:

The three requirements from the last key inspection had been addressed. There were no requirements as a result of this inspection. We discussed with the manager during the inspection that when he assesses people coming into the home he writes to each person to confirm they can meet their needs. We also discussed updating their complaints procedure to include our new name and the address and phone number of our Cambridge Regional Office. The manager agreed to act on these issues. We have recommended that the manager introduce a formal quality assurance system to include internal audits. We have also recommended that the manager consider reorganising management systems as we found some of the management records difficult to find.

Key inspection report Care homes for older people Name: Address: South Wold Nursing Home South Road Tetford Horncastle Lincolnshire LN9 6QB     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: Tobias Payne     Date: 0 7 0 5 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 24 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 24 Information about the care home Name of care home: Address: South Wold Nursing Home South Road Tetford Horncastle Lincolnshire LN9 6QB 01507533393 01507533311 sov1971@aol.com shailenm7@aol.com Mr S Munnien,Mrs Satiavanee Munnien care home 16 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The number of Service Users in the home with Nursing needs must not exceed 13. Date of last inspection Brief description of the care home Southwold is situated in the village of Tetford, which is approximately 5 miles from the A158. The village lies between the market towns of Horncastle and Alford. The home is registered to provide personal and nursing care for 16 people, including those with dementia. The home has a purpose built annexe attached to the rear of a detached property and lies well back from the main road through the village. The annexe is single storey and provides 12 single bedrooms and 2 double bedrooms. The philosophy of the home is to provide individual care and treatment based on individual needs. To maintain high Care Homes for Older People Page 4 of 24 0 0 Over 65 16 16 Brief description of the care home standards of care and practice using a holistic approach. To involve residents and carers in the care programme. To encourage and promote independence, maintain dignity and privacy. To promote and maximise residents independence and to create a homely, therapeutic and safe environment for residents. To the rear of the home there is a large well-maintained garden with views overlooking the surrounding countryside. On the day of this inspection the weekly fees ranged from £375 - £510 depending on the persons assessed needs. Additional charges were for chiropody which ranged from £12 to £13, hairdressing which ranged from £5 to £20 personal newspapers and personal toiletries. Information about the home including the statement of purpose, service users guide and a copy of the last inspection report can be obtained from the manager who is also one of the owners of the home. These documents were available in the reception area at the entrance to the home Care Homes for Older People Page 5 of 24 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 which was unannounced took place over 6 hours. The registered manager who is also one of the owners was present throughout the inspection and was given feedback at the end of the inspection. The main method of inspection used was called case tracking which involved selecting 2 people and tracking the care they receive through the checking of their records, discussion with them and the staff, and where more appropriate observation of interaction between staff and the people living in the home and related care practices. We looked at a sample of care records and walked around the home to see the quality of accommodation and visited some of the bedrooms with the permission of the people living in the home. We spoke with 7 people living in the home, a visiting community nurse and respiratory physiotherapist as well as 4 members of staff. An (AQAA) Annual quality assurance assessment was completed by the manager and sent to us prior to this report being completed. This is a self assessment document completed by the Care Homes for Older People Page 6 of 24 manager of the care home. It sets out evidence from the provider to demonstrate that they are meeting the Care Home Regulations. It is normal procedure to send questionnaires to the people before we make a site visit to obtain their views about the home. This was however not possible on this occasion due to time constraints. However all the people we spoke with were very positive about the home and had no negative comments to make. Their opinions are reflected within this inspection report. Care Homes for Older People Page 7 of 24 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 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 24 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 24 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 coming in to the home receive information and support to help them make an informed choice of where to live. There are assessment processes in place, which ensure that individual needs can be met within the home. Evidence: There was a detailed statement of purpose and 2 leaflets which made up the service users guide together with a copy of our last inspection report at the entrance to the home. We noticed that our name, address and phone number needed to be added to the statement of purpose and complaints procedure. We asked that all information now referred to our Cambridge Regional office. The manager agreed to act on this as soon as possible. The manager told us that where a referal was made to stay in the home he would visit each person and make a thorough assessment of their needs involving the person and any other person involved in their care and support. He confirmed that he did not send written confirmation to them that based on the assessment they could meet their needs. He however agreed to ensure this took place Care Homes for Older People Page 10 of 24 Evidence: in the future. We spoke with one person who told us that I met the manager and was told all about the home. I am very satisfied with the care and approach of staff. The care home does not offer a dedicated intermediate care service. Care Homes for Older People Page 11 of 24 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. Each person had a detailed care plan giving details about their care and support which ensured that the staff were able to meet the needs of the people living in the home. Evidence: We saw records for 2 people. Each person had a separate file with a photograph, admission information, moving and handling assessment, risk assessment, family and social background, care plans, weight, nutrition, dietary and other assessments as required to meet the needs of the person. The care plans were hand written and detailed their individual needs and how their care and support would be provided. Records were signed and dated. We could see that considerable effort had been made to include a detailed mental capacity assessment for each person. We noted clear instructions about how staff should approach a person who had communication difficulties. An example being use short sentances and questions such as yes or no, use gestures as neccesary and communication tools such as a picture board. There were also clear instructions about how staff should meet the particular needs of people who had a dementia. Throughout our visit we saw staff respecting the peoples wishes and choices in the way they made contact with the people living in the home and their Care Homes for Older People Page 12 of 24 Evidence: response. We also saw staff showing good knowledge of the particular needs of the people living in the home. Where required, people living in the home were referred to GPs, Community Nurse, Community Psychiatric Nurse, Tissue Viability Nurse, Continence Nurse, Physiotherapist, Opticians, Dentist, Chiropodist and other specialists. We spoke to a visiting Community Nurse and Respiratory Physiotherapist who were visting the home. They told us that they found the staff to be very friendly and welcoming. Comments included, The staff knew who I was coming to see and introduced me to the person. I received a professional approach throughout my visit and we work closely with the manager. Nurses administered medication. There was a policy and procedure for this and the manager assessed each person before they were considered safe to administer medication. Records we saw were clear and well maintained with a good audit trail. The manager told us that the people were encouraged by the staff team to self medicate but only one person did so, the other people needed a degree of assistance in order to ensure they took their medication safely. People we spoke with were satisfied with the way staff cared for them and had confidence in the staff. We saw throughout our inspection staff attended to the people in a warm, friendly and kind manner, knocking on doors before entering their bedrooms and asking whether they needed any help. The people told us I am very happy here and the staff are very nice, everyday I wake up and feel very happy and content here and the staff are so friendly and I love them. Care Homes for Older People Page 13 of 24 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. Social activities are varied and provide stimulation and interest for people living in the home. Visitors are made to feel welcome and supported. People enjoy varied and nutritious meals. Evidence: When admitted to the home details were obtained of each persons interests. This was contained in ther care records. At our last inspection the manager was required to ensure daily activities were provided to meet the needs of the peopleliving in the home. At this inspection this had been addressed although there was no written programme of activities. The manager told us he had reviewed the range of activities provided and employed a person whose role was to provide activities 3 hours a day. In addition he had arranged every 2 weeks for a specific group activity to take place with the involvement of an outiside specialist. The activities included nail and self care, board games, sing a long using an outside visiting entertainer every month and occassional trips out using a mini-bus. During our visit one of the people told us that she was looking forward to staff taking her outside for a trip in the sun in the afternoon in a wheelchair and we later saw the member of staff talking to her and asking what she wanted to do. The menber of staff Care Homes for Older People Page 14 of 24 Evidence: was later seen to take her out in her wheelchair to meet her wishes. The people living in the home were offered 3 main meals a day plus snacks. Menus were on a four-week rota. There was a set menu but an alternative could be arranged to suit the needs of the person. East Lindsey District Council awarded the home 2 stars (good) on the 20/2/2009 following an inspection, in recognition of the catering service provided. The report required the home to reorganise the food records, replace the fly screen, chopping boards, microwave and fridge. All this had been done but the manager acknowledged the records were still disorganised but during the inspection the manager arranged for a new record book to be ordered. We examined the records for food temperatures, menus and cleaning rotas and found them well maintained and up to date but difficult to find. Meals were served in the dining room, the adjoining lounge or in their bedrooms on a tray. We saw staff were assisting those people who needed assistance in a dignified and sensitive manner. All the people we spoke with were complimentary about the food. Each person had a copy of the 4 week menu. Comments included we have lovely food, just the way I like it, I like the meals and there is a choice if we dont like what is on the menu. Care Homes for Older People Page 15 of 24 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 know how to make a complaint and feel that staff will listen to their views. The care team know how to respond to a complaint and how to act in order to protect people from abuse. They are protected from abuse by correct and safe recruitment procedures. Evidence: Each person received a copy of the complaints procedure. The information was also in the statement of purpose. However it did not contain our new name or Cambridge Regional office address and phone number. The manager agreed to address this. We and the home have received no complaints or safe guarding adults issues since the last inspection. None of the people living in the home or the staff had any complaints about the home and felt they could discuss any concerns with staff or the manager. Staff also knew what to do if they received a complaint from a person living in the home. All staff were correctly recruited including a check by the criminal records bureau (CRB). During their induction each member of staff received information about abuse. Two staff were asked what abuse was and knew their role and what to do if abuse was suspected. Staff also received regular refresher training to ensure their knowledge was up to date. Care Homes for Older People Page 16 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in clean, comfortable, safe and well maintained accommodation. The infection control policy is followed and a safe environment is maintained. Evidence: The home was well maintained, and clean throughout. The manager told us that areas of the home had been redecorated with new carpets. During our visit we walked around the home and found all areas of the home were clean, tidy and odour free. People we spoke with told us they were satisfied with the decoration and cleanliness of the home. They also spoke of how they liked their bedrooms. They were encouraged to bring into the home small items of furniture, television, pictures and personal items. People told us I do like my room it looks out onto the garden and birds and my room is comfortable and my clothes are looked after well. There were grab rails and raised toilet seats. Bathrooms and toilets were wheelchair accessible. There were a variety of pressure relieving mattresses, special profiling beds and a mobile hoist with a variety of slings and other moving and handling equipment. In shared rooms there were privacy screens. Care Homes for Older People Page 17 of 24 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. There is a safely recruited, well-trained, supported staff team available who have the skills to meet the varying needs of the people living in the home. Evidence: People we spoke with felt the home was adequately staffed with people who were experienced and competent to care for older people. People we spoke with did not express any worries about the level or availability of staff. During our inspection visit we saw staff attended to the needs of the people promptly and in a calm and friendly manner. People told us, I am quite happy and content here and I find the staff are kind and helpful and come to my aid if I need any help. We examined the files for 2 new members of staff. Records were clear, detailed and showed that staff were safely recruited in accordance with the regulations including receiving 2 references. This included a check by the Criminal Records Bureau (CRB). Each person received a supported induction programme. There continued to be a wide range of training provided. This included formal training in care to National Vocational Qualification standards (30 of the staff had achieved Care Homes for Older People Page 18 of 24 Evidence: NVQ level 2). The manager acknowledged that the level of staff with NVQ was below the national minimum standards but explained 4 staff had left the home and he had recruited staff to replace them but they did not have an NVQ. He told us he was keen to address this. Two staff were studying for NVQ level 2. Despite this, staff we spoke with showed knowledge about the needs of the people living in the home. The manager told us training over the last year had included, care planning, key legislation, equality and diversity, infection control, dementia awareness, moving and handling, fire prevention, first aid and food hygiene. Staff had also received dementia awareness training Staff told us they received regular supervision and support. We spoke with 5 members of staff who told us when I started here I had an interview, which was followed by an induction. I was supported and this prepared me for the work I was to do. Everyone made me feel welcome and we work very well together as one team. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People and staff benefit from the positive leadership of the manager. Management record systems show that the peoples health, welfare, safety and choices are promoted but some are disorganised. The management team ensures that the people living in the home have the opportunity to voice their views and opinions. The management uses feedback from questionnaires from people living in the home to make improvements. Evidence: -The registered manager was a registered nurse and one of the owners of the home and had considerable experience of delivering care for older people and people with mental health problems. He told us he was to start a management course in the future. He was actively involved in the day to day care and nursing support of the people living in the home as well as the management of the home. The people living in the home and staff told us he was very approachable and they felt they could discuss any concerns or worries. Comments included, If ever I have any Care Homes for Older People Page 20 of 24 Evidence: concerns I can always discuss them with the manager. Everyone in the home is so very helpful and I like it here and the manager is very supportive. Staff told us that they received supervision regularly and records confirmed this. There were financial procedures in place to ensure that the peoples financial interests were safeguarded and protected. There was a range of policies and procedures, some of which which had been reviewed and updated since the last inspection. There were no quality assurance procedures but the manager sent a quality assurance survey to each person each year to obtain their views about the home. He showed us 2 replies out of 13 which had been sent in March 2009. One expressed concern about the way clothes were washed and cared for giving an example of shrinkage as a result of high temperatures. The manager told us this had been addressed as a result of the purchase of a new washing machine. During our inspection visit the people we spoke with had no complaints about the way clothes were washed or cared for. The other was very positive with specific comments we could not manage without the care and service provided by the friendly caring and supportive home. We are well satisfied. The home had comprehensive health and safety policies, which also included up to date risk assessments. There were regular tests of the fire system as well as regular fire drills and monthly monitoring of hot water temperatures. There was also an infection control policy and staff made use of alcohol hand rub bottles throughout the home to further prevent infection. Records were available but were disorganised and in some cases difficult to find. This was acknowledged by the manager who told us he would address this in the future. Care Homes for Older People Page 21 of 24 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 22 of 24 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 33 The manager should introduce a quality assurance system which as well as involving people living in the home, uses internal audits (for example of care records and medication) to monitor the quality of care and services provided. The manager should ensure that records and information (for example, maintenance, health and safety and food) are maintained, well organised and up to date as well as accurate. 2 37 Care Homes for Older People Page 23 of 24 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 24 of 24 - 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!