Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Aaron View Care Home 285 Lane End Chapeltown Sheffield South Yorkshire S35 3UH The quality rating for this care home is:
two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sue Turner
Date: 0 9 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home
Name of care home: Address: Aaron View Care Home 285 Lane End Chapeltown Sheffield South Yorkshire S35 3UH 01142869753 01142869753 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Devaglade Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 30 Number of places (if applicable): Under 65 Over 65 30 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is: 30. 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 30 Date of last inspection Brief description of the care home Aaron View is a residential care home providing care and accommodation for 30 older people. Aaron View is situated in the North of Sheffield in the district of Chapeltown. The home is within a short driving distance to local amenities such as shops, churches and a library. It is a two-storey building with lift access to the upper level. The home is accessible for wheelchair users.The home is well decorated with both single and double accommodation, some rooms are en-suite. There are two lounges and two dining Care Homes for Older People
Page 4 of 27 Brief description of the care home areas. The gardens are accessible to wheelchair users and there is a patio with seating area. A copy of the incorporated Statement of Purpose and Service User Guide was on display at the entrance. Copies of the last Commission For Social Care (CSCI) inspection reports were available to read. Information about how to raise any issues of concern or make a complaint was also on display in the entrance hall.The weekly fees range from, £327 to £401.50. This information was provided on the day of the site visit.The home charges extra for chiropody, toiletries, clothing, telephone, holidays and hairdressing. 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: We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services 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. This was an unannounced key inspection carried out by Sue Turner, regulation inspector. This site visit took place between the hours of 8.10 am and 3.00 pm. The manager is Nicola Waters who was present during the site visit. The manager and was given verbal feedback during and at the end of the site visit. Care Homes for Older People
Page 6 of 27 Prior to the visit the manager had submitted an Annual Quality Assurance Assessment (AQAA) which detailed what the home was doing well, what had improved since the last inspection and any plans for improving the service in the next twelve months. Information from the AQAA is included in the main body of the report. Questionnaires, regarding the quality of the care and support provided, were sent to people living in the home, their relatives and any professionals involved in peoples care. We received one from a person living in the home, four from staff and one from a professional. Comments and feedback from these have been included in this report. On the day of the site visit opportunity was taken to make a partial tour of the premises, inspect a sample of care records, check records relating to the running of the home and check the homes policies and procedures. Time was spent observing and interacting with staff and people. Six staff, one relative and six people living in the home were spoken to. Two professionals visited the home and they were also spoken to. The inspector checked all key standards and the standards relating to the requirements outstanding from the homes last key inspection in January 2008. The progress made has been reported on under the relevant standard in this report. Since the last inspection the home had changed ownership. This is the first key inspection carried out since the change of ownership. The inspector wishes to thank the people living in the home, staff, and professionals for their time, friendliness and co-operation throughout the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: The service provided at Aaron View is of a good standard and everyone involved with the home should be proud of this. So that people health, safety and welfare is not put at risk, peoples must be provided with a care plan that details their individual needs. Staff must make sure that they sign MAR sheets when they have administered medication to people. When errors or omissions from MAR sheets are identified staff should not be signing the MAR sheets retrospectively. A separate record should be kept of any errors made and what action the manager has taken to prevent errors reoccurring. This report also contains a number of good practice recommendations that we discussed with the manager. We acknowledge that the provider and manager continue to evaluate and monitor the Care Homes for Older People Page 8 of 27 service and make any changes necessary to ensure that the home continues to provide the good service that is presently offered. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.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. The home provided sufficient information to inform people about their rights and choices. People were encouraged to visit the home, look around and meet other people staying there. Evidence: The home had an incorporated Statement of Purpose (SOP) and Service User Guide (SUG). These were available for people living in the home and anyone who may be considering living in the home. The SOP and SUG needed to be updated to reflect some recent changes at the home. Before people stayed in the home they were assessed by a social worker. The manager also carried out a pre assessment by visiting people in their own home or hospital. This meant that everyone could be assured that the home could meet the persons needs. The AQAA said, All care plans and assessments are carried out within a seven day period once admission has taken place. This allows both time for service users to
Care Homes for Older People Page 11 of 27 Evidence: familiarise themselves with the establishment and staff to assess the level of independence and care needs. People were invited to visit the home, try out the meals and spend time meeting the staff and seeing the services available. Any information collated from the needs assessment would then form the basis for the care plan. When staff were asked, are you given enough information about people to enable you to care for their individual needs, two staff said always and two said usually. 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. A range of health care professionals visited the home to support peoples care. Medication procedures did not fully protect peoples health and welfare. In the main the health and personal care needs of people were met in a way that maintained their privacy and dignity. Evidence: Each person that lived in the home had an individualised plan of care. These were checked for three people. The AQAA said, The home develops a care plan where possible including both service user and or their significant other. Each care plan raised has aims and actions for all care aspects, and incorporates a risk assessment. The standard of the care plans had improved since the last inspection and the staff had clearly made an effort to meet the requirements made at the last inspection. However care plans seen were very inconsistent, some held much more and better information than others. Further work was necessary to ensure that each person had a care plan that reflected their individual care and support needs and personal preferences. On the day of the site visit we spoke to staff from Sheffield Local Authorities Older Peoples
Care Homes for Older People Page 13 of 27 Evidence: Reviewing Team. They had visited the home last September to evaluate peoples care plans. They said that in September the care plans needed much improvement and therefore they agreed to come back in February to check out the progress made. They agreed that care plans were better but still required further work. Care plans seen contained details of all health care contacts, appointments and treatments, and the home supported access to these to ensure health was maintained. Access to dentists, chiropodists and opticians was available. Staff completed daily records at the end of each shift. Those seen related to the care plans. People seen looked well cared for, were dressed appropriately and had received a good standard of personal care and support. People said, Staff are good and help me if I need it. I would rather be at home but this is OK. Staff are kind and helpful. One health professional said, People appear to be clean and well cared for. Team leaders administered medications. They said they had undertaken training in medication administration. Medicines were securely stored in locked trolleys. There were some gaps in staff signatures on the Medication Administration Records (MAR). The manager said that when she monitored medications, if staff had not signed this was brought to their attention and they where asked to sign the MAR sheet on their return to work. We said this must stop as this was not safe a safe practice. We said that staff must sign for medications given at the time of administration. If errors or omissions occur then this must be recorded but MAR sheets must not be signed in retrospect. Controlled Drugs (CD) were kept securely stored. Staff recorded CDs in a CD register. This was checked and found correct. During the site visit we observed that people were cared for in a friendly way. Some staff were very skillful in ensuring that people maintained their privacy and dignity, others were not as mindful. We talked to the manager about staff being trained in privacy and dignity issues and she said that staff had received training. She said she would continue to make observations of staff practice when caring for people. 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. People were able to maintain contact with family and friends. A limited range of activities was on offer. Further activities and outings would promote choice and maintain peoples interest. Peoples mealtime experience was enhanced by the consideration given to table settings. Evidence: People said they were able to get up and go to bed when they chose, and were seen to walk freely around the home, if able. One relative said they were able to visit at any time and were made to feel very welcome. Staff took time to make sure friends and family were made to feel comfortable whilst visiting their loved one. Some people said they preferred to stay in their room at certain times of the day and that the staff respected their decision. Since the last inspection the home had tried to employ an activities worker to work 10 hours per week, unfortunately they had been unsuccessful. This meant that carers continued to be responsible for organising activities, which although they enjoyed, added to their tasks. Carers said they organised bingo, games, quizzes and music and movement. Volunteers also came into the home to spend time with people. We saw one member of staff rolling bowls with three people. The people were enjoying this,
Care Homes for Older People Page 15 of 27 Evidence: however these people were more able and independent. Other people that were less able were left to sleep in the lounge throughout the morning. We believe it would be better if there was an activities worker so that more activities could be arranged to keep people entertained and help people to maintain their hobbies and interests. People said that trips outside the home were few and far between. We observed breakfast and lunch being served in the dining rooms. Choices were available and staff were aware of peoples meal preferences. Some people required a special diet and this was catered for. At breakfast people had a choice of cereals, grapefruit or porridge followed by bread or toast with preserves. One person said that cooked breakfasts were available twice a week, which they thought was sufficient. At lunchtime the dining room tables were set nicely with tablecloths, cutlery and matching crockery. Condiments were on the tables and a choice of hot or cold drinks was available. The dining rooms were quite small and had a pleasant relaxed ambiance. Staff were seen assisting people to eat in a discreet and supportive way. People said If I dont like it I tell them. Theres always a choice. The food isnt bad. One relative said, The meals always look and smell good. 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 complaints procedure needed reviewing to ensure that peoples complaints were dealt with effectively. The policies and practices for referring adult safeguarding concerns was adequate, staff would further benefit from undertaking formal adult safe guarding training. Evidence: People and their families had been provided with a copy of the homes complaints procedure, which was also on display in the entrance hall. This detailed who to speak to at the home or, if preferred, external to the home to make a complaint, should they wish to do so. The complaints procedure directed people to the manager to deal with any complaints. If the manager was unable to resolve complaints then people were told to go to people external to the service. We believe that there should be further stages within the procedure that allow people to go to the provider if the manager cannot resolve their issues. The home kept a record of complaints, this detailed any action that had been taken and the outcome of the complaint. Since the last inspection the home had received two complaints, which the manager had resolved. We had not received any complaints about the home. The AQAA stated, All staff are trained in adult protection and this includes all domiciliary staff. Staff are reminded in staff meeting and supervision sessions to report incidents or allegation of abuse immediately. We have a robust procedure for dealing with abuse issues which includes whistle blowing and disciplinary action if necessary.
Care Homes for Older People Page 17 of 27 Evidence: Staff said that the safe guarding training provided was watching a video and answering questions. They said they had not received any formal safe guarding training which was available from the adult safe guarding team. On the day of the site visit we were made aware of one recent safe guarding referrel. One member of staff had been suspended pending an investigation. The manager was working alonside the safe guarding team to carry out the investigation and ensure that people were not being put at risk. 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. The home was maintained to a good standard. Procedures for the control of infection were in place which promoted peoples health and welfare. Evidence: The home was clean and tidy. Lounge and dining areas were domestically furnished. Bedrooms were spacious and personalised. Since the last inspection refurbishment of the home had continued. Some carpets and furniture had been replaced and some bedrooms had been redecorated. The toilets and bathrooms were spacious and homely. The home smelt fresh and clean throughout the day. Controls of infection procedures were in place. Staff were observed using protective aprons and gloves. The homes laundry was sited away from food preparation areas. Staff had undertaken training in infection control. Relatives said, There are excellent standards of hygiene throughout the home. Bedrooms and communal areas always appear to be well kept. Care Homes for Older People Page 19 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. Sufficient staff were provided to meet the needs of people. The recruitment information obtained for staff was sufficient to adequately protect the welfare of people. Staff had completed training that ensured they had the competences to meet peoples individual needs. Evidence: Staff interviewed said that they enjoyed working at the home and got a lot of job satisfaction. On the day of the site visit staffing numbers were at an acceptable level. However as the home didnt employ an activities worker, and there was no laundry person or administrator this did make it seem that there was less staff around. Staff said that they had completed mandatory training and further training in specialised topics for example dementia and dealing with conflict was being delivered by the Care Home Support Team. A number of care staff had completed the NVQ Level 2 in Care and others had commenced the training. The number of staff trained met the required minimum of 50 per cent of the staff team trained to NVQ Level 2 in Care. Some staff said they had completed NVQ Level 2 and were going on to complete Level 3. Four staff surveys were returned, when asked did your induction cover everything you needed to know about the job when you started, all four said very well. When asked
Care Homes for Older People Page 20 of 27 Evidence: are you being given training, which is relevant to your role, all four said, yes. The recruitment records of three staff members were checked. The staff had provided employment histories and the home had obtained two written references for each of them. These were satisfactory. Protection of Vulnerable Adults (POVA) checks had been made and Criminal Records Bureau (CRB) checks had been obtained for the staff members. Care Homes for Older People Page 21 of 27 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The managers leadership approach benefited people and staff. Quality assurance systems meant that the home was run in the best interests of everyone. Peoples monies were accurate. Peoples health and safety had been promoted and protected. Evidence: The manager is a registered nurse and was in the process of registering with us. She was committed to ensuring that people living in the home were consistently well cared for, safe and happy. Staff said that she was approachable and listened to them. They said if they went to her with issues, ideas or problems she acted upon their comments in a timely manner. The provider had nominated a person to carry out Regulation 26 visits. He visited the home on a regular basis to keep himself up to date with the service. Staff said he was available for them to speak to should they wish to. Each month he completed a report detailing his findings. Any actions that were identified were then carried out. Quality Assurance questionnaires were sent out to people, relatives and staff annually.
Care Homes for Older People Page 22 of 27 Evidence: When they were last sent out to people in September 2008, the responses were positive. The manager completed a report summarizing the comments made by people and this was displayed in the entrance hall. The manager said she was looking at other ways to make sure that she was gaining peoples views about the service. She planned to send out questionnaires to health professionals who visited the home. Staff meetings were arranged and minutes from these were seen. The home handles money on behalf of some people. This was checked for three people. Account sheets were kept, receipts were seen for all transactions and monies kept balanced with what was recorded on the account sheet. Although accurate the system was very untidy and messy. Receipts and account sheets were not orderly making it very difficult to check out accuracy. Receipts and account sheets could have been easily misplaced and lost as they were kept loosely. Formal staff supervision, to develop, inform and support staff took place at regular intervals. Staff said they found this useful and beneficial. Fire records evidenced that fire alarm checks took place. Staff said that they had received fire training and fire drills. A fire risk assessment had been completed and then updated in November 2008. On the day of the site visit we saw that people were being moved around in wheelchairs that had foot plates in situ for their safety. Care Homes for Older People Page 23 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 24 of 27 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 15 Each persons needs in respect of their health and welfare must be recorded in a care plan. To maintain and promote peoples health and welfare. 30/03/2009 2 9 13 MAR sheets must be fully 16/02/2009 completed and signed at the time of medication administration. So that peoples health and welfare is maintained. 3 9 13 When errors or omissions 16/02/2009 from MAR sheets are identified staff must not sign the MAR sheets retrospectively. To ensure that peoples health, safety and welfare is maintained. 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 Care Homes for Older People
Page 25 of 27 improving their service.
No. Refer to Standard Good Practice Recommendations 1 2 1 9 The Statement of Purpose and Service User Guide should be updated. A separate record should be kept of any errors or omissions made following the administration of medications. This should also detail what action the manager has taken to prevent errors reoccurring. A further programme of activities should be developed to include a wider and more frequent range of activities and entertainment. People should be consulted on their preferences and peoples individual needs and capacities should be considered. An activities worker/coordinator should be employed so that the programme of outings and activities is enhanced. The complaints procedure should be reviewed to include further stages for people to raise their complaints with other representatives of the service. Staff should undertake formal adult safe guarding training. Financial receipts and records should be kept in an organized manner so that the risk of loosing or misplacing them is reduced. 3 12 4 5 12 16 6 7 18 35 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!