Inspection on 27/11/08 for Alexander House

This inspection was carried out on 27th November 2008.

CSCI 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

Alexander House 05/02/07

Alexander House 18/07/06

Alexander House 23/08/05

Alexander House 24/05/05

Alexander House 14/01/05

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Alexander House 140/142 Folkestone Road Dover Kent CT17 9SP     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: Robert Pettiford     Date: 2 7 1 1 2 0 0 8 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. the things that people have said are important to them: They reflect 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 © (2008) 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: Alexander House 140/142 Folkestone Road Dover Kent CT17 9SP 01304212949 01304204615 kerry.allcock@njch.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Elizabeth Lindsay Type of registration: Number of places registered: Nicholas James Care Homes Ltd care home 46 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 46 The registered person may provide the following category/ies of service only: Care home only - 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 - OP Dementia - DE Date of last inspection Brief description of the care home Alexander House (the Service) is registered to provide accommodation and personal care for up to 46 older people (service users). Of this number, up to 25 service users may have special needs for assistance because of a reduced ability to organise and express their thoughts. There is provision for up to three of the service users to be accommodated on a shorter basis. The premises are two large detached properties which have been connected by means of two conservatories and various administration Care Homes for Older People Page 4 of 27 Over 65 0 46 46 0 Brief description of the care home rooms. The accommodation is provided on each of the three floors in the main buildings. All of the bedrooms are for single occupancy. Each of the bedrooms has a private wash hand basin and 25 of them also have a private toilet. There are three passenger lifts which give step-free access around the accommodation. There is a large paved courtyard between the two main buildings. This is shielded from the main road by gates. Also, there is a small enclosed garden area. The Service is located close to Dovers town centre. Consequently, it is quite close to a range of shops and transport links. There is a small amount of off road parking for visitors. The Registered Provider is a private limited company. It runs a number of other residential care resources in the area. The Registered Provider supplies information to prospective service users through a variety of routes. These include the provision of a Service Users Guide. This is a brochure which outlines the principal features of the facilities and services available in the Service. There is a document called a Statement of Purpose available for review in the Service. This gives a more detailed account than does the Guide. Also, the Registered Provider ensures that a copy of the most recent Inspection Report from the Commission, is available for reference in the Service if requested. The range of fees charged currently for residence in Alexander House was not seen at time of inspection. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection took place on 27th November 2008. We agreed and explained the inspection process with the acting manager and registered manager present at the time of the inspection. The acting manager shall shortly be applying for registration as the current registered manager has been promoted. The focus of the inspection was to assess the home in accordance with the Care Home Regulations 2001 and the National Minimum Standards for Older Persons. In some instances the judgement of compliance was based solely on verbal responses given by Care Homes for Older People Page 6 of 27 those spoken with. We used a varied method of gathering evidence to complete this inspection, preinspection information such as the previous report and discussion and correspondence with the registered provider/manager was used in the planning process to support the inspector to explore any issues of concern and verify practise and service provision. The home has completed an annual quality assurance assessment questionnaire (AQAA), which was received on time. This provided us with information relating to What the home considers it does well, What we could do better, What has improved within the last 12 months and plans for improvement. The judgements have been made using the Key Lines of Regulatory Assessment (KLORA), which are guidelines that enable the CSCI to be able to make an informed decision about outcome areas. Further information can be found on the CSCI website with regards to information on KLORAs and AQAAs. Documentation and records were read. Time was spent reading a sample of written policies and procedures, reviewing care plans and records kept within the home. Other areas viewed included risk assessments, pre-admission assessments, rotas, training records and recruitment records. In addition an environmental tour took place. We identified several residents for case tracking. In addition the inspector had the opportunity to speak with several of the residents and a number of staff. Additional evidence was gained to inform judgements following the observation of many of the residents and their interactions with staff. Many completed comment cards were received expressing many positive comments about the home. Residents commented on the quality of care and the activities they enjoyed. One spoke of the activities she enjoyed, such as bingo,keep fit,sing a long and movies. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.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 8 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents know that their needs will be properly assessed prior to moving to the home. Residents who wish it can receive intermediate care can feel confident that they will be well supported Evidence: The standard relating to the assessment of residents prior to them moving into the home was met from the previous inspection. No evidence or intelligence would suggest that the process does not continue to meet with the required standard. Records showed at the previous inspection that residents have an assessment, which identifies their individual needs prior to or on admission to the home. This is then reflected into the care plans and these are developed in agreement with the individual where possible. The assessment focuses on achieving positive outcomes for people and this Care Homes for Older People Page 10 of 27 Evidence: includes ensuring that the facilities, staffing and specialist services provided by the home meet the needs of the individual. The AQAA also confirmed detailed information with regard to ensuring that the home can meet the needs of residents. The home also provide a intermediate care service supported by the local primary care trust. Facilities are provided to support people to get bact to living in their own homes. Staff are provided by the Trust and supported if needed by staff from the home. The assessment process as shown in the AQAA recognises cultural needs and the importance of promoting equality and diversity rather than just meeting needs in a reactive manner. We recommended that the acting manager reviews the homes equalities and diversity policy and ensures that all of the information and policies relating to residents are inclusive to all members of the community. It was also recommended that the home considers giving staff and management Equality and Diversity training. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from having individual plans that identify their physical and medical needsn and provide the support they need, but not enough detail was given to social and personal goals. Residents can feel confident that they are fully supported with their healthcare needs however limited evidence was seen within the care planning process. Residents can be confident that they will be treated with respect and dignity and their rights to make decisions about their lives is respected and they have the opportunity to be consulted on, participate in, all aspects of life within the home as they wish or their capacity allows. However this was not fully evidenced within the care planning system. The homes policy and procedures with regard to the administration and dispensing of medication was not inspected on this occasion. Care Homes for Older People Page 12 of 27 Evidence: The key principles of the home for delivering a quality service are based on the belief that residents should be able to take control of their lives where capacity allows. The staff of the home are strongly committed to supporting all residents including those to make informed decisions, understand the range of options which are available to them and have the right to take responsible risks. Evidence of this was gathered through taking to the residents, staff, and the acting manager. The inspector viewed and discussed with the acting manager the care records relating to several residents at Alexander House. In the care plans viewed there were guidelines in respect to support needed. The home undertakes regular reviews. Formal reviews involving significant professionals where possible are also undertaken. No evidence however was available that residents were involved in drawing up personal care plans in the documentation seen or that they are consulted in reviewing and amending such care plans. The support evidenced within care plans with regard to maintaining stability of behaviour did not show any detail with regard to triggers that would inform staff to enable them to follow an agreed behavioural management plan. This is reccomended in order to have a consistent approach by all staff and support the residents in the best way possible. The homes care plans do not currently use a socially lead model. From the care plans viewed they were very similar and of a medical / clinical based programme approach. The care planning approach needs to move away from a clinical / medical base to one with includes social and personal goals including hopes and aspirations. The home needs to introduce a person centred care planning system that has a holistic approach. The inspector viewed a sample of care records and specific health care records relating to several residents. Records viewed confirmed residents had access to a range of health care input as and when required but not as part of regular health checks. This included access to their chosen G.P (where possible), Dentist, Optician and Chiropodist in addition to identified specialist health care input. The Home facilitates Residents keeping hospital appointments and seeing their own GP. At present limited evidence was seen of regular healthcare checks in all areas to promote healthcare of residents within the care plans viewed. The acting manager is requested to to review its healthcare planning. No requirments have been made at this time. It is evident through talking to members of staff at the home that the emotional health of the residents is of a high priority to the home and that staff are pro-active in Care Homes for Older People Page 13 of 27 Evidence: maintaining and supporting residents with their emotional needs in order to maintain their quality of life. This was not fully evidenced however within the care planning process as previously identified. However this was confirmed in discussions with many of the residents who lived at the home and feedback received from comment cards returned. Risk assessments were reviewed within the home and discussed with the acting manager. Assessments seen detailed how to support residents to minimise risks for personal safety and had been updated and reviewed. The inspector visited the home at 7:30AM. During the inspection the inspector noted that residents were seen making choices about their lives and were seen to be part of the decision process as their capacity allowed. A relaxed atmosphere was noted with the residents interacting with staff. Medication was not inspected on this occasion. This standard was met at the previous inspection and no intelligence or information has been received to suggest that this standard does not continue to be met.The acting manager stated that all staff who administer medication have received training. Daily records were not wholly comprentaneous however in that they had gaps and full names of staff were not seen. It was strongly recommended that the home follow the Nursing and Midwifery Council guidance: Guidelines for records and record keeping. 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. Residents can be confident that they are offered a range of opportunities for personal development. Residents engage in a good level of activities which are appropriate to their needs and capabilities.Residents are supported to maintain contact with family and friends, which ensures they continue to receive stimulation and emotional support. The residents benefit from the appetising meals and balanced diet offered at the home. Evidence: Discussion with staff and residents confirmed that the level of activities were of a good quality and that they enjoyed a good level of stimulation through leisure and recreational activities. We joined residents at 7:30am while they were getting ready for the day. We had the opportunity to speak to several of the residents who expressed their opinion of the home and the activities they participated in and enjoyed. Other residents were Care Homes for Older People Page 15 of 27 Evidence: observed participating and interacting with staff. Residents have been enabled to and encouraged to participate in hobbies and activities which they had an interest in. It was confirmed that residents are enabled to maintain contact with relatives and friends where they wished to do so. The AQAA showed that residents are encouraged to use all aspects of their home according to their ability and wishes. Residents undertake a wide variety of activities including, bingo, crafts, and social functions. Handover witnessed at 7:30AM. Staff spoke of residents in a respectful manner. From observation, records viewed it was evident that residents were offered a choice of menus that meet their dietary needs and individual preferences. Meal times are flexible to suit the residents activities and schedules. Residents are able to choose where to eat, and also and have drinks and snacks for themselves. Residents on evidence seen have had been involved in planning and choosing what to eat where possible. 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. Residents can feel confident that their concerns and complaints are taken seriously. Residents are are protected from the risks of abuse. Evidence: A copy the complaints procedures was reviewed. The procedure included details of how to complain, timescales for response and information for referring a complaint to the service provider. However the complaints procedure is not readily available in different formats. Residents within the service have an understanding of how to make a complaint as their capacity and understanding allows. No complaints have been received from information contained within the AQAA. Systems are in place to ensure that these are dealt with appropriately. The homes Policy for the Protection of Residents and staff Whistle blowing procedure was discussed. These include procedures for the reporting of suspicion or evidence of abuse with a format for the recording of any allegations and action to be taken. Full training has been provided for staff. The home promotes an open culture where Residents feel safe and supported to share any concerns in relation to their protection and safety. Care Homes for Older People Page 17 of 27 Evidence: The acting manager stated that Criminal Record Bureau Checks (CRB) had been obtained for all staff . 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 benefit from living in a good well maintained environment which provides a homely warm atmosphere with safe access to comfortable indoor and outdoor communal areas. Residents are protected by the homes infection control procedures and policies Evidence: It was apparent that the individual and collective needs are being met in a generally comfortable environment. The standard of internal decoration and fixtures and fittings are well maintained overall and of a good quality. However parts of the home would benefit from some carpet cleaning and touch up painting to high traffic areas. One of the kichenettes would also benefit from a degree of refurbishment. An environmental risk assessment has been carried out to maximise the safety of residents. Some remedial work has also been carried out to address previous identified issues. The home has a wide selection of communal areas thus affording residents space should they so wish desire. The premises are kept clean, hygienic throughout and systems are in place to control the spread of infection. The acting manager stated laundry facilities currently meet the needs of the residents living within the home. Care Homes for Older People Page 19 of 27 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 care, social and emotional needs are promoted by the employment of caring staff in such numbers to support their needs who put the interests of the residents first. The standard relating to staff recruitment procedures was not inspected. Evidence: From discussions with the acting manager, observations and reviewing the staff rotas more than sufficient staff were on duty at the time of inspection to meet the residents needs. Staff are receptive to residents needs and work together as a team. The home is not at present full, the number of residents requiring the assistence of two staff has reduced. Staffing levels throughout the 24hr period has been reviewed and additional staff are now available early AM. This addresses a requirment from the previous inspection. The acting manager stated staffing levels are always under review to ensure the needs of the residents are met. Walkie talky radios have been introduced to aid communication. Risk assessments have been prepared both for the residents as individuals and the environment. The staff training records indicated planned and undertaken training in all the key areas. Core training in Infection control,Moving and Handling, Basic Life support, fire Care Homes for Older People Page 21 of 27 Evidence: training, food hygiene, and Adult protection has been provided. The acting manager evidenced that individual and group staff training needs had been identified. Core courses are undertaken by staff to maintain current qualifications and for protection of residents. Staff have achieved NVQ qualifications in Care to level 2 or above, thus meeting with the required standards. The acting manager confirmed that the home has a development programme for all new staff, which meets Sector Skills Councils workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users, and that all members of staff receive induction training to specification. Evidence was not readably available at time of inspection. The inspection of the recruitment files at the previous inspection evidenced that the required checks had been carried out and that the standard was met. The acting manager stated all staff have CRB (Criminal Record bureau Checks). 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 needs are currently being met and can be confident that the home is managed appropriately and that the quality assurance of the service is monitored. Evidence of health and safety safety checks were not fully inspected on this occasion. Evidence: The acting manager is actively involved in the day-to-day management of the home and works with staff and residents. She has many years of experience caring for others. The registered manager who was present at the inspection has been promoted to a area manager position , but supports the acting manager whenever needed. The acting manager is intending to become the registered manager and will be making an application shortly. Outcomes for the quality of care are good. Residents expressed a great deal of satisfaction of the care provided and the staff are very supported of the acting Care Homes for Older People Page 23 of 27 Evidence: manager and have a positive ethos. There is strong evidence that the ethos of the Home is open and transparent. The views of both residents and staff are listened to, and valued. Quality assurance was discussed and the views and opinions of many of the residents and stakeholders sought. The residents spoken with confirmed a great deal of satisfaction living within the home and felt confident that their views and opinions were valued by both staff and management. The home operates a key worker system to identify an individual staff member to directly to work with a service user on a one to one basis. An appointed person of the registered provider of the home does regularly visit the home and complete what is known as a Regulation 26 visit. This requires the provider to assess the quality of care within the home and ensure that it is meeting with the required National Minimum Standards. However the quality of such Regulation 26 visits viewed could be improved and made more comprehensive to ensure compliance with the standards. The Acting manager confirmed that the home has a quality assurance process in place that measures the quality of care given and that the views of residents are included. Evidence of health and safety safety checks was not inspected on this occasion. However it was met at the previous inspection and no evidence would suggest that it does not continue to be monitored. 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 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 © (2008) 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!