Inspection on 09/02/09 for Ashville Care Home

This inspection was carried out on 9th February 2009.

CSCI found this care home to be providing an Adequate 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

Ashville Care Home 20/01/10

Ashville Care Home 20/02/07

Ashville Care Home 13/01/06

Ashville Care Home 30/06/05

Ashville Care Home 04/02/05

Ashville Care Home 20/07/04

Ashville Care Home 16/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ashville Care Home 58 Sandmoor Garth Idle Bradford West Yorkshire BD10 8PW     The quality rating for this care home is:   one star adequate 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: Mary Bentley     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: Ashville Care Home 58 Sandmoor Garth Idle Bradford West Yorkshire BD10 8PW 01274613442 01274618273 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ashville Care Home Limited Name of registered manager (if applicable) Mrs Donna Ruth Brown Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 29 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: Dementia - Code DE Date of last inspection Brief description of the care home Ashville Care Home is in Idle, an area about three miles from Bradford City Centre. It is registered to provide care for up to twenty-nine older people. The home is just off the main road and is well served by public transport. There is car parking to the front of the property. There is level access to the main door of the home and a stair lift is fitted to allow people with mobility problems to reach the bedrooms located on the first floor of the building. The home does not have a passenger lift. All Care Homes for Older People Page 4 of 27 care home 29 Over 65 0 29 Brief description of the care home the communal areas are on the ground floor of the home. There are three lounge areas and one main dining room. There are 23 single and 3 double bedrooms. Fifteen of the single and all three of the double rooms have en-suite facilities (a toilet and large hand wash basin.) There are three communal bathrooms and toilets, which are within reach of bedrooms and lounges. In February 2009 the fees ranged from 377.00 and 450.00 pounds per week. Additional charges are made for hairdressing, private chiropody treatment, reflexology, taxi fares and magazines if purchased by individuals and not provided by the home. 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: one star adequate 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 last inspection was carried out on 20 February 2007. Since then we have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspections 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 enforcement action will be taken. This inspection was unannounced and was done in one day by one inspector between the hours of 9:45 and 4:30. The purpose of the inspection was to look at how the home is meeting the needs of the people living there and to check if the requirements Care Homes for Older People Page 6 of 27 from the last inspection had been dealt with. Since the last inspection the home has changed the registration category and increased the number of places for people with dementia. During the visit we spoke to people living in the home, visitors, staff and management. We observed staff at work, looked at various records and looked around some parts of the home. Before the visit we sent surveys to the home to distribute. These included surveys for people living in the home, visiting health care professionals and staff. In total 11 were returned and the information received has been included in this report. Because most of the people living in the home have dementia and are not always able to tell us about their experiences the surveys we sent to them were completed by relatives or friends on their behalf. We also asked the home to complete a self-assessment which they did. This is called an Annual Quality Assurance Assessment (AQAA). What the care home does well: What has improved since the last inspection? What they could do better: More must be done to make sure that everyone living in the home has an up to date plan of care setting out how their assessed needs are to be met. Whenever possible people or those close to them must be involved in drawing up this plan. This is to make sure that people get the care and support they need in a way that takes account of their wishes and abilities. This was discussed at the last inspection and has not been dealt with. More must be done to make sure that peoples social care needs are dealt with so that they get the right support to follow their personal interests and make the most of their abilities. All parts of the home should be kept free of unpleasant odours so that people can live in a pleasant environment. Care Homes for Older People Page 8 of 27 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. People do not move in until their needs have been assessed. In most cases people or those close to them are given the information they need to help them decide if the home is suitable to meet their needs. Evidence: The majority of the nine people who completed surveys for us said they had been given enough information about the home before choosing it for themselves or on behalf of a relative. One person said the staff were informative, friendly and helpful. Another person said they were told by Social Services that Ashville was the only place that was suitable for their relative. They would have preferred a home nearer to where their relative had lived. The home told us they always carry out an assessment of peoples needs before they move in. This is to make sure they will be able to meet the persons needs. This was Care Homes for Older People Page 11 of 27 Evidence: confirmed by the records. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall peoples care needs are met. However, the care plans are not up to date and do not show that people or those close to them are involved in planning their care. This means that people may not always get the care and support they need in a way that takes account of their individual wishes and abilities. Evidence: Four of the nine people who completed surveys for us said they always get the care and support they need. One person said I am very well cared for. Four people said they usually get the care and support they need and one person said they sometimes do. We looked at the three peoples care records. In one persons records we saw that a detailed assessment of their needs had been done but this information had not been used to draw up care plans. There were no care plans setting out how the persons needs would be met. The records showed that the person had lost some weight since admission but a nutritional risk assessment had not been done. The daily notes Care Homes for Older People Page 13 of 27 Evidence: completed by staff used terms such as good diet or poor diet and therefore it was not possible to get a clear picture of what the person is actually eating. The persons risk of developing pressure sores had not been assessed. The daily notes did not give a clear picture of how the person spends his/her time and the activities records form had only been completed on 2 occasions in January when the person had visitors. In another set of records we saw that there are concerns about the person losing weight. However, the nutritional risk assessment had not been reviewed since October 2007 and the care plan for eating and drinking had not been reviewed since October 2008. The persons risk of developing pressure sores had not been reviewed for four months. Apart from one other care plan relating to this persons mobility needs, which was written in October 2007 there were no other care plans to show how this persons needs are to be met. The manager told us that this persons relatives are very involved in his/her care but there was no evidence of this in the care records. Overall the care records are not person centred and do not provide clear and up to date information about peoples health and personal care needs. Care plans are not done for all peoples assessed needs. The care plans do not show that people, or those close to them, are involved in planning and reviewing how care needs are to be met. When we last visited in February 2007 we told the home that the care records must be improved. This was to make sure that people get the care and support they need in a way that takes account of their preferences and abilities and to reduce the risk of peoples needs being overlooked. This has not been dealt with. Up to date and accurate care plans are particularly important when caring for people with dementia as they may not always be able to express their needs. This was discussed with the manager. Staff that help people with their medicines have had appropriate training and the records showed that people get their medicines as prescribed. Since our last visit a change in the law means that all care homes must have a particular style of cupboard to safely store controlled drugs. The current storage arrangements are therefore no longer suitable. The manager said she would deal with this immediately. District nurses visit the home to provide health care support to people. During the visit we saw that staff are kind and respectful in their dealings with people. Visiting health care professionals told us the home always respects peoples privacy and dignity. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Daily routines are flexible and there are some activities for people to take part in. However more needs to be done to make sure that people are getting the support they need to spend their time meaningfully and make the most of their abilities. Evidence: Daily routines are flexible and talking to staff it was clear that they understand the importance of making sure that peoples choices are respected. We asked if there are activities in the home for people to take part in. Of the nine people who completed surveys for us one said always, the remaining responses were mixed with some people saying usually and other saying sometimes. One person said I am told the home arranges activities although I have not personally seen any. Another person said there is not enough stimulation for residents. People who completed the homes own questionnaires sent earlier this year identified this as an area for improvement. The manager said she is dealing with this and is planning to employ an activities organiser. Some of the activities currently provided include aromatherapy, a motivation group and karaoke. Staff said the karaoke is Care Homes for Older People Page 15 of 27 Evidence: something that most people enjoy. In the care records we saw that there is information about peoples past lives, interests and hobbies but this is not used to develop individualised social care plans. The recording of peoples participation in social activities is poor and it is difficult to get a picture of how people actually spend their time. During our visit there were no organised activities. In the afternoon we saw staff sitting and chatting to people. One person was looking at an old photograph album and talking to staff about the memories it evoked. It was evident from the condition of the album that it is well used. The home has changed the meal times, people now have a light snack at lunchtime and the main meal is served in the evening. The manager said this was because a lot of people had late breakfasts and were not ready for a big meal at lunchtime. She said people are eating better since they made the change. At lunch time most people went to the dining room to eat. There were no table cloths and no condiments on the table. People were offered plastic aprons rather than cloth tabards to protect their clothing. People were offered a hot drink with their meal and some people had a glass of wine or beer. Two of the nine people who completed surveys for us said they always like the food, 4 said usually and 3 said sometimes. Some people said they thought the menu could be more varied. One person said the sandwiches are always made with white bread and they would like to see wholemeal bread available as an alternative. Another person said they were worried that their relative was not getting the right nutrition because their dentures had been misplaced and this meant he/she could only have a soft diet. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In most cases complaints are dealt with appropriately. However, more attention should be given to making sure that everyone is aware of the complaints procedures so that people can be confident their concerns will be taken seriously and acted on. There are suitable systems in place to make sure that people are protected. Evidence: Seven of the nine people who completed surveys for us said they know how to make a complaint if they need to. Most people said they are comfortable talking to the manager or her husband if they have any concerns but some others said they did not always feel their concerns are taken seriously. The home told us they have had one complaint in the last 12 months and this was dealt with. No complaints have been referred to us. All the staff have had training on the protection of vulnerable adults in the past 2 years and the manager said she is arranging training on the Mental Capacity Act. The home has policies and procedures in place to make sure people are protected. Care Homes for Older People Page 17 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall the home provides a comfortable place for people to live. However, more needs to be done to make sure there are suitable arrangements for routine maintenance and to reduce potential risks. Evidence: Five of the nine people who completed surveys for us said the home is always fresh and clean. One person said it is very clean and fresh, it gets cleaned everyday. Four people said the home is usually clean, one person said the laundry could be better. They said things are never repaired, for example peoples clothes have missing buttons and hems that have fallen down. When we visited the home was generally clean, there were some unpleasant odours in places and this was discussed with the manager. The homes own surveys sent earlier this year showed that some people had identified occasional unpleasant odours as a concern. There are 3 lounges and a dining room on the ground floor and these provide ample day space for people to use. There is also a small conservatory which is currently used for storage but is to be converted to a staff room. The standard of decor is generally good and there is an ongoing programme of redecoration. Care Homes for Older People Page 18 of 27 Evidence: People have some personal belongings such as ornaments and photographs in their rooms. Some bedrooms are locked during the day. The manager told us this is to prevent peoples personal belonging being moved or taken by people who wander around and is always discussed and agreed with people or those close to them. There is a small enclosed garden at the back of the home. Plans to make this accessible to people living in the home have been delayed because of problems with a tree with is subject to a Tree Protection Order. The manager told us agreement has now been reached with the Council on how to resolve this issue. It was not clear what the arrangements are for routine maintenance, the home has not had a handyman for several months. There was a problem with the hot water supply in one bedroom and staff told us they had to get hot water from the bathroom nearby. This was discussed with the manager. The home does not have thermostatic valves fitted to control hot water temperatures. Hot water temperatures in areas used by people living in the home should be maintained in the region of 43 Degrees C (plus or minus 2) to reduce the risk of scalding. The majority of staff have attended training on the control of infection. Generally the systems for reducing the risk of cross infection were satisfactory. The home has been awarded a 4 star rating (the best is 5) by environmental health for its standards of food safety and hygiene. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are not always enough staff available to meet peoples needs in a timely way. Staff are supported in gaining the knowledge and skills they need to meet the needs of people living in the home. Evidence: We asked people if staff are available when they are needed. Of the nine people who completed our surveys 3 said staff are always available. Six people said staff are usually available when needed. One person said there is usually somebody within earshot, another person said sometimes none to be found. One person said there seemed to be a high turnover of staff. We asked the manager about this and she said 2 senior care staff had left recently but one had come back. There were 28 people in the home when we visited. The duty rotas show that there are usually 5 care staff on duty during the day until 4:00 pm and 3 care staff between 4:00 pm and 9:30 pm. Overnight there are 2 staff on duty. The manager is not included in the care staff numbers. In addition the home has separate staff for housekeeping and catering. The majority of people said staff listened to them and took notice of what they said. Some people said the staff are very caring and one person described them as Care Homes for Older People Page 20 of 27 Evidence: wonderful. We looked at the files of 2 newly appointed staff. One file showed that all the required checks had been done before the person started work. The other file showed that the person had started work before the PoVA (Protection of Vulnerable Adults) check had been returned. This was discussed with the manager who acknowledged it should not have happened. She is aware that by law she must make sure all the required checks have been completed before new staff start work. Staff told us they get training to help them keep up to date with new ways of working and to help them understand the needs of people living in the home. This was confirmed by the training records. In their self-assessment the home told us that just over 50 of care staff have achieved an NVQ (National Vocational Qualification) at level 2 in care. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is clearly committed to her role and to improving the service. However, more needs to be done to make sure that people using the service experience good quality outcomes in all areas. Evidence: The registered manager is very experienced in the care of older people. She has been in post since the new owners took over just over 2 years ago. The manager is not included in the care staff numbers however a lot of her time is taken up with administrative duties. The home has recently employed an administrator to take over some of these duties. It is hoped this will give the manager more time to concentrate on dealing with areas that need improving such as the care records. The home sends surveys to people every year, they were last sent in January 2009. The results of the surveys had not yet been analysed when we visited. When the responses are analysed an action plan will be drawn up to deal with any issues Care Homes for Older People Page 22 of 27 Evidence: identified. Generally the responses were positive, people said they are satisfied with the care and said the staff are good. People identified some areas where they thought the home could improve, these included activities and the management of odours. The home does not hold meetings for people using the service or those close to them. The home has recently started to produce a newsletter; this is displayed in the home and copies are sent to relatives to keep them up to date with what is happening. There are staff meetings approximately every 3 months. Staff have regular supervision where they are able to discuss various aspects of their work and their training needs. The home does not hold any money for people. Any extra services that people have are charged on their invoices. The majority of maintenance records were available and up to date. The home does not have a current electric wiring certificate. The manager said arrangements have been made to get a new certificate and agreed to send us a copy as soon as it is available. 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 Everyone living in the home 12/06/2009 must have a care plan which sets out in detail how their assessed needs in relation to personal, health and social care are to be met. This is to make sure people get the care and support they need in a way that takes account of their wishes and helps them to make the most of their abilities. 2 27 18 There must be enough staff available at all times to meet the needs of the people living in the home. To make sure that people get the support they need to meet their health, personal and social care needs in a timely way. 24/04/2009 Care Homes for Older People Page 25 of 27 3 29 19 New staff must not start 24/04/2009 work until all the required checks have been completed and all the required documents are available. To make sure that people get the support they need to meet their health, personal and social care needs in a timely way. 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 2 9 12 The home should provide suitable storage for medicines that are classified as controlled drugs. A more individualised approach to social care should be developed to make sure that each person is given the support they need to make the most of their abilities and follow their personal interests. More should be done to make sure that people are aware of the complaints procedure so that they know how to raise any concerns they might have and know how their concerns will be dealt with. Thermostatic valves to control hot water temperatures should be fitted to hot water outlets in all areas accessible to people living in the home to reduce the risk of scalding. More care should be taken with peoples personal clothing. All parts of the home should be kept free of unpleasant odours. 3 16 4 25 5 6 26 26 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!