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Inspection on 07/11/08 for Beechfields Nursing Home

Also see our care home review for Beechfields Nursing Home for more information

This inspection was carried out on 7th 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.

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

What the care home does well

Care plans provided good information to ensure people`s assessed care needs were met properly. Staff had a good understanding of people`s care needs and the level of support required to promote the individual`s health. People who accessed the service were very complimentary of the care they received. We saw people were able to maintain their religious faith and were able to attend their respective place of worship.

What has improved since the last inspection?

Efforts had been made to address all the requirements from the previous inspection visit. The home`s medication system and practices were now more thorough to ensure people received their medicines safely. Medication administration records were now signed to show people had received their medicines. We saw a risk assessment in place for people who self administer their medicines, to ensure they were taking them properly. The management of people`s finances were more thorough to protect people from potential abuse. We saw individual accounts and receipts maintained for auditing purposes. The management have acknowledged the short falls and have been open and transparent to address these, to improve the service delivery.

What the care home could do better:

There was no restrictor fitted to a window located on the first floor. The Registered Manager should ensure that this is risk assessed or fitted with a restrictor to ensure people`s safety. The service Annual Quality Assurance Assessment (AQAA) was not fully completed, to reflect the service provided to show people`s care needs were being met. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Beechfields Nursing Home 1 Wissage Road Lichfield Staffordshire WS13 6EJ     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: Dawn Dillion     Date: 0 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 28 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 28 Information about the care home Name of care home: Address: Beechfields Nursing Home 1 Wissage Road Lichfield Staffordshire WS13 6EJ 01543418354 01543411015 anil_r_patel@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Margaret Richardson Type of registration: Number of places registered: Tudor Care Plc care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users to be accommodated is 35. The registered person may provide personal care with nursing and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories:- Physical Disability (PD) 35 Physical Disability over 65 years of age (PD(E) 35 Date of last inspection Brief description of the care home Beechfields Nursing Home is situated in a quiet residential area in Lichfield, Staffordshire. The home provides a service for older people and also has a registration category that enables them to offer a service to people who have a physical disability. The two-storey property is set within its own grounds and consists of 31 single and 2 shared occupancy bedrooms, 19 of which are equipped with en suite. Bathrooms and toilet areas are located on both floors and are in close proximity to bedrooms and communal areas. The home also provides three lounges and a dining area, all of which are equipped with essential furnishings and fitments to ensure the comfort of people Care Homes for Older People Page 4 of 28 Over 65 35 35 Brief description of the care home living in the home. The home also has a kitchen and a separate laundry. People living in the home have access to a well-maintained garden. Staffing is provided on a 24 hours basis, to ensure the total supervision of people accessing the service. Information relating to the fees charged for the service provided at the home was not made available to us, the reader may wish to contact the home directly for this information. Care Homes for Older People Page 5 of 28 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, the Commission for Social Care Inspection last inspected this service on 09 May 2008. The unannounced key inspection of Beechfields Nursing Home was undertaken in eight hours. The inspection methods used to establish the quality of care provided and the effectiveness of the management of the home involved looking at care records, talking to people who use the service, visiting relatives and staff members. We looked around the property to ensure it was suitable and safe to meet peoples needs. Care Homes for Older People Page 6 of 28 We received seven surveys from people who use the service and a Doctor. The Registered Manager was present throughout the inspection visit. 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 28 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 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who wish to use the service are provided with relevant information, to enable them to make a decision of the homes suitability to meet their assessed care needs. Evidence: We looked at the homes Statement of Purpose and Service User Guide. These documents provided information about the service and provisions available within the home. For example, it told us about the management structure, social activities, visiting times, how to make a complaints amongst other things. These documents should enable people to establish if the service would be suitable to meet their assessed care needs and promote their welfare. People had access to these documents, we saw them in each bedroom. One person Care Homes for Older People Page 10 of 28 Evidence: told us they had received this information before moving into the home. Discussions with the Registered Manager confirmed a needs assessment was undertaken before people moved into the home. We saw three assessments, this enables the service to establish what the persons care needs are and the level of support they will require. The information obtained from the needs assessment provided the basis for the development of the care plan. This should ensure staff know how to meet peoples care needs to promote the individuals health and welfare. One person who used the service told us that the manager had visited them at their home to carry out the assessment. They also said I came to have a brief look around the home with my daughter and son before I decided to move in. The home does not provide intermediate care. Care Homes for Older People Page 11 of 28 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. People can be confident that their assessed care needs will be met to promote their health and independence. Medication practices ensure that people will receive the appropriate support to guarantee their wellbeing. Evidence: Information obtained from the needs assessment is used to develop the care plan. A care plan tells us about peoples care needs and the level of assistance required to promote their health and independence. We looked at three care plans, all provided clear information on the persons health and personal care needs. For example we saw that one person was diagnosed with diabetes, it also told us what medicines were used to control this condition, how often blood samples were taken to monitor the persons sugar level, visits from the Chiropodist and the need to encourage the person to drink more frequently. Care Homes for Older People Page 12 of 28 Evidence: We spoke to three staff who confirmed their knowledge of this persons diagnosis and their care needs as shown in the care plan. We looked at care records which showed this person had access to a Chiropodist as identified in their care plan. We spoke to the person who used the service, they told us about their health and special dietary needs because of their diabetes. They confirmed the service was good and the food provided met their dietary needs. A survey received from a Doctor stated, I have no reservations about the care at Beechfields. The Registered Manager told us that where possible people were encouraged to be involved in planning their care. We spoke to one visiting relative who said her father did not have the capacity to be involved in his care planning but the home ensured that she was actively involved. We saw risk assessments in place for the prevention of pressure sores, this provided staff with information on how to reduce the risk of people developing sores. For example, it told them what equipment should be used, like a special air flow mattress and how often to check the persons heels for signs of redness. We saw this mattress in the persons bedroom. One care record told us the person was prone to infection, it also provided staff with relevant information about signs and symptoms and what to do if they suspect the person was unwell. We spoke to three staff who confirmed their knowledge about this persons health and they were aware of the information contained within the care plan and what to do. Care records showed people had access to relevant health care services, such as Optician and the Doctors. We spoke to one person who told us they were not feeling well. The Registered Manager confirmed she had arranged for the Doctor to visit. A survey received from a person who used the service stated, I have seen Doctors, Physiotherapists, Chiropodist and a Parkinsons Nurse when this has been necessary. The Registered Manager informed us that they provide palliative care. This is where people are experiencing the end of their life due to their health condition. We looked at Care Homes for Older People Page 13 of 28 Evidence: one care record that showed a pain control assessment. This should ensure people are not in pain and are made comfortable. We saw monthly palliative care check list, this showed people had access to relevant health care professionals, such as visits from the McMillan Nurse and their Doctor. The Registered Manager confirmed she had received palliative care training and a Nurse told us she was experienced in this area of care. At the previous inspection visit a number of shortfalls were identified with medication practices, efforts had now been made to ensure people can be confident they will receive their medicines safely. The Pharmacist who dispenses the homes medicines had undertaken an inspection of the medication system on 15 July 2008, the service achieved 100 pass rate. Medication administration records were now signed to show people had been given their medicines. The Registered Manager told us a risk assessment was in place for people who self administered their medicines. We looked at this assessment which showed staff were monitoring the person on a weekly basis, to ensure they were taking their medicines properly. The Registered Manager told us that nurses had received a competency assessment. We looked at a number of staff training records that confirmed this. This should ensure nurses are skilled and competent to give people their medicines safely. We looked at a number of bedrooms, security locks were not provided on doors but each room was fitted with a safe for personal belongings. We saw privacy curtains in the shared bedrooms, to promote peoples privacy. We observed the Registered Manager knocking on bedroom doors when she was delivering the daily post. Care Homes for Older People Page 14 of 28 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 are able to pursue social activities and maintain contact with their local community to promote their interests. People are offered a choice of meals to reflect their likes, dislikes and dietary needs. Evidence: The routine within the home was relaxed, we saw people engaging in pastimes of their choice. For example, reading, watching the television and entertaining their guests. One person told us about the social activities available but said they were limited because of their visual impairment. They confirmed they had talking books and staff would sit with them when playing bingo. They said, Staff always make an effort to sit with me for a chat. One person had a motorised scooter, we saw pictures in their bedroom of their social outings. We saw a number of visitors during the day, they told us they were able to visit at anytime and were always made welcome. One visitor said, The staff are very Care Homes for Older People Page 15 of 28 Evidence: friendly. We saw that people were able to entertain their guest in private. One person said, I can have visitors and staff respect my privacy when they come. One visiting relative told us their brother was religious and was able to continue to attend church and sometimes the church visited him. One care plan showed a person was religious, discussions with staff confirmed their knowledge of this persons faith. They told us the Priest visited on a weekly basis and the person took comfort in wearing a rosary. This person was not able to talk to us but we saw that she was wearing her rosary. We looked at a number of bedrooms and saw that people were able to personalise their rooms with pictures, photographs and were able to bring in their own furnishings. We heard staff asking people if they would like a drink and also offering them a biscuit. The home had a menu which showed people were offered a choice of meals, one person said The food is excellent, we have a choice, too many choices, I cant fault it. One visiting relative said, The food is fabulous. A survey received from a person who used the service stated, When I have been poorly the staff made my dinners look attractive even though the food was pureed. One person confirmed they were provided with meals that met their special dietary needs. We saw that drinks were made available, this was also confirmed by a visiting relative. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to express their concerns and have access to a complaints procedure to promote their rights. Staff have the skills to ensure people are protected from potential abuse to ensure the individuals safety and welfare. Evidence: People had access to the homes complaint procedure, we saw this document displayed in the main entrance of the home. The Service User Guide was located in each bedroom and provided people with detail of how to make a complaint. One visiting relative confirmed they had a copy of the complaints procedure but had never had cause to complain. The Registered Manager told us they had not received any complaints or safeguarding issues since our last inspection visit. We saw a Safeguarding policy in place, this is a policy that tells staff what to do if they suspect people are at risk of potential abuse. The Registered Manager told us that all staff members had received training in Safeguarding. We spoke to three staff members who confirmed this. Discussions with the Registered Manager confirmed training relating to safeguarding was also covered in staffs National Vocational Qualification training. This should ensure staff have the Care Homes for Older People Page 17 of 28 Evidence: skills to protect people from potential abuse. Care Homes for Older People Page 18 of 28 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 layout and facilities provided in the home are suitable to meet peoples needs, promoting their safety and independence. Evidence: The home provided single and shared bedrooms located on the ground and first floor. Nineteen bedrooms were fitted with an en suite. Bathrooms and toilet areas were provided throughout the home in sufficient numbers. We saw people were provided with the necessary equipment and adaptation. For example, one care plan showed the person required a zimmer frame or a tripod to assist them to walk. We observed these equipment in their bedroom and also saw the person using it. There was a passenger lift in place to ensure people had access to all the facilities within the home. The home consisted of three lounges and a separate dining area. People had access to a well maintained garden at the rear of the property. Care Homes for Older People Page 19 of 28 Evidence: Ample car parking was provided at the front of the property. The home was well presented and the Registered Manager informed us, that the service had recently been awarded five stars by the Environmental Health Department, Rate my place. We saw the certificate displayed on the wall. Comments from a survey stated, As you enter Beechfields you are always impressed by the cleanliness. Discussions with the Registered Manager and staff training records we looked at confirmed all staff members had received health and safety training. We saw a Control of Substance Hazardous to Health (COSHH) data sheets, located on the domestics cleaning trolley. This should ensure that staff have access to vital information for the safe use of chemicals. Care Homes for Older People Page 20 of 28 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. People can be confident their care needs will be met by sufficient numbers of skilled and competent staff to promote their health and welfare. Evidence: We looked at the staffs working rotas which showed staffing was provided on a 24 hour basis. The Registered Manager was confident that the current staffing levels were sufficient to meet peoples care needs. However one person who used the service told us, The staff seem rushed but kindness is always there. A visiting relative said, I am always made welcome but sometimes I have to wait a long time before staff answer the door to let me in. However, five out of six surveys received from people who use the service showed staff were available when needed. The Registered Manager confirmed that all staff members had achieved the National Vocational Qualification Level 2 in Care. The staff we spoke to confirmed they had completed this training. People can be confident the care they receive will be delivered by skilled staff to promote their health and wellbeing. We looked at three personnel files for staff which, showed appropriate safety checks were carried out before they started working in the home. This should ensure people are protected from potential abuse. Care Homes for Older People Page 21 of 28 Evidence: The Registered Manager told us that new staff are inducted into their role, we saw an induction programme in one staffs personnel file. This should ensure staff are aware of their roles and responsibilities to provide a good standard of care. Discussions with staff and training records we looked at confirmed they had received the following training: Fire Safety, moving and handling, infection control and safeguarding amongst others. This should ensure staff are equipped with the necessary skills to undertake their jobs and to ensure peoples care needs are met. Care Homes for Older People Page 22 of 28 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 management and administration of the service is based on openness and respect to promote peoples welfare. Improved quality assurance systems ensures quality care standards, to promote peoples rights and independence. Evidence: Since our last inspection visit, the Manager has now been registered by us, we saw the Certificate of Registration displayed in the main entrance of the home. This should ensure the home is managed properly to promote peoples welfare. Discussions with the Registered Manager confirmed she was experienced in health and social care and undertook regular training, such as infection control, safeguarding, care in medicines, amongst others. Care Homes for Older People Page 23 of 28 Evidence: We identified a shortfall at our previous visit, concerning quality assurance systems. This means there were no systems in place to monitor the service provided and to ensure peoples care needs were met properly. The Registered Manager confirmed that quality assurance questionnaires were now given to people. This enabled the individual to express their views on the service they receive. We saw one person completing this form. The questionnaire asked questions about the environment, comfort, health care service, staffing, meals amongst other things. The Registered Manager told us that the information gathered from these questionnaires was fed back to people. This would inform people of what actions will be taken to address any shortfalls, which will ensure their welfare, safety and independence. We discussed the Annual Quality Assurance Assessment (AQAA) with the Registered Manager. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives use some numerical information about the service. We did not request a new service AQAA as this was sent to us within the last six months. The information contained within the AQAA did not provide sufficient information about the service or how they ensure peoples care needs will be met. The Registered Manager confirmed the AQAA would be fully completed in the future to reflect the service provided. We observed monitoring reports completed by the Registered Provider. This is where the Provider (owner) visits the home to monitor the quality of the service. These reports showed that the Registered Provider had spoken to people who use the service and visitors. This gave people the opportunity to express their views on the service they receive, promoting their rights and choice. At our last inspection visit, the services system and practices were not thorough to safeguard peoples finances. The Registered Manager confirmed that the saving account which held every bodies funds had now been closed. Financial records showed peoples finances were now accounted separately and a record was maintained for each transaction, we also saw receipts for expenditures. These practices should ensure peoples finances are well managed and protected from potential financial abuse. The home undertook routine safety checks, to ensure peoples safety. We saw one window on the first floor without a restrictor. The Registered Manager should ensure Care Homes for Older People Page 24 of 28 Evidence: this is risk assessed to identify the level of risk or fit a restrictor, to ensure peoples safety. Care Homes for Older People Page 25 of 28 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 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 33 To ensure the service Annual Quality Assurance Assessment is completed fully to reflect the service provided at the home. A restrictor should be fitted to the window located on the first floor or this should be risk assessed to establish the level of risk to people. 2 38 Care Homes for Older People Page 27 of 28 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 28 of 28 - 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!