Inspection on 14/07/09 for Beechwood House

This inspection was carried out on 14th July 2009.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Beechwood House 06/10/09

Beechwood House 13/10/08

Beechwood House 19/06/08

Beechwood House 22/05/07

Beechwood House 25/07/06

Beechwood House 04/10/05

Beechwood House 22/09/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Beechwood House Front Street Earsdon Whitley Bay Tyne & Wear NE25 9JU     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: Allan Helmrich     Date: 1 5 0 7 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 29 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Beechwood House Front Street Earsdon Whitley Bay Tyne & Wear NE25 9JU 01912524840 F/P01912524840 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Redcote Homes Limited care home 27 Number of places (if applicable): Under 65 Over 65 27 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is 27. The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP, maximum number of places: 27 Date of last inspection Brief description of the care home Beechwood House is a residential care home for older people situated in the village of Earsdon. There are two public houses in the village and a local bus service. Accommodation is provided over two floors. Access to the first floor is via a passenger lift. There are 27 bedrooms, four of which have en suite toilet and hand basin. Toilets are located throughout the building and commodes are provided in bedrooms overnight. There are five bathrooms, three of which have assisted baths and one incorporates a roll in shower. There is a mobile hoist available in the home. Care Homes for Older People Page 4 of 29 1 3 1 0 2 0 0 8 Brief description of the care home Beechwood House has a large lounge and conservatory on the ground floor and two dining rooms. The home is pleasantly decorated and furnished throughout and there is a private garden to the rear. Nursing care is not provided at Beechwood House. The cost of services provided by Beechwood House range from £370 to £410 per week. Information, including inspection reports, is provided for service users to enable them to make a decision about moving to Beechwood House. Care Homes for Older People Page 5 of 29 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 quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Before the visit we looked at: Care Homes for Older People Page 6 of 29 Information we have received since the last visit on 19th June 2008. How the service dealt with any complaints and concerns since the last visit. Any changes to how the home is run. The providers view of how well they care for people. The views of residents, their relatives and other professionals who visit the service. The inspection was unannounced and was undertaken by the link inspector for the service. Information was collected in one day. During the visit we: Talked with people who use the service and their visitors. Talked with the registered manager and staff on duty. Looked at information about the people who use the service and how well their needs are met. Looked at case records for four people and other records which must be kept, including medication. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the building to assess if it was clean, safe and comfortable. Checked what improvements had been made since the last visit. Questionnaires were provided to the home to distribute to residents, staff and professional people who come into the home. Returns were received from fifteen residents, three staff and one professional visitor. Information from these sources is used in the production of this report. 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. Care Homes for Older People Page 8 of 29 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 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 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home obtains sufficient information before admission to limit the possibility of admitting someone whose needs cannot be met. Evidence: In the files of two people recently admitted to the home, there were assessments carried out by senior staff prior to people being admitted. A local authority care plan was also obtained. This information is used by the manager to determine if the needs of the person referred can be met in the home. Shortly after admission further assessments are done and care plans are produced. In the plans of two recently admitted people there was information to show staff how to deal with their; mobility, nutritional needs, personal care and communication. The home does not provide care to rehabilitate people to return home but respite care Care Homes for Older People Page 11 of 29 Evidence: is provided. Care Homes for Older People Page 12 of 29 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. The staff team supports people to maintain their health needs and to consult medical professionals. However the promotion of individualised support could be improved with more person centred care and associated records. Evidence: Shortly after admission a range of assessments are carried out and care plans are produced. The records for four people were reviewed and these were found to be of varying quality. Care plans have improved and some files contained good details of peoples care needs. One file explained to staff how to deal with the persons mobility, nutritional needs, personal care issues and how they communicate. There was also a night care profile and risks in daily living were identified with how they should be addressed. However some information produced in a standard format did not identify the individuals needs. Each file contained a consent to administer medication although one person was in the home for short term respite and would return home. The promotion of peoples Independence should always be considered. One person spoken to stated they would prefer to be left alone to bathe. This was not identified as a need Care Homes for Older People Page 13 of 29 Evidence: to be addressed. Also not all assessments were completed. A pressure sore risk assessment was only partly completed for one person, peoples need for religion was not always identified and arrangements following death were not identified. The health care records included reference to hospital visits and contact with G.Ps and other health care professionals. Since the last inspection when many issues relating to the safe handling of medicines was identified, the home has been provided with much support from appropriate professional people. The homes systems have been reviewed, policies and procedures have been improved and all staff handling medicines have received training. The manager now audits the medicines each month. The system was reviewed again at this inspection. The records were free of errors and no signature gaps were found on the MAR (medical administration record) charts. The storage of medicines was appropriate with the exception of one medicine stored in the fridge that should be stored when opened at room temperature. Other people spoken to stated they were well cared for. One person recorded in a survey they only Sometimes received the care and support they needed, the other fourteen recorded this is Always or Usually the case. People also said they can have privacy and that staff respect dignity. These values were observed in the staff team during the inspection. Care Homes for Older People Page 14 of 29 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. Daily life is flexible around the needs of people in the home. They can exercise choice and control over there lives and take part in a range of appropriate activities. Evidence: People spoken to said that they chose what to do. Also people were seen moving freely around the home, using the conservatory and garden. Everyone who completed a survey stated that staff listen and act on what they say. Since the last inspection a member of the staff team has been given eight additional hours to organise activities. Twelve people who completed a survey recorded that there are Always or Usually activities they can take part in. One person stated I do not want to take part in activities. The homes notice board contained pictures of a tea dance, parties and outings and there was details of future sing-a-longs, exercise sessions and visits by outside entertainers. A activity record showed that recently people had gone out with visitors on car trips to shops and for walks around the village. People are involved in watering the homes tomato plants, there is nail painting and manicures, a special dart board with sticky balls, dominoes, hoops and reminiscence materials. People are supported by staff to go shopping or walk in the Care Homes for Older People Page 15 of 29 Evidence: local area. Each month a Church of England minister holds a service, with communion, for those interested. Two people go out separately with family support to Mass and a Non Conformist church. Visitors spoken to stated they are made welcome by staff and the relative of one person said they had noticed an improvement in their wellbeing. The lunchtime meal was observed. Tables were set with clean linen cloths and centre decorations. Sufficient staff were in place to support those residents who needed it and everyone spoken to stated they enjoyed their meal. The meal was of three courses with a choice of main course and sweet. Liquid refreshments are offered throughout the day and fresh fruit was available in the large lounge. The cook stated she replaces the fruit regularly. Care Homes for Older People Page 16 of 29 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 in the home feel safe and can be sure that any complaint they make will be taken seriously. Staff training related to safeguarding is ongoing to protect people from harm. Evidence: People are provided with a copy of the complaints procedure when they enter the home and a copy is available at the entrance for the benefit of visitors. Twelve of the fourteen people who answered a survey question stated they knew how to make a complaint and eleven people stated they knew who to speak to if they were unhappy about something. Everyone spoken to stated they felt safe in the home. The manager has a log to record any complaints with how they were addressed. No complaints have been recorded since the last inspection. Also no complaints have been reported directly to the Care Quality Commission. Staff spoken to new where the homes policies are kept and were generally aware of how to treat vulnerable people. One member of staff spoken to was vague about their duties related to vulnerable adults. The manager stated that due to staff changes six people currently need training related to protecting vulnerable people. However this Care Homes for Older People Page 17 of 29 Evidence: training is provided as part of induction and Department of Health guidance called No Secrets is available to the staff team. Care Homes for Older People Page 18 of 29 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. Some maintenance work is required but small improvements are being made in the home and there was a reasonable standard of hygiene. Evidence: From the car park there is level access in to the home and a passenger lift is available to the first floor. People were seen freely moving around the home and those spoken to said the home was comfortable. Recently a door entry system has been fitted to provide better security. Two en suites have been installed but lack mechanical ventilation to remove odours. A bathroom is currently being altered to a shower room to provide people in the home with a choice for bathing. Walls have been emulsion painted and some direction signs and signs to identify toilets have been fitted. The carpet in bathroom 1 is rucked and is a trip hazard. A corner of the bath is dangerous for people using this room. The bath and sink plugs are not attached by chains and there was no thermometer to enable staff to check water temperatures are safe. A hoist and clothes trolley were stored in a corridor presenting a possible hazard to Care Homes for Older People Page 19 of 29 Evidence: people walking around the home. The doors to bedrooms 6, 20 and 24 did not close fully onto the rebate to ensure good protection in the event of a fire. Not all doors were checked during the building tour. The bathroom being converted to a shower room needed the wall tiling completed before it could be used. A water leak was evident in the link corridor on the first floor. The diffuser to the strip light in this area was dirty and contained dead insects. The first floor bathroom flooring was lifting creating a trip hazard and the bath panel was broken and potentially dangerous to people using this bathroom. The bathroom also used by the hairdresser has a cracked bath panel and the shower head was blocked. Also a bathroom on the ground floor is currently out of use as the water is cold. In room 24 a new wash basin was fitted but the splash back tiles were missing creating and area difficult to clean. The radiator cover in a toilet on the ground floor was broken making it difficult to keep clean. The door to bedroom 25 was wedged open with a chair. This door should be kept closed or a suitable approved device fitted to retain the door open safely. The laundry was suitable for the homes needs with washing machines capable of meeting current disinfection standards. The kitchen is reasonably well fitted and generally clean. New fans have been recently fitted in the cooker hood to improve ventilation. A deep clean of the kitchen is due and the waste bin is broken and requires replacement. All fifteen people surveyed stated the home is Always fresh and clean. There is a conservatory and small sun terrace at the rear of the home overlooking a large garden. This garden that used to be well kept is now slightly overgrown. Care Homes for Older People Page 20 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient staff are employed and a training programme is in place to support people well who live in the home. Evidence: On the day of inspection there were between three and four care staff in addition to the manager caring for the 21 people currently living in the home. The staff rota showed the current staffing levels are: a senior and three care between 8:00am and 1:00pm, a senior and two care staff between 1:00pm and 10:00pm then a senior and one care staff between 10:00pm and 8:00am. An activities person is also employed for 8 hours each week together with domestic and catering staff. Since the last inspection a deputy manager post has been created to help the manager to develop systems and assist with necessary paperwork. There is currently no vacancies in the staff team. Staff were seen throughout the day providing good support to people in the home. People who commented praised the staff team and of the fifteen returned surveys; 11 stated they Always get the care and support they need, 3 stated they Usually do and 1 person said they Sometimes do. Asked if staff listen and act on what they say, all Care Homes for Older People Page 21 of 29 Evidence: 15 said Yes. The manager provided information that 14 of 23 care staff have a National Vocational Qualification (NVQ) to demonstrate their abilities and 3 new staff are doing an induction into care principles using a workbook that follows national guidelines. Not all staff are appropriately trained, however, the manager has a training plan and future training is to be provided in; Health and Safety, Fire Safety and Dementia Awareness. Six new staff have been employed since the last inspection. A selection of files were reviewed. Appropriate references were obtained and Criminal Record Bureau (CRB) checks. One file did not contain an initial induction into the home and there were no records of interview to demonstrate gaps in employment were investigated. All staff now receive a copy of the General Social Care Council code of conduct identifying what is expected of them in daily life. Staff should receive supervision at least six times a year. Not all staff have an up to date record of having this. Staff spoken to stated they feel supported and have the opportunity to speak at meetings. Minutes were seen for two meeting held so far this year. Staff also said that training is provided but one staff spoken to was unsure about the protection of vulnerable people and about the homes whistle blowing policy. Three staff surveys returned identified a good supportive teaching culture in the home. Care Homes for Older People Page 22 of 29 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. Although the manager works hard to promote a home run for the benefit of the people who live there, management systems are not fully developed to provide a safe comfortable home for all. Evidence: The manager who is now supported by an able deputy has managed the home for two years. In that time improvements have been made to care planning, staff training and some systems to monitor health and safety. The manager who has achieved the Registered Managers Award to demonstrate her ability to care for older people has also recently done additional training to improve her working knowledge associated with; protecting vulnerable people, emergency first aid and the Mental Health Act. Requirements made of the proprietors to monitor the quality of care provided and Care Homes for Older People Page 23 of 29 Evidence: conduct regular regulatory visits have not been fully addressed. Although the most recent visit on 30th April 2009 did identify several areas for improvement but these have not been followed up with action plans. A system is in place to hold small sums of money for those people who require it. A record of all transactions is made with details of any expenditure and two signatures to evidence the transaction. The records show that some bulk purchases are made and not strictly accounted to each person. The manager must demonstrate that actual charges only are levied. New staff receive health and safety training and training related to the safe handling of people. Regular fire checks are recorded a recent fire risk assessment was seen and staff receive regular fire instruction to ensure people in the home are safe. A selection of maintenance records were requested. A gas servicing record was in place and portable electric appliance testing has been done but a certificate to demonstrate the homes internal wiring is safe could not be located. Care Homes for Older People Page 24 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 33 24(1) (a) (b) Effective quality assurance 30/09/2008 and monitoring systems should be developed. A copy of quality assurance reports should be forwarded to CSCI This requirement is outstanding from previous inspections. The proprietors must in 31/07/2008 accordance with this regulation, visit the home each month and prepare a report on their findings which is then available for inspection. 2 33 26 Care Homes for Older People Page 25 of 29 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 19 12 The manager must ensure 30/09/2009 peoples health and safety is maintained in the home. All doors must close onto their rebates to promote fire integrity. Trips and hazards identified in bathrooms must be addressed. The bedroom carpet that is a trip hazard must be refitted or renewed. Hoists and trolleys must not be stored temporarily in corridors. Doors needed to be kept open must be fitted with an approved device. People should be safe from harm when in the home. 2 26 12 Hygiene standards must be 30/09/2009 promoted in the home. Poor maintenance makes it difficult to maintain hygiene standards. Broken tiling and areas requiring re decoration should be addressed. Care Homes for Older People Page 26 of 29 The broken bin in the kitchen must be replaced. A strip light diffuser should be taken down and cleaned. The radiator cover identified should be refurbished. Good hygiene standards ensure peoples wellbeing. 3 38 12 The manager must obtain a certificate t indicate the homes internal wiring is safe. People should live in a home that is safe and well maintained. 31/08/2009 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 3 7 Continue improving the information obtained about people before and after admission to promote individualised care. Ensure care plans produced are specific to the individual and do not limit people ability to maintain some independence. Ensure risk assessments are fully completed and where appropriate associated care plans are produced. Continue with staff training related to safeguarding and ensure all staff are aware of how to protect vulnerable people. Bath and sink plugs should be attached by a chain for convenience. The kitchen canopy over the cooker needs a deep clean. A new shower head is needed in the bathroom used by the hairdresser. 3 4 8 18 5 19 6 35 The manager should ensure that any items bought for people in the home are specifically charged and the costs Care Homes for Older People Page 27 of 29 are not shared. Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) 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 29 of 29 - 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!