Inspection on 29/09/09 for Benthorn Lodge

This inspection was carried out on 29th September 2009.

CQC found this care home to be providing an Good 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Benthorn Lodge 03/09/08

Benthorn Lodge 14/03/08

Benthorn Lodge 27/11/07

Benthorn Lodge 01/12/06

Benthorn Lodge 13/02/06

Benthorn Lodge 12/07/05

Benthorn Lodge 27/01/05

Benthorn Lodge 10/06/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Benthorn Lodge 48 Wellingborough Road Finedon Northants NN9 5JS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Irene Miller     Date: 2 9 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 27 Information about the care home Name of care home: Address: Benthorn Lodge 48 Wellingborough Road Finedon Northants NN9 5JS 01933682057 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: benthorn.lodge@ntlworld.com Mr Frank Bennett,Mrs Pam Bennett care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: No person falling within the category DE(E) can be admitted where there are 18 persons in the category DE(E) already in the home. The Home will limit its services to the following service user categories: No person falling within the category Older Persons (OP) can be admitted where there are already 4 persons of category OP in the home. The total number of service users in the Home must not exceed 18. Date of last inspection Brief description of the care home Benthorn Lodge is a home providing personal care and support for 18 Older People, by reason of old age and dementia. Community healthcare professionals meet healthcare needs. The home is situated on a main road leading into the centre of Finedon and is within Care Homes for Older People Page 4 of 27 Over 65 18 4 0 0 0 3 0 9 2 0 0 8 Brief description of the care home easy access of public transport and local shops. The home comprises of a three-storey building of which the first two floors are used for residents accommodation. The original frontage of the house has been retained so that the home blends in with others in the road. There is off road parking at the side of the house, and a small paved garden to the front, which is accessible for residents. Accommodation is provided in both single and shared rooms, one of the single rooms has en suite facilities. A copy of the last inspection record is held in the homes office. Current fees range between 355.21 to 381.63 pounds per week. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of all inspections undertaken by the Care Quality Commission (CQC) are based upon seeking the outcomes for people using the service and their views of the services provided. This visit was unannounced and focused on the key standards under the National Minimum Standards and the Care Standards Act 2000 for homes providing care for older people. The care records of people using the service were sample checked which involved looking through written information on their care, such as their individual care plans (a care plan sets out how the home aims to meet the individual service users personal, healthcare, social and spiritual needs). We case tracked people during the visit which included looking at records of their Care Homes for Older People Page 6 of 27 care, asking them how they view the care provided at the home, observing care practice and discussion with staff on the needs of people using the service. Records in relation to the homes management and administration systems, quality assurance, staffing recruitment and training, and general policies and procedures were viewed. Prior to this visit we sent out to the provider an Annual Quality Assurance Assessment (AQAA). This document allows the provider to supply us with information on how they view their own performance, and gives the opportunity for them to tell us what they do well, what they could do better and their plans for future improvements. The AQAA was returned to CQC within the timescale set, and gave an insight into how the home is managed and quality assessed. We sent out to the home satisfaction surveys for distribution throughout people using the service and staff working at the home, comments received back from the surveys are quoted throughout this report. Throughout this report the term we is used to describe the CQC as a collective body. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? We sample checked the medication storage and administration records and are satisfied that requirements issued following the last inspection have been complied with. Some re - decoration work has began to take place of halls and landings, and there has been some replacement of bedroom carpets, this needs to continue to ensure that all rooms are to an acceptable level of decor. Dementia training has been rolled out to staff, in discussion with staff who have completed the training they said they had gained much from the course. Care Homes for Older People Page 8 of 27 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 on page 4. 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 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 are given sufficient information and their needs assessed to ensure that the home is right for them. Evidence: The Statement of Purpose was viewed which gave information about the home and the services it offers. The Service User Guide is available in large print to make the information accessible to older people who may have difficulty reading ordinary print. Within the care plans viewed there was records available to demonstrate that people are thoroughly assessed before they move in to the home to ensure that the home can meet their needs. In discussion with one visitor they confirmed that they had visited the home on their relatives behalf prior to moving in to ensure that the home was right for them. The person commented that they were very happy with the care of their relative at the Care Homes for Older People Page 11 of 27 Evidence: home saying their relative looked ten years younger. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal needs of people using the service are generally being met. Evidence: The care plans viewed had information available to identify the persons needs, and there was records of regular review and evaluation of the care plans. There was information on the individual preferences such as the persons preferred name, their likes and dislikes. Thought had been put into the care plans on how staff were support people living with dementia in making choices, such as help to choose what clothes to wear and what to eat. We looked at the care for one person with advanced dementia which presented in the person being very active around the home and at times intrusive around other people using the service. Within the care records the staff had recorded on a number of occasions, incidents that had occurred involving other people using the service which Care Homes for Older People Page 13 of 27 Evidence: had resulted in the person being subject to physical and verbal harassment. There was an absence of a formal behavioural risk assessment being in place to address these risks, the importance of protecting the person through having a behvioural risk assessment and management plan in place, was discussed at the time of the inspection with the registered provider. In addition the importance of involving healthcare professionals, such as the Community Psychiatric Nurse (CPN) for help and advice in the persons care. We looked at the care of a person who is immobile and in the main cared for in bed, we observed that pressure relieving equipment was in use such as a pressure relieving mattress and cushion. In discussion with staff said the person was prone to skin tears and that they did not have any breaks to their pressure areas. The pressure relieving equipment had been provided as a preventative measure, although no formal pressure area risk assessment had been put in place. The staff were keeping records within the daily notes, on any changes to the persons skin condition such as marks and skin tears. There was records of the person receiving regular visits from the district nurse to treat the skin tears and monitor their condition. The importance of monitoring the tissue viability of people at risk due to immobility, frailty and health conditions, through using a formal pressure area risk assessment and management plan, was discussed at the time of the inspection with the registered provider. Records were available of the personal care preferences for individuals, such as bathing and hair and nails attended to. Records showed that people have access to health professionals such as, general practitioners, opticians and district nurses as determined by their health needs. We sample checked the medication storage and administration records of people using the service and apart from the medication store needing a tidy up, which was immediately attended to at the time of inspection all was in order. Observations made during the visit indicated that the staff know the people using the service very well and that treat all with respect and choices is promoted and facilitated. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have some control over their daily routines and have the choice of participation in various social activities within the home each week. Evidence: The care plans viewed had some information on the previous occupation, family and friends, hobbies and interests. The home employs an activity person who is avaiable at the home three and a half days per week, in discussion with the activity person they confirmed that they are flexible with their hours and often come in at weekends to take people on outings etc. There is a weekly programme of activities which acts as a framework, the activities person explained that the programme is flexible and decided on a day to day basis dependent upon what people feel like doing. The activity person was observed spending time with a small group of people within the ground floor lounge, playing cards and board games, singing songs and favourite hymns. Care Homes for Older People Page 15 of 27 Evidence: The staff were observed to communicate with people with advanced dementia who have difficulty in verbal communication very well, they were aware of the different communication needs of each of the individuals and showed skill in engaging all in discussion and participation. The atmosphere was light hearted and jovial and people involved were fully engaged in the activities taking place. A relative told us the activity person is really good with the residents, she really gets their attention and they love her company. Community groups are encouraged to visit people at the home, such as children from the local primary schools, cubs, brownies and guides groups. A church service is held at the home monthly and Holy Communion weekly for anyone who wishes to attend. People from the home regularly attend a local coffee morning at Finedon Football Club and recently people had visited a local flower festival. There is resident dog at the home called Jake, several people were observed to stroke and pat the dog and enjoy the animals company. Lunch on the day of the visit was Chicken Pie and vegetables, and Tapioca pudding for sweet. The staff when asked what was on the menu for lunch were unsure, the menu was written on a board outside the main kitchen, however this is not displayed until later in the morning and the area is not within the vicinity for all people using the service to access. We looked at the care records of one person who is very active and finds difficulty in remaining seated for their meals, their eating and drinking care plan was very basic and did not reflect the high level of support required to ensure they receive sufficient calories and fluid intake and no nutritional risk assessment was in place. This was discussed with the registered manager at the time of the inspection. Staff were observed assisting people with their meals in a sensitive manner. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are protected by the homes complaints and safeguarding policies, procedures and practices. Evidence: The home has a complaints procedure which outlines what people should do if they wish to raise a concern about the home and the response that they can expect. The procedure has the contact details of the Northamptonshire Safeguarding Adults Team and the The Care Quality Commission (CQC) available. A copy of the complaints procedure is available on the notice board within the front entrance of the home. In the twelve months since the key inspection no concerns or complaints have been received by CQC and in discussion with the registered provider they confirmed that no formal complaints had been received directly to the home. People spoken to told us that they would speak to staff or to the manager if they had any concerns. Discussions with staff showed that they knew how to raise any concerns that they may have and that they understood their responsibilities under the locally agreed safeguarding adults procedure. 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. Continued building upkeep will ensure that people live in a home that is clean, safe and homely. Evidence: The communal areas were generally homely and clean throughout. Some of the bedrooms viewed had been made personal with photographs and other personal items, and some looked in need of re - decorating it was noted that some re decoration work has began to take place of all halls and landings, and some replacement of bedroom carpets. It was apparent that within one of the bedrooms viewed there was a strong odour which appeared to permeate from the carpet. Efforts had been made to protect the carpet in this room by use of protector mats, and staff had opened windows to ventilate the room. The person using this room spends all of their time in there and dependent upon the weather and the time of year, it is not always possible to have the windows opened for any length of time. There is a pleasant outdoor seating areas at the front of the building for people to sit out and enjoy any warmer weather. In discussion with the registered provider they confirmed that a recent visit by the Fire Care Homes for Older People Page 18 of 27 Evidence: Officer had identified that the homes fire risk assessment was in need of review, the provider said that this was soon to be addressed. It is important that the fire risk assessment is reviewed and updated as necessary. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are met by a dedicated competent and caring staff team. Evidence: On the day of the visit the staffing numbers indicated that there was sufficient staff on duty to meet the needs of the people using the service. We sample checked staff recruitment files one staff file viewed had one professional written reference available, the registered manager confirmed that this had been an oversight and would seek to obtain a second written reference without delay. It is important that the provider obtains all of the relevant employment documents as set out in Schedule 2 of the Care Standards Act 2001. It is the practice that staff start working at the home following receipt of a check with the Protection of Vulnerable Adults Register (POVA) first. This check is to to ensure that staff are suitable to work with older people. We were told that new staff work alongside an experienced member of staff whilst awaiting clearance through the Criminal Records Bureau (CRB). We viewed the staff rota which showed the days that the new members of staff had worked on the same shifts as a senior member of staff. It is important that people are protected through robust record keeping of staff supervision arrangements whilst awaiting the CRB clearance. Care Homes for Older People Page 20 of 27 Evidence: Mandatory training such as Fire Awareness, Health and Safety, Food Hygiene, and Moving and Handling are completed during induction training. Staff told us that they were happy working at the home and that they have sufficient training to enable them to carryout their jobs and opportunities for self development. Six staff had recently completed a dementia care distance learning course, comments about this training were very positive, some of the staff that had worked at the home for many years, and said that they had gained much from the course and found it very enlightening. In discussion with the registered provider they confirmed that further dementia care training is due to be rolled out to more staff in November 09. Deprivation of Liberty (DoLS) training has been attended by two of the senior staff, and in discussion with the registered provider they confirmed they are seeking to ensure staff receive training on the Mental Capacity Act, these training courses are important especially when caring for people with dementia who may have communication and behavioural difficulties. All senior care staff have received training in the safe handing and administration of medication and basic first aid. The CQC surveys completed by staff indicated that they feel supported and there is sufficient training available to enable self development. Comments received were the home does well in providing activities, seeing the people enjoying themselves with games ans singing, and outdorr entertainment, we have good opportunities to study at various levels of NVQ, I believe the people are well looked after, they look happy, and enjoying going out in the community for coffee mornings, over 60s club, stroke club etc. they all know their carers well. The home has a friendly relaxed atmosphere and relatives are always made welcome. The home takes great care in looking after the people, meeting their comfort and medication need, people stay with us for many years, because of the good care provided at Benthorn. I have worked at the home for four years, it is a very friendly home, always plenty of activities going on, if I needed to go into an old peoples home I would be very happy at Benthorn. All the staff work together as a team, I have worked at the home for seven years and have never had any problems. I will enjoy working there for many years to come. Staff were observed helping people in a kind and caring manner showing an understanding of individuals needs and preferences. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clarity in recording risk assessment and recruitment arrangements would ensure the safety and welfare of people are fully met. Evidence: Benthorn Lodge is owned by Mr and Mrs Benson, Mrs Benson is registered as the manager of the home. On the day of the visit both were available at the home. We looked at compliance with the requirements issued following the last key inspection and were satisfied with the work that has been put into meeting the requirements. As outlined in the health and personal care and the environmental sections of this report there are still some areas that need further work to meet full compliance and therefore the requirements have been brought forward. Records show that the home carries out a satisfaction surveys twice a year with people using the service and stakeholders, the outcomes of the latest survey was viewed and comments about the care and services provided by the home were Care Homes for Older People Page 22 of 27 Evidence: generally positive. We sample checked records of money held on behalf of the people using the service with records of individual itemised expenditures such as payment for chiropody, hairdresser, outings, and purchase of toiletries. Care Homes for Older People Page 23 of 27 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 26 16 The premises must be kept free from unpleasant odours This is to ensure that people using the service are provided with a clean home that is free from unpleasant odours. 31/12/2009 2 38 13 Risk assessments must be in 31/12/2009 place for people using the service which are based upon individual vulnerability. This will ensure that individual risks to people using the service are addressed and their safety needs met. 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 19 13 The homes fire risk assessment must be reviewed and updated without delay. This will ensure that people are provided with a safe environment. 07/12/2009 2 29 19 Records must be available to 07/12/2009 evidence the supervisory arrangements of new staff appointed whilst awaiting CRB clearance. This is to ensure that people using the service are protected and safe at all times. 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 15 Nutritional risk assessments should be in place to closely monitor food and fluid intake of people identified at risk of Care Homes for Older People Page 25 of 27 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 missing out on meals and drinks due to their high level of physical activity. This will enable appropriate actions to be taken to ensure good nutrition and hydration is maintained. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC 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. 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