Inspection on 06/10/08 for Blenheim Care Centre

This inspection was carried out on 6th October 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Blenheim Care Centre 08/10/07

Blenheim Care Centre 19/06/06

Blenheim Care Centre 17/10/05

Blenheim Care Centre 25/04/05

Blenheim Care Centre 13/01/05

Blenheim Care Centre 01/06/04

Blenheim Care Centre 04/12/03

Blenheim Care Centre 01/07/03

Extracts from inspection reports are licensed from CQC, this page was updated on 16/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Blenheim Care Centre Ickenham Road West Ruislip Middlesex HA4 7DW     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: Clare Henderson-Roe     Date: 0 7 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Blenheim Care Centre Ickenham Road West Ruislip Middlesex HA4 7DW 01895622167 01895622240 blenheim@lifestyle.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Southern Cross (LSC) Ltd care home 64 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: 10 Beds for service users with dementia requiring nursing care. Of these 10 beds, 5 may be used to accommodate service users with dementia requiring personal care or nursing care. 12 Beds for service users in the category of old age requiring nursing care 12 Beds for service users with Dementia requiring personal care. 22 Beds for service users falling within the category of old age requiring personal care. 8 beds for service users with a physical disability requiring nursing care. Date of last inspection Brief description of the care home Blenheim Care Centre is a purpose built Care Home providing care for 64 residents. There are 5 separate units and these are designed to provide a homely environment, consisting of single accommodation with en-suite toilet and hand washbasin facilities and fitted telephone sockets and residents can have a land line or mobile phone as Care Homes for Older People Page 4 of 27 Over 65 0 64 0 64 0 64 Brief description of the care home they so wish. Each house has a spacious lounge, with a designated smoking room on one floor. There is an enclosed garden and some residents bedrooms and a communal lounge open out onto it. The home is located on the Ickenham Road next to West Ruislip underground station and visitors car parking is available. The fees range from six hundred pounds to eight hundred and thirty one 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: This was an unannounced inspection carried out by 2 Inspectors. A total of 30 hours were spent on the inspection process. We carried out a tour of the home and service user plans, medication management, staff records, financial & administration records and maintenance & servicing records were viewed. 13 residents, 14 staff, 10 visitors and 2 healthcare professional were spoken with as part of the inspection process. The Annual Quality Assurance Assessment (AQAA) document completed by the home plus comment cards from residents, staff and health professionals have also been used to inform this report. Where any issues were raised on the comment cards these have been fed back to the home in general terms. It must be noted that it can be difficult to ascertain the views of residents living with the experience of dementia. Care Homes for Older People Page 6 of 27 Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: Although overall medications are being managed, some shortfalls identified on specific units with regard to receipts and administration recording need to be addressed. Cleanliness issues were identified with the kitchen, and this needs prompt attention. Some shortfalls were identified with the staff employment records, and again this needs to be addressed without delay. There have been few staff meetings in recent months, however the management are aware of this and are taking action to address Care Homes for Older People Page 8 of 27 this. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are fully assessed prior to admission to the home, to ascertain that the home is able to meet their needs, to include specialist needs. Evidence: The home has a clear pre-admission assessment and those viewed had been fully completed, to ascertain that the home is able to meet the needs of the resident. The home also obtains copies of the Social Services assessment documentation. The home does not provide intermediate care. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service user plan documentation documentation is well completed and provides staff with the information to meet each residents needs. Some shortfalls were identified with the medication documentation, which could place residents at risk. Staff care for residents in a gentle and professional manner, respecting their privacy and dignity. The home provides good end of life care, thus ensuring that residents and their families have their wishes and needs discussed, recorded and met. Evidence: Service user plans were sampled on each unit. Overall these had been clearly completed and provided staff with specific information about each residents needs had how these are to be met. The service user plan documentation had been reviewed monthly and when a residents condition had changed. Risk assessments for falls and other areas of risk had been completed and updated following any falls. There was evidence of input from the residents and their representatives. Wound care documentation was viewed. Careplans were in place for each wound and Care Homes for Older People Page 12 of 27 Evidence: body charts and photographs of wounds were available. Wound treatment, assessment and dressing record documentation had also been completed. Pressure sore risk assessments were in place and the specific pressure relieving equipment in use for each individual had been identified. There was evidence of analgesia being administered prior to dressings being carried out. The need to complete a pain assessment was discussed and the Acting Manager said that this would be addressed. Evidence of pain control was recorded in some care plans viewed. Moving & handling assessments were in place and the specific equipment to be used for each move had been documented in the moving & handling care plan. Risk assessments for the use of bedrails had been completed and written consents for their use obtained. Nutritional assessments had been carried out and weights are carried out monthly unless concerns are identified, when they are then carried out weekly. Where a concern is identified, input is sought from the GP and dietician. Continence assessments had been completed. There was evidence of input from healthcare professionals to include the GPs, tissue viability nurse, physiotherapist, chiropodist, dietician, speech & language therapist and optician. We spoke with 1 GP who visits the home regularly, who commented that staff are efficient, provide accurate information and communicate well. We viewed the medication management for the home. A list of specimen signatures and initials for staff administering medications was available on each unit, however this was incomplete on the YPD unit and needed updating. On some units there were some gaps in administration records, and also not all receipts of medications had been recorded. The home uses the correct system of disposal of medications and disposal records were up to date. The home uses a monitored dosage system for most medications, which aids with stock control. Liquid and boxed medications are dated when opened. The appropriate coding was being used on the medication administration record (MAR) for any refused or omitted medication. Controlled drug records were up to date and the register was being completed correctly. Professional single use lancets are in use for blood glucose monitoring. For residents being fed via a percutaneous endoscopic gastrostomy (PEG) tube this had been clearly recorded and a copy of the feeding regime was available in the service user plan. For residents on warfarin therapy, the results of the most recent blood test were available and we recommended that these be kept with the MAR, which was actioned at the time of inspection. The medication fridge and room temperatures are recorded daily and were within safe range. It was noted that the minimum and maximum fridge temperatures are recorded, but not the actual temperature, which is to be addressed. The clinic rooms were clean and tidy. The home has policies and procedures in place for the management of medications and copies are available on the medication trolleys. Medications are being securely stored in the home. Care Homes for Older People Page 13 of 27 Evidence: Staff were seen caring for residents in a gentle, caring and professional manner and good interaction between residents, relatives and staff was observed on both days of inspection. Bedrooms had been personalised and there was a homely atmosphere throughout. Personal clothing viewed was labelled and residents were well groomed and dressed to reflect individuality. The home has plans in place to promote the dignity challenge training for all staff throughout the home. The AQAA completed by the Acting Manager stated that the home was working towards the Gold Standard Framework for palliative care, and that staff had received training in palliative care. Service user plans viewed contained information regarding the residents individual wishes in relation to health deterioration and end of life care. There was also evidence that representatives had also been consulted where a resident has cognitive impairment. 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. The activity provision is good and residents are consulted about their interests, thus ensuring individual wishes are catered for and respected. The home has an open visiting policy, thus encouraging residents to maintain contact with family and friends. Advocacy arrangements are in place, thus ensuring the residents rights and opinions are respected. The food provision is of a good standard, offering variety and choice to meet the residents preferences. Evidence: The activities co-ordinator has a lot of experience and clearly enjoys her role. Activities programmes are on display throughout the home and individual events have eyecatching advertisements also. Residents have been consulted as to their interests, and new events such as the Monday Pub Night and Film Shows have been introduced as a result of this. The activities programme covers 7 days per week and the activities coordinator said that the staff on the units are helpful in ensuring activities take place throughout the week, and this was also evident during the inspection. Birthdays, festivals and other significant dates are celebrated in the home. Other events include pet therapy, keep fit, alternative therapies, musical entertainment and outings. Church services are also arranged to meet a variety of Christian beliefs. Should a resident with Care Homes for Older People Page 15 of 27 Evidence: other religious beliefs be admitted to the home, then action would be taken to accommodate their needs. Several of the residents on the YPD unit attend local Day Centres as part of their care provision. The home has an open visiting policy and visiting is encouraged. Visitors spoken with said that they are made very welcome and offered refreshments. Representatives are kept informed of any issues affecting the welfare of their loved one. Information about advocacy services was on display throughout the home, to include Age Concern and the local Residents and Relatives Association. The home is aware of the practical implications of the Mental Capacity Act 2005 and are putting protocols and training in place to address this. We viewed the kitchen and areas were in need of cleaning. A requirement is set under Standard 26. Kitchen records were up to date and copies of the menu choices made by residents were available. One comment received was that the menus are written in very small print, and the Operations Manager said that this had already been identified and action is being taken to provide clear menus for residents. There was a good supply of fresh, frozen, tinned and dry foodstuffs available. Residents spoken with said that they were satisfied with the food provision. Each unit has a small kitchenette and snacks and drinks are available throughout the 24 hour period. Since the last inspection the evening mealtime has been reviewed to provide a better gap between meals. We sampled the lunchtime meal on the first day of inspection and this was well presented and tasty. 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. There are clear systems in place for the management of complaints and safeguarding adults, which are adhered to, thus protecting residents. Evidence: The home has a clear complaints procedure and this is displayed throughout the home. There had been 3 complaints in the last 12 months and these had been investigated and addressed. Concerns are also referred to Social Services so that they are aware and can become involved as appropriate. Complaints are audited monthly by the Operations Manager. The home has procedures in place for safeguarding adults and also follows the Hillingdon Safeguarding Adults procedures. Staff spoken with confirmed that they had received training in Safeguarding Adults and were clear to report any concerns. They were also clear on the Whistle Blowing procedures. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has the facilities to meet the residents needs, is being maintained, and there is a plan for ongoing redecoration and refurbishment, thus ensuring the home continues to provide a safe and homely environment to live in. There are systems in place for infection control, however these had not been adhered to in the kitchen area, so this could place residents at risk. Evidence: A tour of all units was carried out. Some areas of the home were looking worn and in need of some decorative attention. A full time maintenance man is employed by the home. Regular home audits are carried out. There is evidence of an ongoing programme for the decoration of the home and of some refurbishment to include chairs. The bedrooms viewed were in good decorative order and had been personalised. The grounds were well maintained and tidy. For residents with cognitive impairment there was evidence of appropriate signage to assist them in finding their way around the unit. The corridors of the residential dementia care unit had been decorated to resemble a market place, and was interesting for residents to look at. In addition to en suite wash hand basin and toilet facilities for each bedroom, there are assisted toilet, bath and shower facilities available to meet the needs of the residents. Care Homes for Older People Page 18 of 27 Evidence: We viewed the laundry room, which is sited away from resident areas. This was clean and tidy. Washing machines have a sluice facility. The laundry person was clear about the processes involved in handling infected laundry. Infection control procedures were available. Protective clothing to include aprons and gloves were seen in areas throughout the home. The home with the exception of the kitchen was clean, hygienic and fresh throughout. Cleanliness issues had been identified in the kitchen at a recent Environmental Health Officers visit, and issues were also noted during our inspection. These need to be addressed robustly to ensure that the kitchen is clean and hygienic at all times. 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. The home is appropriately staffed to ensure that the needs of the residents can be met. Systems for vetting and recruitment are in place, however these are not always followed and could place residents at risk. There is a training programme in place to provide staff with the skills and knowledge to care effectively for the residents. Evidence: At the time of inspection the home was being appropriately staffed to meet the needs of the residents. There was evidence that the home has had a recruitment drive over the last few months and have increased the numbers of permanent and bank staff. Some comment was received regarding incidents of particular units being short staffed, and the home has worked to address this. There have been some staff members on extended leave, and the importance of providing temporary cover for all posts involved was discussed with the Operations Manager. The AQAA states that 20 of the care staff are qualified to NVQ level 2 in care or above. Several of the care staff are in the process of completing this training and one member of staff is in the process of completing the NVQ Assessors training. We met an NVQ coordinator from an external college and they said that the home was proactive and encouraging to staff to enable them to gain NVQ qualifications. Care Homes for Older People Page 20 of 27 Evidence: We viewed 3 sets of staff employment records. These did not contain all the required information. There were no photographs available and for one person only one reference was available. The importance of ensuring all required checks and documentation are available prior to employment was discussed with the Acting Manager. Also, some of the documentation needed systematic sorting and filing so that the records are easy to read. The home has an induction training programme that includes the Skills for Care common induction standards, and this is given to all new care staff for completion. They also have a general induction to familiarise them with the the workplace. The AQAA lists several topics of training relevant to the needs and diagnoses of the residents, and this is also recorded on the training matrix. 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. The home is being effectively managed to ensure that the needs of the residents and staff are being met. Systems for quality assurance are in place, thus providing an ongoing process of review and feedback. Residents monies are well managed, thus safeguarding their interests. Systems for the management of health & safety throughout the home are good, thus safeguarding residents, staff and visitors. Evidence: The Acting Manager is a first level registered nurse and has many years experience in care of the elderly. She has also recently completed dementia care training. The Acting Deputy Manager is an experienced registered nurse with a mental health qualification and has several years experience of caring for people living with the experience of dementia. Residents, visitors and staff spoken with said that the management team are approachable and work hard to address any issues raised. Southern Cross have a comprehensive quality assurance system in place. This includes Care Homes for Older People Page 22 of 27 Evidence: regular medication, service user plan, accidents, environmental and full home audits. Evidence of these was available to view. It was identified that few staff meetings had been taking place, and this was to be addressed. A relatives meeting had been planned for the near future. The Acting Manager has a weekly surgery for anyone who wishes to meet and discuss topics with her, and this was advertised in the home. Residents and visitors spoken with said that they do have the opportunity to speak with the Acting Manager and other staff and any issues raised are addressed. The home produces a regular Newsletter and copies were available for anyone who was interested to take. This is informative and details any planned activities or other events within the home. Health & safety meetings take place and minutes of these were available. Regulation 26 visits are undertaken monthly and copies of the reports from these visits were seen. We viewed some of the records for the management of residents personal monies and these were up to date, with income and expenditure being clearly recorded and receipts available. Records are maintained on the computer system and there is individual account information for each resident. Interest is allocated to each resident. There is a petty cash float so that items can be purchased outside office hours. Monies are securely stored. We viewed some of the maintenance and servicing records and these were clear and up to date. Policies and procedures for health & safety are in place. The maintenance man was aware of his role and ensures that the home is being well maintained. Staff had undergone health & safety training to include fire safety, moving & handling, food hygiene and infection control. The Acting Deputy Manager is in charge of staff training and had identified those staff due for health & safety refresher training, and this was to be carried out. The fire risk assessment had last been completed in August 2008 and a recent health & safety audit had also taken place. Fire drills had been carried out for day and night staff, and these had been recorded. Risk assessments for equipment and safe working practices were available, and these were due for annual review, which was discussed with the Acting Manager. Overall health & safety is being well managed in the home. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 All receipts and administration of medications must be accurately and clearly recorded. To ensure that residents receive their prescribed medication. 05/12/2008 2 9 13 A full list of specimen signatures and initials must be available for all staff administering medication. So that all medication administration is clearly identified. 05/12/2008 3 26 16 A high standard of cleanliness must be maintained in the kitchen areas at all times. To provide a clean and hygenic environment and protect residents, staff and visitors. 05/12/2008 Care Homes for Older People Page 25 of 27 4 29 19 Staff employment records must contain all the information required under Schedule 2 of the Care Homes Regulations 2001. To protect residents. 05/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!