Inspection on 11/01/09 for Broadmead Rest Home

This inspection was carried out on 11th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Broadmead Rest Home 11/01/07

Broadmead Rest Home 31/10/05

Broadmead Rest Home 19/01/05

Broadmead Rest Home 09/08/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Broadmead Rest Home Broad Layings Woolton Hill Newbury Berkshire RG20 9TS     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: Sandra Crosby     Date: 1 1 0 1 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. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Broadmead Rest Home Broad Layings Woolton Hill Newbury Berkshire RG20 9TS 01635253517 01635254489 broadmead@dsl.pipex.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Jan Bunton Type of registration: Number of places registered: Broadmead Rest Home Limited care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 38 The registered person may provide the following category of service only: Care home only (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 (OP) Dementia (DE) Mental disorder, excluding learning disability or dementia (DE) Date of last inspection Brief description of the care home Broadmead, is a privately owned and managed care home providing personal care and accommodation for up to thirty eight persons in the categories( OP) older persons,(DE) Care Homes for Older People Page 4 of 28 Over 65 0 0 38 38 38 0 Brief description of the care home dementia and MD(E) mental disorder (over 65 years) in 22 single and 8 shared rooms two of which have en-suite facilities. The home which comprises a large old house and a newer single storey extension, is set in a large mature garden situated in a quiet, rural area on the Berkshire/ Hampshire border close to the town of Newbury. A small post office is within easy walking distance but other community amenities are some distance away requiring transport to access them. The registered manager confirmed that the current fees range from £347.00 to £560.00 per week. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means that people who use this service experience good, quality outcomes. This report contains the findings of the homes key inspection and takes account of information obtained from various sources since the last inspection of 11 January 2007, including an Annual Service Review dated 28 May 2008 and a visit to the home. The key inspection visit was unannounced and carried out on Sunday 11 January 2009 between 10.30 and 15.30 hours. During the inspection the inspector spoke with the registered manager, the deputy manager, staff on duty, and two residents. Various records were seen and an accompanied tour of some areas of the home was made. Care Homes for Older People Page 6 of 28 Information contained in the completed Annual Quality Assurance Assessment (AQAA), was comprehensive and information gained and observations made at the time of the inspection visit has been used when completing this report. The people living at Broadmead prefer to be referred to as residents therefore this report will reflect this. The findings of this inspection were discussed with the registered manager and deputy manager at the end of the visit. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 28 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 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A full care assessment is undertaken for everyone wishing to live in the home to ensure the home can meet their care needs. The home has the provisions to provide intermediate care to residents who have been assessed as needing short-term residential care. Evidence: The completed AQAA documentation states that prospective residents and advocates have the information they need to make an informed choice of where to live. The home has an open door policy for all prospective residents enabling them to visit at any time. The Service User Guide is written in plain English and in a format suitable for intended residents. Each resident has a written contract and or terms and conditions. No person moves into the home without having their needs assessed by people trained to do so. Prospective residents, friends and relatives have the opportunity to assess Care Homes for Older People Page 11 of 28 Evidence: the quality and suitability of the home prior to admission. The managers complete an assessment with the proposed resident and their representatives in order to ascertain as much information as possible to ensure the home can meet their needs, the assessment includes information about general health for example diagnosis, mobility, equipment needed, personal care, skin and pressure area, sensory aids, nutrition, spiritual and cultural needs. The registered manager has previously confirmed that the home does provide intermediate care to persons who require a short term stay. The registered manager completes the assessments and ensures staff receive training to meet the individuals needs. The home has appropriate accommodation enable this. These standards were not inspected as this visit, and the judgement has been made using the information contained in the completed AQAA documentation and confirmation from the registered manager that the documentation remains the same, and that pre-assessment visits are undertaken and documentation is completed. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents need to be involved in the development and review of their care plans. The home has good practices to ensure that residents health care needs are fully met. Staff are not following the homes clear procedures for handling medication and this may not protect residents. Residents feel that their independence is supported and they are treated with respect most of the time. Evidence: Two care plans were seen. The plans contained all components as required by regulation, however the present form of reviewing is to print another care plan monthly. These were not signed and for one resident the weight record indicated a weight lose and this was not recorded in the review of the care plan with the action taken to monitor this issue. The registered manager confirmed that it had been discussed with the GP, however was unable to provide any written record. Inappropriate wording in one of the daily records seen was discussed and the registered manager agreed to address this issue. Discussion took place about the Care Homes for Older People Page 13 of 28 Evidence: handover book seen, and the registered manager agreed to ensure that information about individual persons would be recorded in the individual care plans. The registered manager showed the inspector a new format that was going to be implemented as the care planning system for the home. This new system was to be implemented in the near future. A requirement was made previously for the registered manager to ensure residents or their representatives are involved in the regular reviewing of their care plans, this was not seen as being recorded. However from discussion with the registered manager and deputy manager it was indicated that there is regular communication and exchange of information with residents and relatives. When the new care planning system is implemented records will be maintained in relation to this. Two residents spoken with said that staff provide them with care and support as they would like. Records showed that residents received visits from GPs and other health professionals such as the district nurses and psycho-geriatrician. The home administers from a single blister pack system provided by the local pharmacist and medications were seen to be stored appropriately, in sufficient quantities. The home uses Medicine Administration Record Sheets (MARS) system for recording the administration of medication. The medications records were seen and a number of inaccuracies in recording were observed. These were discussed with the registered manager and deputy manager in that mainly medication was not signed as being administered but the medication was not in the blister pack. An issue in relation to the recording of controlled drugs was also discussed with the senior carer, as the numerical recording was inaccurate. Management agreed to address these issues. Medication that is in need of disposal is returned to the local pharmacy and a record is kept by the home that is signed on receipt by the pharmacist. Throughout the visit, staff were seen to knock on doors and wait before entering rooms, staff spoke to residents in their preferred manner, as stated in their care plans, and were mainly friendly but respectful. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to exercise some control over their lives, participate in social activities, receive visits from friends and relatives as they wish and enjoy a variety of meals. Evidence: Residents are able to exercise choice by participating in social activities if they wish. Currently activities include a person who comes on a Thursday and engages residents in for example quizzes and reminiscence. A person visits once a month to provide music for health session, and a person visits monthly and entertains by playing the accordion. The hairdresser visits regularly. The deputy manager said there are no arranged outings, however some residents are able to go out with their relatives, and residents have access to the garden area. The home has an open visiting policy. This was evidenced by the records of visitors to the home and visitors seen at the home at the time of the visit. The home employs one cook and one assistant cook who prepares and cooks meals. The cook said that all of the meals are prepared freshly. It was seen that the kitchen is Care Homes for Older People Page 15 of 28 Evidence: well stocked to ensure alternatives are available. The dinner for the day was seen, and later the mealtime was observed in the dining room. It was discussed with the registered manager that the meal was in the hot trolley around 11.15am, and that assorted sandwiches for the tea were already made and in the fridge. The registered manager agreed to review these practices. On observing the serving of the meal it was discussed with the registered manager that staff poured out squash drinks. They did not ask what the person would like and there was no choice offered although it was seen that there was a red coloured squash and an orange coloured squash. The registered manager spoke to staff about this, and then ensured that residents were told what was for dinner. The residents spoken with said they enjoyed the food. Some residents choose to eat their meals in their bedroom; others enjoy socialising in the dining room. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and staff are confident that their complaints will be listened to, taken seriously and acted upon. Staff have a good understanding of adult protection issues that protects residents from potential abuse. Evidence: The completed AQAA documentation states a copy of the complaints procedure is included in each Service Users Guide, and is prominently displayed on the notice board along with the complaints book. This book was seen and contained no entries, and the registered manager confirmed that there had been no formal complaints made since the last inspection visit. It was discussed that records of any complaints made need to be individually kept and the registered manager agreed to change the format of recording complaints. It was previously reported that residents spoken with had said they would go straight to the manager if they had a concern or complaint and were confident that the manager would take their concerns seriously and staff spoken with were aware of the homes complaint procedure. The home has procedures for staff to follow should abuse be suspected, including Hampshire County Councils Protection of Vulnerable Adults, the Department Of Care Homes for Older People Page 17 of 28 Evidence: Healths No Secrets guidelines and Whistle Blowing. The registered manager confirmed that policies and procedures are reviewed and available for staff to access regarding complaints and protection, staff confirmed this. Staff have received formal training in abuse awareness, and certificates have previously been seen to confirm this. Staff are currently undertaking training in relation to the Mental Capacity Act. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment provides residents with a warm and comfortable home. There is a good infection control procedure at the home to safeguard the welfare of residents. Evidence: The home was warm, clean and welcoming, all parts of the home seen were tastefully decorated. The home has an ongoing maintenance programme. The AQAA documentation states that the home has been upgraded in several areas including three bathrooms, three toilets and a new non-working kitchen for the use of staff to prepare refreshments for service users and families. One of the upgraded bathrooms was seen. There is ample communal space; the home has three lounges, one quiet room and a dining room. Residents bedrooms that were seen looked comfortable and contained many personal items such as pictures and ornaments. Two residents spoke of their satisfaction with their rooms with comments of its comfy. Accommodation in one part of the home is provided over two floors. Access to the first floor is by one flight of stairs that has a stair lift. The home has a well equipped laundry, the washing machine has a sluicing facility. Care Homes for Older People Page 19 of 28 Evidence: Infection control procedures were in place. Staff were mainly observed to follow the guidance, equipment such as gloves and aprons were available. A carer was seen moving full closed bags of clinical waste in a wheelchair and this practice was discussed with the registered manager who said that the wheelchair would be cleaned with disinfectant after transporting the bags. There is a well maintained enclosed garden area that is accessible for residents use when the weather permits. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents feel that mainly there is a sufficient number of staff on duty to meet their individual and group needs. There is sufficient skill mix within the team to meet the residents needs. The homes comprehensive recruitment practices ensure residents safety. Staff receive mandatory and specialist training and are supported to obtain NVQ level 2 or above. Evidence: The staff rota was seen and indicated that there were five care staff on duty for the am shift and four care staff on duty for the pm shift, together with three care staff on duty for the night shift starting at 8.00pm. The staffing level was discussed with the deputy manager and later with the registered manager as there is no designated activities person and care staff, undertake this role together with at the weekend undertaking domestic and laundry duties. Previous rotas seen showed that there had been four care staff on duty until 10.00pm, and the registered manager agreed to reinstate these care hours together with reviewing the staffing level at the home. It was mainly evident from practices and interactions observed that staff had developed a good relationship between themselves and residents. Comments previously made from residents included that staff were very kind and always helpful Care Homes for Older People Page 21 of 28 Evidence: and that they were a good team. One resident praised the domestic staff for their hard work in keeping their bedrooms clean and tidy. The AQAA documentation and records previously seen indicate that 95 of staff have achieved an equivalent to an NVQ level 3, which exceeds the standard of 50 . The staff confirmed that they undertake training regularly, and this includes training in the necessary health and safety subjects such as fire safety, first aid, moving and handling, health and safety, infection control and food hygiene. Other training courses attended by staff include abuse training, pressure area care, wound care, diabetes, behaviour changes in dementia and communication skills. Training certificates were not seen at this visit, as keys were not available to open the secure files, the standard was reported as met at the last inspection visit. One member of staff spoken to said that they had not had induction training but had been supervised when she first started work at the home. The registered manager was unable to provide any written record that induction had been completed, but said that the senior carer had worked with the new carer. Previously staff spoken with stated that the induction programme run by the home was useful and detailed. The registered manager confirmed that the homes induction programme meets the recently amended Skill For Care standards for induction. The registered manager said all of the care staff have been recruited from overseas via a recruitment agency. Staff records were not viewed at this visit as management did not have the keys to access the files. It was previously reported that the staff records were detailed with the necessary checks taken to ensure staff are fit to work at the home. Other records seen on file included criminal record bureau and protection of vulnerable adults register checks, registered nurse identification pin numbers, work permits and each staff member has a job description and contract of employment. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefits from good leadership from the registered manager who is well supported by the senior staff team in providing clear leadership throughout the home and residents can be confident that their home is well run. The health, safety and welfare of residents and staff are promoted and protected. Evidence: The manager is registered with the Commission. She has the required experience and is competent to run the home. It was previously reported that she has started her Registered Mangers Award (RMA) and keeps up to date with her professional development by attending training in Dementia, abuse training for managers and receives various monthly publications such as care management, caring times and healthcare magazines. The AQAA documentation states that the registered manager has introduced more robust systems across all administrative practices and that has been made easier to Care Homes for Older People Page 23 of 28 Evidence: introduce by the appointment of a deputy manager to assist the registered manager in the day to day running of the home enabling the registered manager to concentrate on adminstration. It was indicated that the registered manager is keen to maintain standards and to free her time to enable her to concentrate on the paperwork side of managing the home. There is a strong ethos of being open and transparent in all areas of running of the home. Discussions with staff and observations showed there are clear lines of accountability within the home. Also the management approach of the home creates an open, positive and inclusive atmosphere. Residents spoken with commented that management and staff are very approachable, always make themselves available and readily help with any problems. They also had nothing but positive comments to say about staff for example they really care. A quality assurance and monitoring system based on seeking the views of residents, relatives and professionals is in place. Questionnaires were sent out and returned in May 2008. As well as completing questionnaires, residents told the inspector that management are always asking how things are and if they would like anything different. The staff said they attend regular staff meetings that are minuted. The minutes are available at the home for reference. It was previously reported by the registered manager that some residents prefer the home to safeguard small amounts of money for them, the inspector at the last visit saw the records for two residents money, both were found to be correct. These records were not viewed at this inspection visit. Each resident has lockable storage in their bedrooms to safeguard their valuables. During the observation of the main meal of the day an inappropriate moving and handling technique was observed carried out by a member of the care staff, and this was later discussed with the registered manager who said that there was moving and handling training booked for the 14 January 2009. A declaration has been made in the AQAA documentation that the service meets the requirements of the fire regulations and that maintenance of all equipment is up to date. It was previously reported that the home has a satisfactory reference file for the Control of Substances Hazardous to Health (COSHH) information leaflets for each chemical being used within the home. The home has a policy, procedures and information on health and safety. A sample of policies and procedures was seen at the Care Homes for Older People Page 24 of 28 Evidence: last inspection visit and showed that these are reviewed regularly. The employers insurance liability certificate was displayed and current. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered person shall make arrangements for the recording handling safekeeping safe administration and disposal of medicines received into the care home Ensure that medication records are signed when medicines are administered Ensure that the controlled drugs register is appropriately recorded 31/01/2009 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 12 14 27 Increase the range of activies that are offered Residents are spoken with and offered choices in relation to drink and meals Review the staffing levels at the home to ensure that there are sufficient numbers of staff on duty at all times to meet the needs of the residents. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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