Inspection on 18/09/08 for Broomfield Lodge

This inspection was carried out on 18th September 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Broomfield Lodge 08/10/07

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 23/11/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Broomfield Lodge 1 Hunters Forstal Road Herne Bay Kent CT6 7DN     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: Sue McGrath     Date: 1 8 0 9 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: Broomfield Lodge 1 Hunters Forstal Road Herne Bay Kent CT6 7DN 01227740417 01227741260 broomfield-lodge@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Susan Carol Gould Type of registration: Number of places registered: H U Investments Limited care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 21. The registered person may provide the following category/ies 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 categories: Dementia (DE) Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Broomfield Lodge is a care home providing care and accommodation for 21 older people with dementia. The home is owned by HU Investments Ltd. The home is located in a residential part of Broomfield village. The home is a large detached property with gardens to the rear and car parking facilities at the front. Accommodation is over 2 floors with access to the 1st floor via passenger lift. Care Homes for Older People Page 4 of 27 Over 65 0 21 21 0 Brief description of the care home The fees range from 378 pounds to over 500 pounds per week. Hair-dressing, chiropody etc are not included in the fees. 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 a key inspection that took place in accordance with Inspecting for Better Lives (IBL) process. Key inspections are aimed at making sure that the individual services are meeting the standards and that the outcomes are promoting the best interests of the people living in the home. The IBL process for a key inspection involves a pre inspection assessment of service information obtained from a variety of sources including an annual self assessment and surveys. It is now a legal requirement for services to complete and return an Annual Quality Assurance Assessment (AQAA). This assessment is aimed at looking at how services are performing and achieving outcomes for people. Judgments have been made with regards to each outcome area in this report based on Care Homes for Older People Page 6 of 27 records viewed, observations and verbal responses given by those people who were spoken with . These judgements have been made using the Key Lines of Regulatory Assessment (KLORA), which are guidelines that enable the Commission for Social care inspection to be able to make an informed decision about each outcome. Further information can be found on the CSCI website with regards to the IBL process including information on KLORA and AQAAs The actual site visit to the service was carried out over one day by Sue McGrath, Inspector, who was in the home from approximately 09:30 to 16:00. The main focus of the inspection was to view any improvements made since the last inspection and the well being of the service users. Time was spent touring the building, talking to the people living in the home, talking to staff and reviewing a selection of assessments, service user plans, medication records, menus, staff files and other relevant documents. Prior to the site visit the AQAA had been returned and some surveys had been sent out to service users, families and professionals to gain further feedback as to their opinion of the service. A number of survey had been returned. At all times the manager and her staff were helpful and demonstrated a pro-active approach to ensuring that service users were being supported to the best of their abilities and resources. This report contains evidence and judgements made from observation, conversations and records. Overall this was a very positive inspection with good outcomes for service users. The inspector on leaving the home was satisfied that the residents were both safe and well cared for and wishes to thank the manager and her staff for their assistance and hospitality. What the care home does well: What has improved since the last inspection? What they could do better: Consideration should be given to replacing some of the damaged vanity units around some of the sinks in some of the bedrooms and some new commodes are required. Some of the chairs in the lounge are starting to show signs of wear and tear and should be considered for replacement. It is advised that the home looks at the level of first aid training given to staff, as there Care Homes for Older People Page 8 of 27 should be a least one member of staff with the HSE recommended First Aid at Work qualification on duty at all times. 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. The homes statement of purpose and service user guides are comprehensive and provide prospective residents with the information they need to make an informed choice about moving into the home. People who live in the home benefit from a comprehensive assessment of their needs prior to moving into the home to ensure their assessed needs can be met. Evidence: The home had a written statement of purpose and a service user guide for prospective service users and their families that reflected what the home offered. It was recommended that the home makes these documents more freely available. The contents of the statement of purpose met with the requirements of Schedule Two of the Care Standards Act 2001. Care Homes for Older People Page 11 of 27 Evidence: The registered manager confirmed that all service users were supplied with a written contract/statement of terms and conditions that had been agreed by either the service users or their representative. Copies of contract were seen in service users files. Discussion took place regarding the admission procedure used by the home for any new service user. Copies were also viewed of completed forms. The procedure was comprehensive and gathered all the relevant information required by the home to produce a comprehensive care plan. One relative confirmed she had been involved with both the admission process and the drawing up of her relatives care plan. The care plan had been read and agreed by the relative on behalf of the service user. The registered manager explained that they worked hard to ensure they could meet the assessed needs of any prospective service user before they were admitted. The registered manager stated the home would not admit any service user who they felt they could not met their needs. Service users and relatives can feel confident the home will meet their needs. Prospective service users and their relatives were encouraged to visit the home prior to admission to assess the quality, facilities and suitability of the home. Trial periods of four weeks were offered. At the end of this time a decision would then be made for the resident to become a permanent client. The home does not offer intermediate care 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. People who live in the home have clear and in-depth care plans that identify their individual needs and gives clear guidance to staff. Health care need are well met and service users have full access to all professional health care services as required. People who live in the home are protected by the homes policies and procedures for dealing with medicines. Evidence: Four care plans were viewed and were found to be comprehensive, clearly setting out the needs of the service user and giving clear instructions to staff on how to meet their needs. Service users or their relatives had signed the plans to say they agreed the contents and had been involved with drawing the plans up. The plans contained risk assessments for falls, development of pressure areas, nutrition and personal care etc. All plans were individualised, comprehensive and easy to read. Care Homes for Older People Page 13 of 27 Evidence: All of the service users benefited from having good access to other health care professionals including GP,s District Nurses, Community Psychiatric Nurses, Psychiatrists, Opticians, Chiropodists and Dentists. Where behavioral problems had been identified advise had been sought from the Psychiatrist and the local Home Therapy Team from the Health Service. The manager confirmed this had been very beneficial to service users and staff. Specific behavioral management plans had been drawn up to enable staff to manage the care in a professional and safe manner. All visits or telephone calls from professionals had been recorded with actions confirmed in writing. Evidence was seen that care plans were reviewed on a regular basis to identify any changes in the condition of the service users. The home administered medication in a safe and well managed way. None of the service users had the capacity to self medicate and senior staff had been trained to administer the medication safely and professionally. The MAR records were viewed and no gaps or errors were seen. Staff were seen to interact with service users in a friendly and caring manner. Staff were observed using a hoist to move a service user from a wheelchair to an armchair. This was done in a supportive and very professional manner. A visitor confirmed that this was normal practice. The visitor also confirmed that she was often in the home and that staff were excellent in all aspects of care and said that nothing was too much trouble for them. Privacy and dignity was at the heart of the ethos of the home. Discussion with the manager confirmed the home dealt with illness and death in a caring and sensitive way. Where possible this information was added to the care plans. 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 who live in the home have their social and recreational interests and needs provided for with a range of organised activities. People who live in the home benefit from flexible routines and are supported to maintain contact with families and friends. Where possible service users are given opportunities to make choices, therefore allowing for some level of control over their lives. Evidence: Since the last inspection the home had advertised for an activities co-ordinator but had been unable to find a suitable person. The staff continued to arrange the activities during the day and the manager confirmed that one staff member works extra hours to ensure some activities take place. These activities range from skittles, ball games and art work including making plaques and table mats. An aromatherapist visits the home weekly, this is an extra charge for the service users. An entertainer visits on a regular basis, approximately twice a month. Although there was a structure to the activities they were very much led by the wishes of the service users on the day. Most Care Homes for Older People Page 15 of 27 Evidence: activities were recorded in a single book but the manager confirmed she was currently arranging for the activities to be recorded on each individual care plan. Birthday and anniversaries were celebrated with a party with families invited where possible. One visitor spoke about how well the staff handled Christmas last year with all service users receiving a present from Father Christmas. Summer parties were also arranged including a buffet and entertainers. Outside visits were more difficult as most service users required a one to one staff ratio. Some did go out to the local garden centre occasionally. Residents spoken with all confirmed they were happy with the level of activities on offer, saying they were flexible and enjoyable. They also confirmed there were no restriction on how they spend their days or on what time to get up or go to bed. The home caters for people with varying degrees of dementia and lifestyles can be very challenging for some. With the levels of dementia within the home it was not always easy to ensure full choices were given at all times, however staff were seen to offer choices where possible and where not possible gave full support and consideration. The home had a cat which was also enjoyed by the service users. Several visitors were spoken with and all confirmed they were always made very welcomed and were offered refreshments on arrival. The main office could be made available for private conversation if required. Relatives also confirmed they had been encouraged to bring in some personal items of their relatives to make their rooms feel homely and more personalised. All who were spoken with said the food was of a very high quality and that choices were aways given. Evidence was seen that fresh fruit and vegetables were available and that menus rotated on a four weekly rolling basis and appeared wholesome and varied. The home was awarded four stars on the door by the Environmental Health Officer on their last visit. 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 who live in the home are protected by a robust complaints system and residents and relatives feel their views are listened to and acted upon. The home has robust adult protection policies and procedures in place to ensure that residents are protected from abuse. Evidence: The home had a robust complaints procedure in place that was also contained in the statement of purpose. The home has not received any formal complaints since the last inspection. The Commission has also not received any complaints since the last inspection. Service users and relatives spoken with said they were aware of the procedure but had never had to use it . They also confirmed the management team would normally deal with any minor issues promptly and efficiently. The home had robust adult protection policies and procedures in place. The manager was able to display a sound knowledge of her responsibilities regarding reporting and acting on allegations of abuse. Three staff members were also spoken with and were very familiar and confident regarding issues around adult abuse. They also confirmed they had received training on adult abuse during induction and on further training sessions. Care Homes for Older People Page 17 of 27 Evidence: Staff are recruited in a safe manner to ensure the safety of the people who live the home. Care Homes for Older People Page 18 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. People who live in the home benefit from living in a safe, clean and well maintained environment and have safe access to comfortable indoor and outdoor communal areas. Evidence: The owners had invested a lot of money in the environment of the home in the last year. The lounges had been decorated with new carpets fitted howeve, some of the furniture in the lounge was showing signs of wear and tear. The hallways had been decorated with new carpets fitted. Four bedrooms had also been refurbished with new furniture fittings and carpets. Three other bedrooms also had new carpets fitted. There were plans to continue the refurbishment of the bedrooms. It was recommended that during these planned refurbishments the condition of some of the sink units are assessed as some were in a poor state of repair. Some of the commodes also needed replacing. The manager did say that five new commodes were on order. The majority of the bedrooms were viewed and were found to be comfortable, clean and well personalised. Relatives confirmed they had been encouraged to bring in small personal items to ensure familiarity and a homely atmosphere for their relatives moving into the home. The shower room on the lower floor has been completely refurbished with a new walk Care Homes for Older People Page 19 of 27 Evidence: in shower and wall tiles. One of the remaining bathrooms was currently undergoing refurbishment. All of the remaining toilets were clean and fresh and had liquid soap and paper towels to ensure sound hygiene practices. On the day of the inspection major work was being undertaken in the main entrance hall. The manager had assessed the risks and put in place robust systems to ensure minimum disruption to the people who lived in the home and to ensure their safety. The home generally was clean and fresh. The kitchen was clean and the last visit from the Environmental Health Office (EHO) awarded a Fours Stars on the Door award for good practices. The laundry was clean and well manager. A new impermeable floor had been fitted following the requirement made at the last inspection. Evidence was seen that the home has a hoist on each floor and other suitable equipment for the safe handling of service users. The manager confirmed the building complies with the requirements of the local fire office. The front garden had ample parking areas and the rear garden had safe and secure areas for the residents to enjoy. Care Homes for Older People Page 20 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. People who live in the home benefit from the support of carefully selected and well trained staff who understand their needs. Evidence: Rotas were viewed which evidenced the home employed care staff in sufficient numbers to meet the needs of the people who live in the home. The current staffing levels were four in the mornings, three in the afternoons and two waking nights. In addition the manager is in the home from Monday to Friday. There were dedicated domestic staff and two cooks. The home shared a handyman with its sister home in Whistable. Four staff files were viewed and contained all of the information required under Schedule two of the Care Standards Act 2001. The people who lived on the home and their relatives who were visiting on the day of the inspection confirmed there were sufficient staff at all times and that routines remain flexible. Staff also confirmed they felt they had sufficient staff on duty for most of the time. The home does not use agency staff with regular staff covering the necessary shifts. Training is a high priority within the home and over 50 of staff have completed a National Vocational Qualification (NVQ) to level two or above. Four staff had achieved Care Homes for Older People Page 21 of 27 Evidence: NVQ level three and places had just been booked for four more staff who had completed level two to start level three. Two staff were currently undertaking NVQ level two. Other mandatory training is also up to date for the majority of staff. First aid training was discussed and the following recommendation was made. There should be at least one first aider on duty at all times in the care home and on occasions a greater number of qualified first aid staff may be required dependent upon the number and needs of the residents. The standard of first aid training within care services is the three or four day First Aid at Work course approved by the Health and Safety Executive. Other staff may have undertaken the one day Appointed Persons course, although this is suitable only for lower risks situations. As assessment of first aid need should be undertaken, which may justify a lesser level of training or first aid presence. The provider should also identify any other first aid needs related to individuals and record this is their care plans and arrange training/briefing for staff as appropriate. Several staff have just completed an in depth dementia course and were waiting their results. Care Homes for Older People Page 22 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. People who live in the home benefit from having a manager who is supported well by senior staff in providing clear leadership throughout the home and by staff who demonstrated a good awareness of their roles and responsibilities. Sound financial procedures protect the people who live in the home. Current arrangements were sufficient to fully protect the health, safety and welfare of the people who live in the home and staff. Evidence: The manager had been in post for approximately four years and had gained the necessary qualifications to become the Registered Manager. She was able to display a sound knowlledge and understanding in caring for people who have a diagnosis of dementia. She was also seen to be familiar with all the individuals living in the home and clearly enjoyed working alongside her staff. The management of the home was Care Homes for Older People Page 23 of 27 Evidence: competent and effective. There were clear lines of accountability in the home and staff and service users benefited from the competency of the manager and the inclusive atmosphere at the home. All staff spoken with stated they felt well supported by the management team. The providers had just started a quality assurance exercise within the home and questionnaires had been sent to all interested parties. The manager confirmed the results of the questionnaires would be collated and a report would be produced and made available to all parties as soon as possible. The last quality assurance exercise was completed in June 2006. The manager had completed a food quality survey which was very positive. Resident meeting had been tried but due to the level of dementia within the home the outcomes were not helpful to the residents with some of them feeling confused and worried. The decision was taken to stop the meetings and to concentrate on the staff acting as advocates for the residents of needed. Professional advocates could be arranged if needed. The home also produces a newsletter which is informational and fun. Service users monies are managed in the home in a safe and robust manner. Only small amounts of monies are held for minor expenditure by the service users. Records evidenced and staff confirmed that regular supervision is undertaken for all staff. Records were seen on staff files. The AQAA and comments from the manager on the day confirmed that the health,safety and welfare of service users and staff was well managed with all necessary records being up to date. All maintenance checks were also up to date. Care Homes for Older People Page 24 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 25 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 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 30 It is recommended that the provider carries out a full risk assessment to ensure staff have the appropriate level of first aid training. 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!