Inspection on 27/10/08 for Byker Hall

This inspection was carried out on 27th October 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Byker Hall 12/05/08

Byker Hall 26/06/07

Byker Hall 29/06/06

Byker Hall 05/12/05

Byker Hall 22/04/05

Byker Hall 09/12/04

Byker Hall 27/07/04

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Ann Charlton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Byker Hall Allendale Road Byker Newcastle Upon Tyne NE6 2SB     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: Suzanne McKean     Date: 2 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 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: Byker Hall Allendale Road Byker Newcastle Upon Tyne NE6 2SB 01912240588 01912763080 Byker.Hall@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Tamaris Healthcare (England) Ltd Type of registration: Number of places registered: care home 48 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: A maximum of 5 service users can be admitted in the category PD aged 50 years plus. Date of last inspection Brief description of the care home Byker Hall Care Home is purpose built and is situated in a residential area of Byker. The site is shared with another home owned by the same company. The Home is within easy reach of shops, public transport and all other amenities. Byker Hall provides general nursing care for up to 49 older people in single en-suite rooms. The home has communal lounges, dining rooms and smoking rooms on each floor. The laundry and kitchen areas are on the lower ground floor, from resident areas. All areas of the home are accessible and a passenger lift services all floors. Externally there is a garden and patio area and there is ample car parking. The home provides information about the service through the service user guide. A copy of the last inspection report Care Homes for Older People Page 4 of 28 Over 65 48 0 0 5 Brief description of the care home from The Commission for Social Care Inspection is available in the entrance to the home. 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: Summary - This is an overview of what the inspector found during the inspection and how the inspection was carried out:Before the visit we looked at :Information we have received since the last inspection on 12 may 2008. How the service dealt with any complaints and concerns since the last visit. Any changes to how the home in run. The providers view of how well they care for people. The views of people who use the service and their relatives, staff and other professionals. A unannounced visit was made on 27 October 2008. During the visit we:Care Homes for Older People Page 6 of 28 Talked with people who use the service, relatives, staff, the manager and visitors. Looked at the information about the people who use the service and how well their needs are met. Looked at other records which must be kept. Checked the staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the building to make sure it was clean, safe and comfortable. Checked what improvements had been made since the last visit. The home charges fees between 345 and 505 pounds depending upon the individual need of the resident. As the home provides nursing care the free nursing care element of the funding is provided in addition to the costs charged to the resident. We told the Manager and the Regional Manager what we found. What the care home does well: What has improved since the last inspection? What they could do better: Although it is acknowledged that the residents are provided with good quality nutritious food the dining experience could be improved to make it a more positive experience. Additional support could be given to residents to maintain their independence and therefore promote their dignity. Further improvements are planned to the social activities programme so that it is given in a more person centered way and recorded to show how this is achieved. Ongoing refurbishment is planned and although improvements have been made there is still some redecoration and replacement of furniture needed in both the communal areas and the residents bedrooms. The work carried out on the bathrooms must be completed to make sure that there are enough for the number of people living in the Care Homes for Older People Page 8 of 28 home and to give them choice about how they have their personal hygiene needs met. 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 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. The pre-admission assessments make sure that the home only admits those residents who they can care for. The residents can be confident that their needs will be met. Evidence: The company has very detailed assessment tools which are being used effectively by the home. These cover all of the aspects of the residents needs and identify choices and preferences the residents have so that the care plan can be specific to their needs. The assessments are carried out prior to a placement being offered to a perspective resident. Care plans showed that these assessments are used consistently as a starting point to develop the more detailed care plan for each resident. Also where a need, in one case for particular pressure relieving mattress, had been identified. This had not been effectively communicated to the nursing team or the equipment sourced prior to, or soon after, the admission. This resulted in a period of Care Homes for Older People Page 11 of 28 Evidence: time when the resident did not have appropriate equipment in place. This has been improved since the last inspection. 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. People have their health and personal care needs met in a planned way and the care is given with respect and with regard to their dignity. Evidence: All residents have a care plan which includes an assessment of their needs and a plan of how these should be met. These were up to date and contained information necessary to care for the residents safely. They are now completed in sufficient detail to show the changing and complex needs of the residents. They were date and being updated by the staff on a regular basis. The Four Seasons documentation includes a variety of risk assessments for prevention of falls, wound care, and moving and assisting as well are assessment tools for clinical areas such as continence promotion. These are completed to a good standard and reflect the health or social care needs of the residents in sufficient detail to tell the staff who are giving the care how to do it safely. The wound management care plans are up to date and show the way individual Care Homes for Older People Page 13 of 28 Evidence: residents wounds are managed. Discussions with a specialist NHS nurse confirmed that the home is working well with outside advisors to provide good care. Communication between the nursing team has improved and this has resulted in them being more aware of the current advice when they were providing care. The care plans are now more person centered, training has been provided to the staff to make sure that all qualified staff are able to be involved in the care plan development and maintenance. Care plan audits are being carried out and they show that there is an understanding the further improvements can be made. Residents access NHS services and facilities as necessary. The care plans showed that specialist advisors are used for individual residents. The home liaises with the General Practitioners who provide care to the residents. The care was being given by staff who were pleasant and courteous and number of residents were enjoying the staffs company. Generally, the staff were friendly toward the residents and were attempting to engage them in conversation. Residents said that they felt well supported by the staff an example in one of the surveys was that they felt that the staff were nice and helped them. The staff are working with the Primary Healthcare Trust specialist nurse in end of life care to support people who require the integrated care pathway approach in the end stages of their lives. The manager felt that this had worked well when they had needed it and that the specialist nurse had given them the support they needed. Medicines management was looked at for the residents whose care plans were examined and these were satisfactory. Ordering was controlled by the Home and photocopies of prescriptions were kept alongside MAR charts. Good waste medicine records were available. The ground floor storage was appropriate. The controlled drugs cupboard was small for the amount of stock, however the records were good and all stock balanced with the register on the day. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made to the way the residents are supported to spend their leisure time and more are planned. The meal times could be improved further to make it a more positive experience and encourage the resident to maintain a good nutritional intake. Evidence: The staff give residents ways of taking control of their daily routines, in simple but important ways for example the time they get up, what and when they eat and how they spend their time. Staff confirmed that they assist residents to make choices about how they spend their day, and residents confirmed that this is the case. During the visit some choices were being made although there are further improvements that would be made in this area around the meal times. The home is now being managed in a way with improves the way choices can be given, this is also better because of the improvement in the leadership and staffing numbers. The home employs an activities co-coordinator who was working as a carer in the Care Homes for Older People Page 15 of 28 Evidence: home prior to her appointment. There has been improvements in this area as a result of both the appointment and the general improvement in the staffing levels. She has started to develop the social activities programme of activities offering differing opportunities. This is now more developed to offer individualised activities for the residents in line with their social assessment. It has improved the residents opportunity to live active and fulfilled lives. The residents spoken to were happy with the way this was progressing. The dependency level of some of the residents means the activities on offer need to be less active and provided on a more one to one basis. The staff involved are continuing to work toward achieving a more detailed social assessment and record of activities participated in. Residents have visitors at any time and are able to use their own rooms, the small lounges or the larger, busier lounges to receive them. Relatives are given information within the residents guide about visiting arrangements. Residents said they were satisfied with the arrangements for visitors and that staff welcome them. During the visit the main lunch time meal was observed. There were some problem as the hot trolley that is used to transport the food to the dining rooms had broken and a replacement had not yet arrived. This meant that the residents on the ground floor had to wait for a long time to be served as the had been encouraged to sit in the dining room at the usual time. During the second visit (to give feedback to the manager and regional manager) this had been resolved and the meal time was better organised. However on both occasions there were some residents who were struggling with their food and although some had been assessed as needing plate guards or large handled cutlery not all had them in place. This results in them being less independent. The dining rooms have been, or are in the process of being decorated. The way the dining rooms are organised and the presentation of the tables could be improved to give a better experience for residents and encourage them to have a better nutritional intake. There are no residents who have unexplained weight loss so there is not a problem with the food generally and it looked and tasted nice on the day. The views of the residents in the surveys and during the visits was positive and some described the food as very good. There was no negative comments about the food. The tea trolley which is taken around the home mid morning and mid afternoon had tea or coffee available on both floors but only one floor had juice also available. Biscuits were being served without plates and residents were putting them on the sides of their chairs or on their laps. Improvements could be made in this area. 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. Complaints and safeguarding issues are well managed and staff are following the company guidance to reduce the risk of harm to residents. Evidence: The companys complaints procedure is available in the service users guide and a copy is available at the front entrance and is displayed in the home. The records of the complaints were examined. Staff are continuing to try to resolve small problems at a very local level and for other issues there is a formal process for staff to follow. Those staff spoken to were aware of the process or how to report any concerns to a more senior member of the staff team. Relatives who were visiting the home were aware of the complaints procedure and had raised concerns in the past. There are no active complaints being investigated at this time. Staff felt that they were now given opportunities to express their concerns with the manager, and the manager and regional manager take steps to find out their views. Staff are given protection of vulnerable adults training both as part of the in-house training package and from outside organisations. The company has written guidance in place regarding the protection of vulnerable adults through detailed policies and procedures. These are included in the induction training and ongoing in-house training. Care Homes for Older People Page 17 of 28 Evidence: Care staff confirmed that they knew about the safeguarding guidance and could identify the action they would take if they were made aware of or had any concerns. Improvements have been recently made as the new manager has a good understanding of the safeguarding processes. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The redecoration programme, which is not yet completed, has resulted in the home now being a more pleasant place for the resident to live in this along with improvements in the control of infection practices mean that the home is a more comfortable and safe environment for people to live in. Evidence: The homes location and layout is suitable for the current needs of the residents. There is easy access to the garden area from the downstairs dining room and the main reception. All of the bedrooms have an en-suite facility and there are bathrooms, shower rooms and toilets close to all resident areas. The bedrooms are all for single occupancy. Residents have brought small items with them making their rooms personalised and homely. Some of the bedroom furniture is showing signs of wear and some of the rooms have wheelchair damage to doors and walls. Also some carpets are worn or stained and need to be replaced. Some improvements have been made but not all of this work has been completed as yet. A significant of redecoration has now been completed and the majority of the communal areas have been redecorated and the carpet replaced. Also some Care Homes for Older People Page 19 of 28 Evidence: furnishings including lounge chairs have been replaced there are still a number that require repair or replacement as they are worn or damage and dirty. The sluices were locked and there are disinfectors on both floors. The laundry is on the lower ground floor. There are separate areas for clean and soiled linen. The home was clean and tidy and the control of infection practices are being followed with staff using good strategies to reduce the risk of cross infection in the home. Soiled incontinence pad are being placed in plastic bags prior to appropriate disposal. All areas requiring liquid soap, disposable hand towels and waste bins had them provided, making it easier to ensure that staff are able to follow control of infection practices. All of the four bathrooms were out of use during the first of the visits as they had been removed for replacement to be undertaken. This resulted in there only being one shower on each floor for the residents to use. Work was planned to have the new assisted baths to be put in on the week of the visit. The manager explained that this work had been done at the same time as additional electrical supply had to be put into the bathrooms for the specific baths being fitted. By the second feedback visit two new baths had been fitted and the other two were in the building awaiting the work to the bathrooms to be completed before they could also be put into place. This is not an exhaustive list of the work that is needed but it is an overview of the type of issues that were found. The home has identified the work to be carried out as part of the remedial action plan which is part of the companys quality assurance process. 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. Staffing levels and systems around recruitment, selection and training of staff are sufficient to meet the range of needs of the people using the service. Evidence: Staff recruitment and selection records were complete including two references and a completed application form. The requirement to have a CRB and POVA check in place is applied to all of the staff in the home. There have been problems in the recent past with changes in the staff team particularly with regard to the qualified nurses. The company has put additional resources into the home so that the training programme will support the staff. This has made improvements in the way the care is planned and reviewed. The staffing rotas showed that there are now fewer periods when staff shortages resulted in the need for staff to move around into other roles or to work additional hours to cover gaps. Staff sickness and holidays results in periods when there are insufficient numbers of staff on duty but additional staff means that these gaps are now filled easier. Relatives continue to be concerned that there are not enough staff on duty and that there were times when the nurse call buzzers were not being answered within a reasonable time scale but this has improved and they are feeling more Care Homes for Older People Page 21 of 28 Evidence: confident. The staff are now up to date with statutory training and a large amount of additional resources were allocated to achieve this. This has reduced the number of outstanding training and there is an action plan in place to ensure that the training programme is maintained in the future. There is now an number of training opportuniites made available to the staff around specialist clinical areas. The staff are showing a commitment to improve the practices in line with the training being given. 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. The current management systems are working effectively to make sure that residents are safe and have thier needs met and that the home is managed in the best interest of the people living there. Evidence: The home has had a number of managers in post over since the last inspection and currently there is a temporary manager in place who has made improvements to the way the home is managed. The proprietor has plans to leave him in the home until the permanent manager has had her induction period. The company have a number of reporting mechanisms so that the senior managers have the information about the home to be used in the quality review of the service. Weekly reports are sent to the regional management team regarding the day to day issues in the home. This includes those residents at risk e.g. with pressure damage or who are loosing weight, and the care being given to address the risk. Care Homes for Older People Page 23 of 28 Evidence: Supervision is given to the staff so that they have an opportunity of one to one discussion with management. There is a format for the supervision which is used and the programme is up to date. The manager has the overall responsibility for the safe working practices although the staff are aware of the need to maintain the home in a safe state. Accident reporting in the home is appropriate. Case tracking showed that entries in the accident book were reflected in the daily record within individual files. Accidents are monitored and anaylised so that risks can be identified. Safety is promoted for residents by using these systems effectively and by having a staff group that is trained in fire safety, moving and assisting, infection control and food hygiene. The home is subject to a large range of internal audits around a number of areas, this is analysed by the senior managers and an action plan is developed by the manager and the regional manager. Staff meetings are now held regularly and staff said that they found them useful, giving them the chance to to hear what is planned in the home. Staff spoken to said that they felt that they were being listened to when they expressed views about the changes. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 19 23 The home must be well 01/12/2008 maintained and decorated to bring the home back to the required standard. Bathing facilities must be provided at adequate numbers for the resident numbers and their needs. Bedrooms must be maintained and furnished to satisfactory standards to meet the needs and comfort of the residents. 01/09/2008 2 21 16 3 24 16 01/10/2008 Care Homes for Older People Page 25 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 12 16 The residents must be consulted about their social interests and arrangements made to participate in suitable activities. The residents must be supported to live active and fulfilled lives in line with their choices, abilities and in relation to their recreation, fitness and training. 01/05/2009 2 15 16 The residents must be supported to have their meals in a suitable environment and be provided with appropriate equipment and support. The residents require support to maintain their Independence and the environment can be important in encouraging the residents to find the meal times a positive experience. 01/05/2009 Care Homes for Older People Page 26 of 28 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 31 It is recommended that there is a strategy to put into place to ensure that the home is managed in a consistent and effective way so that the improvements can be maintained. 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. Re-publishing this information is in breach of the terms of use of that website. 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