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Inspection on 28/04/09 for Canwick House

Also see our care home review for Canwick House for more information

This inspection was carried out on 28th April 2009.

CQC found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The care home offers a comfortable environment. Staffing levels ensure that the needs of residents are met. Staff, are supported by the homes managers. Residents said that their individual needs are being met. A resident stated "we do have residents meetings and if we bring up concerns these are addressed by the registered manager."

What has improved since the last inspection?

There were seven requirements made at this inspection, none were made at the last inspection. The home now holds residents meetings.

What the care home could do better:

The Registered manager must ensure that the infection control procedure, the health and safety procedure, medication procedure and the recruitment procedure of the home is consistently followed. The care records must be improved, care plans need to include all the identified needs of residents and give instructions to staff how these are to be met using the resources of the care home. Residents should have risk assessments in place which advise staff how to minimise or remove risk when providing care to residents. Care plans should identify the equipment and number of staff needed to provide safe care to each resident. All-new residents must receive a comprehensive assessment to identify all of their needs prior to them been admitted to the home. This assessment must include deciding if the resident has the ability to make decisions for themselves. This is to ensure that identified needs of each residents can be met by the staff. An ongoing maintenance program must be put in place to ensure that the care home remains fits for its purpose and provides a safe environment for residents. The registered manager should monitor the general welfare of residents and inform the Care Quality Commission of any incident which affects the safety of an individual resident. It is important that all policies and procedures including infection control and health and safety are consistently followed by staff to keep residents safe.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Canwick House Hall Drive Canwick Lincs LN4 2RG     The quality rating for this care home is:   zero star poor 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: Ken Hague     Date: 2 8 0 4 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. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 30 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Canwick House Hall Drive Canwick Lincs LN4 2RG 01522522275 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : canwickhouse@tiscali.co.uk Mrs C Paul care home 22 Number of places (if applicable): Under 65 Over 65 22 22 dementia old age, not falling within any other category Additional conditions: 0 0 The maximum number of users who can be accommodated is 22. The registered provider may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, Dementia over the age of 65 years - Code DE(E) Date of last inspection Brief description of the care home Canwick House is a large three storey, listed building with a modern extension. The house is situated in a small village, which is approximately one mile from the centre of the city of Lincoln. The home has been adapted and extended to provide accommodation for up to 22 residents to receive personal care. The home is accessed by going through a shared driveway which opens on to a small tarmac car park. Care Homes for Older People Page 4 of 30 Brief description of the care home There is a local church nearby with all other amenities located within the city centre. The home is not located on a bus route and residents rely on relatives or the proprietors for transport when this is needed. To the rear of the property are secluded grounds and gardens, which are well maintained. Accommodation for residents is on the ground and first floor of the building. The second storey is reserved as the private accommodation of the proprietor. The home is run as a family business and the proprietor is fully involved in the management of the home as well as the delivery of personal care.The statement of purpose for the home is kept in the managers office Fees charged by the home for residential care on 14/04/09 were £450 to £460 Care Homes for Older People Page 5 of 30 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: zero star poor 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 key Visit was unannounced any previous information held by the Commission for Social Care Inspection about the home was taken into account. Throughout this report the terms we and us therefore refer to the Care Quality Commission. Before the visit the provider had returned an Annual Quality Assurance Assessment (AQAA). This gave us information about how the home is meeting the needs of residents using the resources of the care home. We sent out surveys to residents but the Registered manger said these were not received by the home. The main method of inspection used is called case tracking. This involves selecting a proportion of the residents and tracking the care they received through the checking of Care Homes for Older People Page 6 of 30 records, discussions with them and the staff who care for them, and observations of care practice. The views of residents was obtained by discussions carried out during the visit. Peoples views and comments are reflected within this report 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 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 30 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 9 of 30 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents do not receive a full comprehensive assessment before being admitted to the care home. This could result in some needs not being met. Evidence: Some assessments of peoples needs were not up to date and important points such as peoples wishes and choices were not recorded. One person who was at risk of falls had no record of how this risk can be minimised in his care plan. Although records included nutritional assessments there was no evidence of how the results of the assessments were recorded. No recorded evidence was found of the residents being involved in their initial assessment which were not signed or dated. The home had not confirmed in writing to any resident that they could answer their identified needs before admitting them to the care home. On the day of the site visit the registered manager was heard to agree to admit a new Care Homes for Older People Page 10 of 30 Evidence: resident. She stated that she had assessed this resident on the 27th of April at the hospital. The assessment documents were not fully completed. The care records and assessment did not therefore fully reflect this residents needs. A risk had been identified from Hospital records but no risk management was recorded. The registered manager was seen to admit this resident without obtaining any further information. Care Homes for Older People Page 11 of 30 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are at risk as some do not have up-to-date plans, medication is not safely administered, and accidents are not monitored. Evidence: Some residents had been admitted to the home without care plans. The care plans that were in place did not include things like personal care needs, levels of mobility and up-to-date detailed risk assessments. Staff stated that care plans are not used as working documents and do not reflect the current needs of all residents. On one occasion medication charts had been signed to indicate that a drug had been given to a resident. However there was evidence that this had occurred. The care home has a policy which allows residents to self medicate should a risk assessment show that this is safe practice. A resident stated I would like to self medicate but we are not given the opportunity, medication is given out here to everyone regardless of their ability. Staff said that they could not immediately call a GP if needed, there was a time delay introduced as they were expected to seek the permission of the Care Homes for Older People Page 12 of 30 Evidence: registered manager. There was no written evidence found of accidents and incidents being monitored by manager of the care home. Care Homes for Older People Page 13 of 30 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. People are offered only a limited range of activities. They benefit from being able to maintain links with the local community. Residents are not always offered choices in their diet. Evidence: Residents likes and dislikes for food were found on some residents individual care cares but not on all. The registered manager and staff stated that residents are offered a choice of food and the menu showed that choices are available. However there is no evidence of staff discussing meals prior to them being presented in the dining-room. A resident stated we are not always offered a choice of food. They stated the quality of food deteriorated recently but this was raised at the residents meeting and an improvement has now been noticed. The individual residents choices of social activities were not recorded within care records. Care plans did not guide staff as to how they could ensure that social stimulation was provided to all residents. Staff stated that they did try to provide stimulation and activities for residents, and they said that activities do take place on a Care Homes for Older People Page 14 of 30 Evidence: daily basis. Staff and residents confirmed that an outing was planned for the following weekend for residents to go out into the community for the day. Staff said that residents are encouraged to maintain links with their own family and the community. A resident stated that my family can visit me at any time within reasonable hours. T he registered manager stated that activities are provided for residents. Their choices and wishes for diet and activities were found on some residents individual care records but not on all files. Care plans did not guide staff how they could ensure that social stimulation was provided to all residents. Staff stated they endeavoured to provide stimulation and activities to residents. They stated activities do take place on a daily basis. Staff and residents confirmed that an outing was planned for the following weekend for residents to go out into the community for the day. The registered manager and staff stated that residents are offered choice of food. The menu does offer choices but no evidence was found of staff discussing meals prior to them being presented in the dining-room. A resident stated we are not always offered a choice of food. They stated the quality of food deteriorated recently but this was raised at the residents meeting and an improvement has now been noticed. The registered manager and staff stated that visitors are free to visit at any reasonable time. Staff stated that residents are encouraged to maintain links with their own family and the community. A resident Stated that my family can visit me at any time within reasonable hours. Care Homes for Older People Page 15 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know how to complain, however there are risks to peoples safety which are not managed appropriately by staff. Evidence: The home has a complaints procedure which is displayed in the care home. A resident stated that they felt confident in being able to raise concerns. They said We complained at the residents meeting about the menu and there has been an improvement. A second resident said I can complain if I am unhappy or have concerns however I am not sure about the residents who are confused? There were two ongoing adult protection investigations being carried out for this home on the day of a site visit. Neither of these two case were referred by the staff of the home. Two members of staff were interviewed and only one could confirm that they had received training in protecting residents from potential abuse in 2007. Members of staff were aware of new laws about making decisions and said there was a book in the office about this they stated that they had no detailed knowledge of this law. Staff had no knowledge of the new law about Deprivation of Liberties safeguards. All staff are to receive further training in adult protection on the 30th of March. Care Homes for Older People Page 16 of 30 Evidence: The staff who were interviewed stated that they would feel able to use the company whistle blowing procedure if they had any concerns about care practice at the home. Staff stated they were confident in being able to protect residents from any potential abuse. A resident stated I feel safe living in this care home. All of the residents spoken to confirmed that they felt safe living in this home. Care Homes for Older People Page 17 of 30 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not live in a safe and well maintained home. Evidence: There was no evidence found of ongoing maintenance. Staff could not give details of any areas of the home which had been decorated or improved. Some new chairs were observed in lounges but otherwise little evidence of the replacement of furniture and decorating was seen. The home smelt fresh and most areas were clean. There were windows on the second floor which could not be secured and would allow the resident to fall the ground floor level. Some window restrictors had been fitted but these allowed the window to open too wide to offer protection to residents. Many bedrooms had plastic carpet protectors fitted in small areas, which were held down with temporary tape. Staff stated this was to cope with incontinence. Pieces of old wood were placed behind headboards and at the sides of beds staff said this was said to stop the bed marking the wall. The nurse call system has not been maintained and some were not working. A small bedside light was found to be damaged and unsafe. This was immediately removed from the room. A soiled continence pad was found behind a bedside cabinet. The yellow container for soiled bedding and pads was unlocked in the drive of the care Care Homes for Older People Page 18 of 30 Evidence: home. The cupboard which contained substances that are hazardous to health was locked but the keys were hung on the outside of the cupboard. The water temperature of the care home was measured by the deputy manager and found to be 69 degree Centrigrade; this is much higher than the recommended 43 degrees. Two fire exit doors were fitted with chains, and staff stated this was to prevent a resident wandering out of the home. A stair carpet had been repaired using gaffer tape. Care Homes for Older People Page 19 of 30 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are not recruited safely which places residents at risk. Staff, are supported by the manager, however the lack of training places people at risk. Evidence: The personal files for two staff member were viewed. There were no written references on the file for one new member of staff. The registered manager had obtained a protection of vulnerable adults form for two new members of staff. There was no record of a criminal records bureau check for either of them, however both members of staff were allowed to work unsupervised. The registered manager produced evidence that 88 percent of staff hold an NVQ level 2 in care or an equivalent qualification. She stated that supervision and appraisals are being provided to staff. However staff stated that supervisions had not been provided to everybody until the deputy manager carried out this task. Staff confirmed that staff meetings and residents meetings do take place. Staff, were able to discuss in detail the needs of the individual residents being case tracked. Staff said that they feel that they are well supported by the registered manager and work well as a team. Care Homes for Older People Page 20 of 30 Evidence: Staffing levels were discussed with the registered manager, the deputy manager and two members of staff. Concerns have been raised in the past by two relatives of residents who considered staffing levels were low. All of the staff interviewed stated that in their opinion there was always sufficient staff on duty. Residents spoken to during the inspection stated they felt staffing levels allowed their needs to be met at any time. Both members of staff interviewed confirmed that they had no training in food hygiene although both prepared and gave out food to residents. Staff stated that some members of staff had been trained dementia care. The deputy manager stated that future training includes deprivation of liberty laws, fire training, adult protection, and equality and diversity. All of these courses will be completed between the 16th of May and 13th of June 2009. A resident stated staff are very kind here and take their time helping us. A second resident said we have got good staff here. A third resident stated staff, here are helpful. Care Homes for Older People Page 21 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes health and safety procedure and infection control procedure, has not been followed which places residents at risk. The home care records including notifications, recruitment and accident records are not being managed properly to ensure the safety of residents. Evidence: Staff stated that the deputy manager provides supervisions, plans training courses and is very supportive. Staff interviewed said the registered manager supports staff. Staff stated that they understood the management roles of the deputy and registered manager. They stated the deputy manager particularly concentrates on staff development and planning future training courses. Staff stated that opportunities have increased for future training since his appointment. The registered manager stated that the deputy manager has a greater input into the care records of the home. She stated that she concentrated on the care practice of the home. Care Homes for Older People Page 22 of 30 Evidence: The deputy manager showed a quality assurance form to the inspector which was being used in the home. However one of the check son the quality assurance form was that water temperatures should be kept at 43 degrees centigrade. The water temperature was found to be 69 degrees centigrade. A temperature check was carried out with the deputy manager on the day which resulted in the above evidence. The registered manager stated that the hot water system temperatures were only checked on a yearly basis. Staff stated that they have been trained in moving and handling techniques. They stated the hoist had been serviced, and equipment is provided to ensure people can be moved safely. However care plans did not detail how these tasks were to be carried out, or how many staff were needed for each task. Care Homes for Older People Page 23 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 30 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 1 3 14 All new residents must 30/06/2009 receive a full comprehensive assessment prior to them being admitted to the care home. This is to ensure that identified needs can be met by the resources of the care home. 2 7 15 A care plan must be written for each resident to guide staff as to how identified needs can be met by the resources of the care home. Care plans must include all areas of need and be in sufficient detail to enable care staff to provide comprehensive care, including peoples choices and preferences. They must also be reviewed and updated regularly. This helps to make sure that staff have access to up-todate information and can therefore meet peoples needs. 19/06/2009 3 9 13 Staff must be trained in the 22/05/2009 administration and storage of medication. Staff must follow the medication procedure of the care home ensuring that medication records are completed accurately. This is to ensure the safe administration and storage of Care Homes for Older People Page 25 of 30 medication. 4 19 23 The registered person must after consultation with the fire authority ensure that there is adequate means of escape in the event of fire and exits are not blocked. This is to enable staff to evacuate residents safely in the event of fire. 5 38 13 The registered manager 14/05/2009 must ensure that all parts of the home are so far as reasonably practical free from any risk to resident safety. This should include ensuring that hot water temperatures are controlled to prevent residents been scolded. To ensure that residents are protected from any possible area of risk which threatens their health and safety. 6 38 13 The infection control procedure in the home must be known to staff who must then follow this procedure. This is to ensure that residents are protected from any possible source of infection. 14/06/2009 29/04/2009 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 Care Homes for Older People Page 26 of 30 1 3 14 All new residents must 30/06/2009 receive a full comprehensive assessment prior to them being admitted to the care home. This is to ensure that identified needs of each resident can be met by the resources of the home 2 9 13 Staff must be trained in the administration and storage of medication. Staff must follow the medication procedure of the care home ensuring that medication records are completed accurately. This is to ensure the safe administration and storage of medication. 22/05/2009 3 9 15 A care plan must be written for each resident to guide staff as to how identified needs can be met by the resources of the care home. Care plans must include all areas of need and be in sufficient detail to enable care staff to provide comprehensive care, including peoples choices and preferences. to guide staff how identified needs can be met by the resources of the home. 19/06/2009 4 18 13 All staff must be trained identify abusive situations, and how to keep people safe. 28/06/2009 Care Homes for Older People Page 27 of 30 This is to ensure that residents are safe from harm. 5 19 23 The registered person must after consultation with the fire authority ensure that there is adequate means of escape in the event of fire and exits are not blocked. This is to enable staff to evacuate residents safely in the event of fire. 6 26 13 The infection control procedure in the home must be known to staff who must then follow this procedure. This is to ensure that residents are protected from any possible source of infection. 7 38 13 The registered manager 14/05/2009 must ensure that all parts of the home are so far as reasonably practical free from any risk to resident safety. This should include ensuring that hot water temperatures are controlled to prevent residents been scolded. To ensure that residents are protected from any possible area of risk which threatens their health and safety. 14/06/2009 29/04/2009 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 Care Homes for Older People Page 28 of 30 improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) 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 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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