Inspection on 17/12/08 for Carlton House Rest Home

This inspection was carried out on 17th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Carlton House Rest Home 17/01/07

Carlton House Rest Home 27/01/06

Carlton House Rest Home 20/12/04

Carlton House Rest Home 19/04/04

Carlton House Rest Home 19/08/03

Carlton House Rest Home 14/04/03

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Carlton House Rest Home 15 Barton Court Road New Milton Hampshire BH25 6NN     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: Ian Craig     Date: 1 7 1 2 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 29 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 29 Information about the care home Name of care home: Address: Carlton House Rest Home 15 Barton Court Road New Milton Hampshire BH25 6NN 01425612218 Telephone number: Fax number: Email address: Provider web address: herridge19@hotmail.com Name of registered provider(s): Name of registered manager (if applicable) Mrs Caroline Herridge Type of registration: Number of places registered: Mrs Caroline Herridge care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Service users in the category MD must be at least 55 years of age Date of last inspection Brief description of the care home Carlton House was originally a hotel and was converted for use as a care home some years ago and has been extended and improved over time. The home provides personal care for up to 33 older people and older people who may have dementia or a mental disorder. It is located in a residential area some 400 metres from the centre of the town of New Milton and all the amenities that can be expected in an urban setting. It is a large detached building with accommodation for residents situated on 3 floors. All bedrooms are single, some with en-suite facilities. The communal/shared rooms are located on the ground and second floors and comprise two lounges and a large dining Care Homes for Older People Page 4 of 29 33 33 0 Over 65 0 0 33 Brief description of the care home room on the ground floor and a lounge on the second floor. A passenger lift provides access to all floors where assisted baths and WCs are available. There is an attractive level garden and patio area that is readily accessible for use by residents. The current charges, as given in the pre inspection questionnaire are 485.00 to 615.00 pounds per week. Items not covered by the fee include chiropody, hairdressing, personal toiletries and newspapers. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection consisted of a 6 hour site visit to the home. Discussions took place with the deputy manager. The registered manager was not available. Unfortunately, this meant that certain records could not be located. Two staff were interviewed about their work at the home and another staff member was spoken to. Four residents and a residents relative were interviewed. Records, documents and policies and procedures were looked at. Surveys were sent to residents, staff and health and social care professionals. These were returned by 9 residents, 5 relatives of residents, 5 staff and 4 professionals connected with the home. Information contained in the surveys has been used for this report. Care Homes for Older People Page 6 of 29 Care services are required by the Commission to complete and return an Annual Quality Assurance Assessment (AQAA). The AQAA was returned to the Commission but had significant incomplete sections and was for the wrong age range of residents. What the care home does well: What has improved since the last inspection? Training for staff has improved and there is now a specific staff member responsible for the training and development of staff. The manager has enrolled on a leadership and Care Homes for Older People Page 8 of 29 management course. 4 bedrooms have been fitted with en suite facilities and 2 new toilets have been created near communal areas. One of the lounges has been refurbished. An interactive televisual games facility is now available for the residents to use. The exterior facilities have been improved by the redesign and landscaping of the garden incorporating level surfaces for the residents. 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.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 29 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 29 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. Potential residents are able to make an informed choice about moving into the home. The home takes staeps to ensure that it only admits those people whose needs it can meet although the availability of records for this needs to be improved. Evidence: The home has a Statement of Purpose which gives information about the services provided by the home. The AQAA details how each resident is given a copy of a Service Users Guide following admission to the home. 8 of the 9 surveys completed by residents confirmed that they received enough information about the home before moving in, including a copy of the Service Users Guide. Information from surveys and from interviews with residents and their relatives during the visit, show that residents come to have a look round the home before making a decision about whether or not to move in. Care Homes for Older People Page 11 of 29 Evidence: Residents confirmed that they have a contract for their stay at the home, although one person said, No. I didnt realise I needed one. The procedure for assessing potential residents needs prior to moving in was discussed with the deputy manager. This involves a member of the management team, usually the registered manager, visiting and assessing the person when a pre admission assessment pro forma is completed. For five people admitted to the home in 2008 only one of these assessments was available for someone admitted on a short term basis. For one person an assessment of need had been carried out one month before the person was admitted to the home. The deputy manager explained that the pre admission assessments could not be located due to the absence of the registered manager. Copies of referring social services care managers assessments were also not available, although a social services review was for one person. Care Homes for Older People Page 12 of 29 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. Whilst each person has a care plan these do not always reflect the current needs and preferences of the individual. Residents are treated with respect and dignity. The homes medication procedures do not meet current guidelines and are potentially unsafe. Evidence: Care records were looked at for 5 people who live at the home. These include comprehensive assessments of need in a document called, Assessment for Good Care Planning. The following needs are included: personal profile, social and leisure, physical health, mental health, risk assessment, falls risk assessment, behaviour assessment, pressure sore assessment and nutrition screening assessment. For one person the assessments were not dated . Alongside these assessments are care plan instructions for staff to follow. There is a separate care plan, called, Needs and Care Homes for Older People Page 13 of 29 Evidence: preferences in a Care Plan Diary, which also includes the persons daily records. These are not routinely completed and had only been done so for one person. There is a system for reviewing the care plans by the use of a monthly evaluation. This had not been completed for one person and for another person was first carried out 7 months after the person was admitted to the home. For two other people, the reviews did not accurately reflect the changing needs regarding behaviour and the care plan did not include these needs. Discussion with 2 of the staff showed that they have an awareness of how to handle any aggression by residents. Information was received from social services that staff had failed to meet a residents needs and that the persons care plan had not been updated to show how staff should provide care for this need. 6 of the 9 surveys returned by residents state that they always receive the care and support they need. Two people answered usually to this question and one person sometimes. Residents and relatives who were spoken to on the day of the inspection said that the staff are very caring and nothing is too much trouble for them. A relative commented that he/she is satisfied with the standard of care. 7 of the 9 surveys returned by residents say that staff listen and act on what they say. One person answered no to this question and another person said, not always. Two residents said that the standard of care regarding personal care is good. One person said that he/she likes the provision of a daily bath using one of the specialist bathing facilities. A relative said that the homes laundry provision is of a good standard. Relatives who returned a survey state that the home always meets the health needs of the residents and that the privacy and dignity of individuals is always respected. Surveys were returned by 3 health and social care professionals. Two of these state that individuals health care needs are always met and that the privacy and dignity of residents is always respected. One professional stated that the standard of care can be dependent upon which staff are on duty and is variable. This person added that it would be beneficial for staff to receive further training in dementia. Staff said that the home meets the needs of the people living there and that they have the right skills and knowledge to meet residents needs. Each bedrooms is single. Residents said that they are treated with respect and that staff are responsive when assistance is required. The homes medication procedures were looked at. Records show that staff sign a record each time medication is administered to a resident. There were exceptions to this, where on 5 occassions a staff member had failed to record a signature. The stocks of medication show that the medication had been given. Recognised procedures Care Homes for Older People Page 14 of 29 Evidence: for the storing, handling and administration of controlled medication are not being followed. The medication is not stored in a controlled drug cupboard and only one staff member administers the medication and records a signature, when this should be two. A balance record of any remaining medication is not made. The home has a written procedure for the administration of controlled medication which is not being followed. The procedure also needs to be expanded to include the recording of the remaining balance by 2 staff each time it is given. The deputy manager acknowledged that the homes procedures do not meet pharmaceutical guidelines and has already taken action to obtain a controlled drug register. Confirmation was also received following the inspection that the home has implemented the use of a controlled drug register. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have opportunities for engaging in meaningful activities and are able to exercise choice in how they spend their time. Varied and nutritious meals are provided. Evidence: The provision of activities and stimulation for residents was looked at by discussion with the deputy manager, interviews with residents and staff, surveys from staff, residents and relatives, as well as observation. Residents confirmed that activities are provided. From the 9 surveys returned by residents, 1 person says that activities are always provided, 4 usually provided and 3 sometimes provided. One person did not respond to this question. A resident commented, I enjoy music and movement with Gaynor. Residents and their relatives spoken to on the day of the visit said that activities are provided and that this includes a musical performance every 2 weeks as well as the occassional outing. One resident said how much he/she likes sitting in the garden with the other residents in the summer, but found that there was less to do in the winter. Information on activities and events is displayed in the lounge. Individual activities attended by residents are recorded. Care Homes for Older People Page 16 of 29 Evidence: There are links with the local community with trips out and visits to residents in the home by members of local churches. One person has access to interpreting services and has regular contact with his community he/she lived in prior to living at Carlton House. A staff member described the differing cultural needs of the residents. Two relatives commented that they can visit as often as they like. Residents, and their relatives, said that the home supports them to lead the lives they choose. Two people said how they like to spend their time in their room and not in the lounge. Comment was made by one relative that the provision of activities could be improved. There was a mixed response regarding the residents views on the provision of food. From the 9 surveys returned by residents two said that they always like the food, 2 usually and 4 sometimes. One person did not answer the question about food. Residents confirmed that they are able to have a choice if they dont like the midday meal. The home has a set menu and information on the midday meal was displayed. The cook states that residents have at least 5 potions of fruit or vegetables a day and that specialist diets are catered for. The midday meal on the day of the visit was home made lamb pie, with potatoes, leeks and peas. Dessert was home made jam and coconut sponge. Individual residents records include a nutrition screening assessment. Care Homes for Older People Page 17 of 29 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. The home has an accessible complaints procedure, although records were not available to show how the home dealt with recent complaints. Procedures are taken to protect the residents from possible harm. Evidence: Each person who returned a survey states that they know what to do if they are not happy and know what to do if they have a complaint. The complaints procedure is included in the Service Users Guide, which is provided to each resident. There is a complaints logbook in the hall. According to the AQAA the home has received 5 complaints in the last 12 months, all of which were resolved within 28 days and none of which were upheld. Records of the complaints and how the home had dealt with them were only available for one complaint recorded in the logbook. The deputy manager could not locate any recorded details or correspondence for the 4 other complaints saying that the manager had stored them. A relative states that his/her complaint was not effectively dealt with. The home has an adult protection policy. Staff confirmed that they receive training in safeguarding vulnerable adults and that they know what to do if a residents expresses concern about how he or she has been treated. Care Homes for Older People Page 18 of 29 Care Homes for Older People Page 19 of 29 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. Residents benefit from a clean, well maintained home which has good quality furnishings and facilities. Evidence: A tour of the home took place which included a number of residents bedrooms and the communal areas. The home was found to be clean and there was an absence of any unpleasant odours. Residents and their relatives commented that the home is always fresh and clean. One relative said that the homes hygiene standards are high and that the laundry service is particularly good. Signs have been placed on bedroom and other doors to help residents find their way around. This includes signs in the native language of residents whose first language is not English. Bedrooms have been personalised with residents belongings and furniture. 18 of the 33 bedrooms has an en suite toilet facility and there are plans to create more en suite facilities. Each bedroom has a radio controlled assistance call point so that the resident can summon help when needed. There is a specialist bath facility on each of the 3 floors, plus other communal toilets Care Homes for Older People Page 20 of 29 Evidence: and bathrooms, including a walk in shower for those with mobility needs. There are 3 lounge areas with seating, wide screen television and leather sofas and chairs. The home also has a garden which residents say they enjoy using in the summer. The home has a passenger lift which serves the first and second floors. Two relatives of residents state that the security in the garden should be improved. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well trained staff team supplied in sufficient numbers to meet their needs. A good staff recruitment process protects the people who live in the home. Evidence: The home aims to provide the following staffing levels: 6 care staff from 8am to 1pm each day and 3 care staff from 1pm to 9pm. A management team of between 2 and 3 staff also work in the home mainly in the day time. Night time staff consists of 2 waking staff and one sleep in staff member. There are additional staff for catering, laundry and cleaning. The staff rota, observations and discussions with the staff and management confirm that these staffing hours are being achieved. Residents said that staff are either always or usually available when needed. Surveys from staff said that there are always or usually enough staff to meet the individual needs of the residents. One staff member, however, commented that there is sometimes enough staff adding that the home is usually short staffed. A relative also expressed the view that the staffing levels need to be increased. At the time of the visit the home was in the process of recruiting additional staff for the weekends. Care Homes for Older People Page 22 of 29 Evidence: Health and social care professionals described the staff as caring and dedicated and that they have a knowledge of health and care issues. As previously stated, one health professional states that the staff should receive additional training in dementia. Currently staff have access to training by video in caring for those with dementia. One staff member has completed a training course in working with those with Parkinsons disease. The deputy manager explained that consideration is being given to providing staff training in working with those who exhibit challenging or aggressive behaviour. 9 of the 17 care staff have attained National Vocational Qualification (NVQ) level 2 and five of these staff have NVQ level 3 in care. At the time of the visit, a further 3 staff were in the process of studying NVQ level 2 in care. Staff have enrolled for training provided by Skills for Care. Records show that staff have an induction after starting work. This was also confirmed by staff who said that the induction is satisfactory. Staff also said that there is a variety of training courses available and that regular supervision is provided. 3 of the 4 staff surveys state that staff always have the right skills and knowledge to meet residents needs. One person replied usually/sometimes to this question. The homes recruitment procedures were looked at for 3 staff who have recently started work. These show that 2 written references are obtained for each person and that staff only start work after a protection of vulnerable adults (POVA) check has been obtained. Each staff member is also subject to a criminal record bureau (CRB) check. Records of recruitment interviews with staff are held with staff details. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally well managed although improvements are needed to ensure that issues regarding the health care of residents as well as monitoring the homes performance are addressed. Evidence: The homes manager has NVQ level 4 and the Registered Mangers Award qualifications. She has updated her training in other areas and attends courses run by Hampshire county council. At the time of the visit the manager was unable to attend the inspection visit. Arrangements were made for the deputy manager to assist with the inspection. Certain records could not be found namely, details of how complaints had been dealt with and records relating to assessing potential residents needs before moving in. The deputy manager responded positively to the findings of the inspection and stated Care Homes for Older People Page 24 of 29 Evidence: her committments to addressing any matters in need of attention. Significant parts of the AQAA had not been completed and the service had used an AQAA for adults 18 to 65 years rather than older persons. Residents and their relatives are asked for their views on the home by the use of a survey. This was confirmed from residents, relatives, discussions with the manager and from the AQAA. The home has a quality assurance policy but a completed quality assurance report and an annual development plan were not available. The home looks after the monies for some of the residents. These are securely stored and records maintained of any amounts depositted and withdrawn plus a corresponding balance. The AQAA confirms that the homes appliances and equipment are serviced by suitably qualified persons. Staff receive training in moving and handling, first aid, fire safety, health and safety and food hygiene. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 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 7 15 Individual care plans must be updated according to the assessed and changing needs of the person. So that staff have clear guidelines on how to meet each persons needs. 27/02/2009 2 9 13 Controlled medication must 20/02/2009 be handled and administered by 2 staff who both must sign a record each time it is admistered as well as a record of the remaining balance. The homes written procedure must be updated to include these details. So that controlled medication is safely handled. 3 9 13 All controlled drugs, including temazepam, must be stored in a Controlled Drugs cupboard, that complies with the Misuse of Drugs (Safe Custody) Regulations 1973. 05/03/2009 Care Homes for Older People Page 27 of 29 So that medication is securely stored. 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 9 Temazepmam should be administered and recorded by two staff both of whom must use a controlled drug register to record the amount, the date and balance remaining. The homes written procedure for controlled medication should be updated to include these procedures. Care Homes for Older People Page 28 of 29 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 29 of 29 - 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!