Random inspection report
Care homes for older people
Name: Address: Castle Court Nursing Home Margrove Road Boosbeck Saltburn-by-Sea TS12 3BL one star adequate service 19/11/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Katherine Acheson Date: 1 6 0 6 2 0 1 0 Information about the care home
Name of care home: Address: Castle Court Nursing Home Margrove Road Boosbeck Saltburn-by-Sea TS12 3BL 01287653990 01287651600 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Angela Moody Type of registration: Number of places registered: Conditions of registration: Category(ies) : Continuum Healthcare Limited care home 38 Number of places (if applicable): Under 65 Over 65 19 19 dementia old age, not falling within any other category Conditions of registration: 0 0 The maximum number of service users who can be accommodated is: 38 The registered person may provide the following category of service only: Care Home with Nursing - Code N 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, maximum number of places 19 Dementia, Code DE - maximum number of places, 19 Date of last inspection 1 9 1 1 2 0 0 9 Care Homes for Older People Page 2 of 18 Brief description of the care home Castle Court Nursing Home is registered to provide personal and nursing care to a maximum number of thirty eight people. The home provides care to both older people and older people with dementia. Castle Court is situated in Boosbeck on the outskirts of Guisborough and Skelton. A bus service is available to transport people locally. The building was formally an old school that has been converted into care home. The home is divided into two units. The ground floor of the home accommodates twenty eight older people. There is a large lounge, small lounge and dining room. There are twenty eight single bedrooms some of which have ensuite facilities consisting of a toilet and hand wash basin. The first floor of the home accommodates ten older people with dementia. Communal space consists of a lounge, a small kitchen area and a small dining room. There are ten single bedrooms one of which has ensuite facilities. There is a passenger lift. There are panoramic views of the Cleveland hills and surrounding countryside. Care Homes for Older People Page 3 of 18 What we found:
This unannounced random inspection took place on 16 and 29 June 2010. On 16 June 2010 the inspection was carried out by two Regulatory Inspectors. On 29 June 2010 the inspection was carried out by a Regulatory Inspector and a Compliance Manager. Following the last inspection of the service on 19 November 2009 we held a management review where it was decided that we would issue a warning letter as we found that a number of regulations had been breached. The reason for this inspection was to check/monitor compliance against breaches in regulation. Before this inspection visit we looked at all of the information that we have received since the last inspection of the service in November 2009. Numerous records were examined including care records of people living at the home, risk assessments, medication records, staff recruitment and training records and some policies and procedures . People living the home and staff working there were also spoken to. Discussion also took place with the Acting Manager and Responsible Individual. We carried out a Short Observational Framework for Inspection (SOFI) on 16 June 2010, which is a methodology we use, to understand the quality of the experiences of people that use services, who are unable to provide feedback due to their cognitive or communication impairments. SOFI helps us to assess and understand whether people that use services are receiving good quality care that meets their individual needs. It allows us to get an insight into the general state of well being of individuals and to monitor how well staff interact with those living at the home. We walked around the home with the Acting Manager. Health and personal care The last inspection of the service in November 2009 highlighted the need for care plans to be developed to ensure that they were individual and specific to the person, for care plans to be reviewed and updated at least monthly, for assessments to be regularly reviewed and for bed rail risk assessments to be agreed and signed by a multi disciplinary team to confirm that they are the safest option for the person. Two care files of people that use the service were were looked at during the inspection visit on 16 June 2010. Assessments looked at during this inspection had still not been reviewed on a regular basis. A nutritional assessment for one person should have been reviewed/updated on a monthly basis. This nutritional assessment had been reviewed in June 2009 and February 2010. A pressure sore assessment for the same person which should have been reviewed/updated on a monthly basis had been reviewed/updated in January, March and April 2010. A bed rail risk assessment was on file for this person. This risk assessment had commenced on 20 February 2008 but had only been reviewed and updated in January, June and December 2009. The use of bed rails had not been discussed with a multi disciplinary team to confirm that the use of bed rails was the safest option. The bed rail risk assessment needs to be updated to include best practice safety measures that need to take place prior to using the bed rails and safety checks
Care Homes for Older People Page 4 of 18 that need to take place on a regular basis whilst the bed rails are in use. Care plans looked at during the inspection visit on 16 June 2010 did not show any improvement from the last inspection in November 2009. One care file looked at during the visit contained a plan of care for a wound that needed dressing. This plan of care did not state the dressing to be used or how often the dressing should be changed. This plan of care had not been reviewed and updated on a regular basis. Another plan of care for the same person highlighted that help was needed with hygiene and dressing. This plan of care stated, Ensure has a shower at least twice a week. The care file of a person who was admitted to the home on 11 May 2010 contained basic information. This file contained a basic life history, a partially completed mobility assessment and documentary evidence of the person having been both verbally and physically challenging. All other assessments such as nutritional, moving and handling and falls were blank. Plans of care had not been developed for this person. The SOFI observation was carried out on the dementia unit. The majority of interactions which we observed between staff and those living at the home were positive. Out of thirteen time frames where information was recorded only three resulted in a neutral interaction (where a staff member is present but does not interact with the person being observed). There were no recordings of poor interactions. Examples of neutral interactions from staff were evidenced when only some of the people in the lounge were spoken to, or asked if they were OK. One person kept trying to establish eye contact with staff, with very little response. Staff must be mindful of the need to interact with those who may be unable to communicate verbally. In the main, staff interact well with those living at the home. We looked at peoples state of being and the level of engagement which they experienced. Some people were observed to be reading and listening to music. The level of engagement could be improved upon by more social stimulation. Although people did seem to enjoy the music being played it was the same CD, which was left on repeat. More activities should be available for the people on this unit so that people are given appropriate social and leisure opportunities. Out of the thirteen time frames recorded five resulted in a recording of none in terms of peoples level of engagement. This meant that they had nothing to do and that no interactions took place. Their state of being was passive, and there was no observed stimulation. Additional staffing should be considered so that a staff member is present at all times in the lounge area. This would enable more social activity to take place; it would also enable people the opportunity to go outside more often. We were told that this usually happened when all of the people on the unit wanted to sit outside. The last inspection highlighted that staff at the home had failed to give medication as prescribed and make a record at the time it was given. A count of medication for one person indicated that there was still the same number of tablets that had been supplied at the beginning of the month. Medication had not been signed for. At the inspection of the service 16 June 2010 this requirement was revisited and the home were found to be still in breach. A Medication Administration Record (MAR) for one
Care Homes for Older People Page 5 of 18 person detailed that they were prescribed Ranitidine 150mg twice a day (morning and tea time). This medication had been signed for and given on the morning, however there were not any signatures on the MAR to confirm that medication had been administered on a tea time. A blister pack dated 26/05/10 was found containing 28 Ranitidine suggesting that the medication had not been administered. Gaps in medication administration recording meant it was not possible to determine if people had received their medication as prescribed to them. Variable dose medicines had either few, or no entries detailing the amount of medicine actually administered. The amount of medication carried forward and supplied to the home was not recorded for some medicines, meaning it was not possible to accurately check the stocks held. Handwritten entries on MARs were not countersigned to check and ensure their accuracy. Following inspection of the service we held a management review. We are considering the action that we are to take. We were informed on 16 June 2010 by the Responsible Individual that he does medication competency assessments on Nurses who are responsible for the administration of medication. The staff file of one Nurse was looked at on 16 June 2010, medication competency assessments were not available on file. The Responsible Individual said that he had the competency assessments with him. On the 29 June 2010 six medication competency assessments were available on file for the staff member, five of the six assessments were not dated. The Responsible Individual said that he had done five of the assessments on one day on commencement of employment. Complaints and protection A recommendation at the last inspection in relation to updating the complaints procedure had been partly addressed. The complaints procedure had been updated to include the name, contact details of the provider and council but not the Primary Care Trust. Timescales for action had been included. The Acting Manager said that the recommendation to update the adult protection procedure to link to No Secrets, Teeswide inter-agency policy/procedure and practice guidance had not been done. Environment On the first day of the inspection we walked around the home with Acting Manager. It was evident that lots of improvements have been made to the home environment since the last inspection of the service. The ground floor corridors had been painted and new wall paper has been put on. The Acting Manager said that new flooring is to be fitted to the ground floor corridor areas in the next few weeks. Two toilets on the ground floor had been refurbished. We were informed that the rest of the toilets and bathrooms were to be refurbished over the next twelve months. Some new beds and bedroom furniture had been purchased. The main lounge and dining room were observed to be pleasantly decorated and contained appropriate furnishings. The smaller lounge on the ground floor had been redecorated since last inspection. The Acting Manager said that this was to be an activities lounge. She said that this lounge would be used by both people from older
Care Homes for Older People Page 6 of 18 persons unit and dementia unit. This lounge had a door that lead to stairs to the dementia unit. A risk assessment must be carried out to determine if there is a need to fit a key pad locking system to this door to ensure safety of people that use the service. There was a keypad locking system at the top of the stairs to to prevent people coming downstairs and harming themselves. Since the last inspection the dementia unit lounge (on the first floor) had been painted. The room next to the lounge, which was previously a bedroom has been made into a small dining room. This had two small tables with chairs and a hand washing sink. Next to the dining room there was a small kitchen, this had previously been a staff room. The Acting Manager said that that the kitchen was used by both people that use the service and staff. There was a hot kettle that contained some boiling water. This room contained a fridge, cutlery and crockery. There were some chairs for service users to sit at. The top window in the kitchen area needed to be restricted to ensure the safety of people that use the service. The Acting Manager said that new flooring is to be fitted to the corridor areas on the first floor of the home. Bathrooms on the first floor were still in need of refurbishment as were some of the bedrooms, the Acting Manager said that the refurbishment of bedrooms and bathrooms was in the homes refurbishment plan. A bedroom on the first floor of the home had an offensive odour that appeared to be coming from the carpet and the vanity unit around the sink needed to be replaced. The last inspection of the service highlighted that appropriate sluicing facilities were not provided. We looked at the sluice areas on the ground and first floor of the home at the inspection on 16 June 2010 no changes or improvements had been made. Following inspection of the service we held a management review. We are considering the action that we are to take. The cracked sluicing sink in the laundry that was identified at the last inspection had been replaced key pad locking system has been fitted to the front entrance of the home to increase security. The last inspection of the service highlighted that workmen/decorators were staying at the home and sleeping in empty bedrooms whilst refurbishment was taking place. The Care Quality Commission advised the Responsible Individual that this was inappropriate. The Responsible Individual advised at inspection on 29 June 2010 that workmen/decorators no longer stay at the home when refurbishment work is taking place. Staffing On 16 June 2010 a Social Worker who was visiting the home approached Inspectors and raised concerns about staffing levels. The Social Worker said that she had had been made aware that on 15 June 2010 there was only two Care Assistants and a Nurse on duty. The Social worker said that she had raised her concern with the contracts and commissioning department of Redcar and Cleveland Borough who were to look into the concern. The Acting Manager said that a number of staff had recently left and that there had been some difficulty in covering shifts. She said that usually there would be a be a minimum of three Care Assistants and one nurse on duty. On 29 June 2010 there were three Care Assistants on duty, two of which commenced working at the home in April 2010 and another Care Assistant from Manchester that works at another home in the group. We
Care Homes for Older People Page 7 of 18 were informed that the home were in the processs of recruiting new staff however were awaiting Criminal Record Bureau Checks. Also on duty on 19 June 2010 was a Nurse who had commenced working at the home in May 2010. The staff files of four newly recruited staff were looked at during the inspection. Files contained evidence to confirm that staff had of commenced an induction that included the standards as set by Skills for Care. Of the four staff files looked at, two had references from the last employer two did not. At the inspection of the service on 19 November 2009 training records were disorganised. We were unable to determine if training that had taken place and training that was due. Certificates of training did not match up to that detailed on training matrix and on some occasions certificates were not available to confirm that training had taken place. At the inspection on 16 and 29 June 2010 we found that staff have not received appropriate training to the work that they perform. We looked at the recruitment and training files for three care staff. Records examined informed that care staff had not received training in first aid, food hygiene and health and safety. One person had not received infection control training. One person had not received training in safeguarding adults. Two of the three staff files looked at highlighted that staff had last received fire training in September and November 2008. Only one of the three files looked at contained a certificate to confirm that staff had received training in dementia awareness. Staff had not received training in challenging behaviour. Examination of staff files at the inspection of the service on 16 and 29 June 2010 highlighted that a Registered Nurse had started working at the home prior to the receipt of a Criminal Record Bureau Check. Evidence of an ISA Adult First, however records examined and a discussion with the provider highlighted that the nurse had not been supervised prior to the receipt of a Criminal Record Bureau Check. Duty rotas looked at during the visit informed that the nurse had worked fifteen nights in May 2010 and nine nights in June 2010 without supervision. As part of the management review of the service we discussed breaches in regulation in relation to staff not receiving appropriate training and staff working without supervision. A decision was made to issue a warning letter. Further visits will be made to the home to monitor compliance. What the care home does well:
THE SOFI observation of people on the dementia unit on 16 June 2010 showed that the majority of interactions that staff had with people were positive. The provider has demonstrated a commitment to improve the standard of the home environment. Numerous improvements have been made to the home since last inspection. The ground floor corridors have been painted and wall paper has been put on. Two toilets on the ground floor have been refurbished. The small lounge on the ground floor has also benefited from redecoration. The lounge on the dementia unit has been
Care Homes for Older People Page 8 of 18 painted. The amount of communal space on the dementia unit has increased. A small kitchen and dining room has been created for people to use. What they could do better:
Following the last inspection of the service on 19 November 2009 we held a management review where it was decided that we would issue a warning letter as we had found that a number of regulations had been breached. Two of the breaches identified in the warning letter were, medication had not been given as prescribed and a record made at the time it was given and the home did not have appropriate sluicing facilities. At inspection on 16 and 29 June 2010 both areas of concern were revisited and the home were found to be still in breach. Other concerns were also identified in relation to medication. Gaps in medication administration recording meant it was not possible to determine if people had received their medication as prescribed to them. Variable dose medicines had either few, or no entries detailing the amount of medicine actually administered. The amount of medication carried forward and supplied to the home was not recorded for some medicines, meaning it was not possible to accurately check the stocks held. Handwritten entries on MARs were not countersigned to check and ensure their accuracy. Although there was evidence of medication competency assessment they were not carried out at regular intervals Two care files of people that use the service were looked at during the visit care files did not have detailed plans of care, care plans were not reviewed on a monthly basis and for one person, assessments had not been carried out and care plans had not been written. The bed rail risk assessment needs to be updated to include best practice safety measures that need to take place prior to using the bed rails and safety checks that need to take place on a regular basis whilst the bed rails are in use. The use of bed rails should be discussed with a multi disciplinary team to confirm that they are the safest option for the person. Evidence of discussion should be available within the bed rail risk assessment. More activities should be available for people on the dementia unit so that people are given appropriate social and leisure opportunities. The needs and dependency of people on the dementia unit should be reviewed to determine if there are sufficient staff on duty. Additional staffing should be considered so that a staff member is present at all times in the lounge area. This would enable more social activity to take place. The Registered person needs to carry out a dependency assessment of all people that use the service and make sure that there are sufficient, suitably qualified, competent and experienced staff on duty at all times. The complaint and adult protection procedure need to be updated. The provider needs to continue with the plan of action to refurbish bathrooms and toilets on the ground and first floor and bedrooms on the first floor of the home. A risk assessment must be carried out to determine if there is a need to fit a key pad locking system to the door in the activities lounge that leads to the staircase to the dementia unit. Consultation with the fire Authority must take place prior to the fitting of
Care Homes for Older People Page 9 of 18 any lock. The kettle that is in the kitchen on the dementia unit must be emptied and locked away after use. Consideration must be given to fitting a key pad locking system to the kitchen door because of the hazards within. Window restrictors must be fitted to the first floor kitchen window. The offensive odour in the bedroom on the first floor must be eliminated and the vanity unit around the sink replaced. Staff need to receive mandatory training and training appropriate to the work they perform. In particular staff must receive training in first aid, food hygiene, health and safety, fire, infection control, dementia awareness and challenging behaviour. Any new staff member employed at the home who starts work on an ISA Adult First must be supervised by a suitably qualified person until receipt of a satisfactory Criminal Record Bureau Check. Two appropriate references should be obtained for people who are to work at the home one of which should be from the last employer. 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 2. Care Homes for Older People Page 10 of 18 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 9 13 Medication must be given as prescribed and a record made at the time that it is given. This will ensure that people receive their medication correctly and the treatment to their medical condition is not affected. 19/11/2009 2 26 23 The registered person must ensure that appropriate sluicing facilities are provided. This will help to prevent the spread of infection. 28/02/2010 3 30 13 The registered person must 31/01/2010 ensure that mandatory training is up to date and that certificates are on file to confirm that training has taken place. This will help to ensure that staff are trained and competent to do their job. Care Homes for Older People Page 11 of 18 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 29 19 Any new staff member 29/06/2010 employed at the home that starts work on an ISA Adult First must be supervised by a suitably qualified person until receipt of a satisfactory Criminal Record Bureau Check. To ensure the protection of people that use the service Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 3 14 Comprehensive assesments 30/07/2010 of needs including nutrition, moving and handling, pressure area and falls must be carried out for people that use the service. To ensure the health safety and wellbeing of the person. Care plans must be 30/07/2010 developed for each assessed need/problem and be specific to the person. Care plans must set out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the person are met. 2 7 15 Care Homes for Older People Page 12 of 18 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 To ensure the health safety and wellbeing of the person. 3 7 15 Care plans must be reviewed 30/07/2010 at least once a month, updated to reflect changing needs and current objectives for health and personal care. Monthly reviews/evaluations need to contain any deteriorations or improvements made. This will ensure that needs of the person using the service are met. Care plans for those people 30/07/2010 with dementia must include the level of the dementia or impact of the dementia on life. Care plans for those people with aggression/challenging behaviour must detail in what way the person is aggressive/challenging, the triggers to the aggression and measures/action to take to manage the problem. To ensure the health safety and wellbeing of the person 5 9 13 Medication Must be given as prescribed and a record made at the time it is given. This will ensure that people receive their medication correctly and treatment to their medical condition is not affected. REPEAT REQUIREMENT
Care Homes for Older People Page 13 of 18 4 7 15 19/11/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 PREVIOUS TIMESCALE FOR ACTION NOT MET WE ARE CONSIDERING THE ACTION THAT WE ARE TO TAKE. 6 19 23 Continue with the plan of 30/09/2010 action to refurbish bathrooms and toilets on the ground and first floor and bedoroms on the first floor of the home. This will enhance the environment for people that use the service. 7 20 13 A risk assessment must be 30/07/2010 carried out to determine if there is a need to fit a key pad locking system to the door in the activities lounge that leads to the staircase to the dementia unit. Consultation with the fire Authority must take place prior to the fitting of any lock. To ensure the safety of people that use the service. 8 20 13 The kettle that is in the 30/07/2010 kitchen on the dementia unit must be emptied and locked away after use. Consideration must be given to fitting a key pad locking system to the kitchen door because of the hazards within. To ensure the safety of
Care Homes for Older People Page 14 of 18 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 people that use the service. 9 20 13 Window restricors must be 30/07/2010 fitted to the first floor kitchen window. To ensure the safety of people that use the service. 10 24 23 The offensive odour in the bedroom on the first floor must be eliminated and the vanity unit around the sink replaced. To enhance the environment 11 26 23 Appropriate sluicing facilities 28/02/2010 must be provided. This will help to prevent the spread of infection. REPEAT REQUIREMENT PREVIOUS TIMESCALE FOR ACTION NOT MET WE ARE CONSIDERING THE ACTION THAT WE ARE TO TAKE. 12 27 18 The Registered person must 30/07/2010 carry out a dependency assessment of people that use the service and make sure that there are sufficient, suitably qualified, competent and experienced staff on duty at all times. To ensure the health safety and welfare of people that use the service. 13 30 18 Staff must receive mandatory training and 10/09/2010 13/08/2010 Care Homes for Older People Page 15 of 18 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 training appropriate to the work they perform. In particular staff must receive training in first aid, food hygiene, health and safety, fire, infection control, dementia awareness and challenging behaviour. This will make sure that staff have the correct knowledge and skills to care for people that use the service. PREVIOUS TIMESCALE FOR ACTION OF 31/01/2010 NOT MET 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 8 The use of bed rails should be discussed with a multi disciplinary team to confirm that they are the safest option for the person. Evidence of discussion should be availble within the bed rail risk assessment. The bed rail risk assessment needs to be updated to include best practice safety measures that need to take place prior to using the bed rails and safety checks that need to take place on a regular basis whilst the bed rails are in use. Medication competency assessments should be carried out at regular intervals and dated. More activities should be available for people on the dementia unit so that people are given appropriate social and leisure opportunities. The Complaints procedure should be updated to advise people that they can contact the Primary Care Trust
Page 16 of 18 2 8 3 4 9 12 5 16 Care Homes for Older People 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 (funding authority) should they with to make a complaint. 6 18 The adult protection procedure should be updated to link to No Secrets, Teeswide inter-agency policy/procedure and practice guidance The needs and dependency of people on the dementia unit should be reviewed to determine if there are sufficient staff on duty. Additional staffing should be considered so that a staff member is present at all times in the lounge area. This would enable more social activity to take place. Two appropriate references should be obtained for people who are to work at the home one of which should be from the last employer. 7 27 8 29 Care Homes for Older People Page 17 of 18 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 18 of 18 - 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!
