Inspection on 10/12/09 for Cedar Court

This inspection was carried out on 10th December 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cedar Court 09/11/09

Cedar Court 15/10/09

Cedar Court 18/12/07

Cedar Court 02/04/07

Cedar Court 11/04/06

Cedar Court 22/09/05

Cedar Court 17/05/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for older people Name: Address: Cedar Court 37 New Road Whittlesey Cambridgeshire PE7 1SU     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Janie Buchanan     Date: 1 0 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 26 Information about the care home Name of care home: Address: Cedar Court 37 New Road Whittlesey Cambridgeshire PE7 1SU 01733350320 01733205930 cedarcourtcare@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Cedar Court Care Limited care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: 1 named female with physical disabilities under 65 years of age (PD) for the duration of her residency only 24 older people (OP) for the duration of condition 1 The 3 places registered for DE(E) will have their mental health nursing care needs met by the community psychiatric service The maximum number of places not to exceed 25 Date of last inspection Brief description of the care home Cedar Court is a single storey purpose-built home that provides personal and nursing care and support for up to 25 people over the age of 65 years. It is owned by Cedar Court Care Ltd The building is situated in the market town of Whittlesey and is within reach of shops, pubs and other local amenities. Accommodation comprises 21 single Care Homes for Older People Page 4 of 26 Over 65 3 24 24 0 0 1 Brief description of the care home bedrooms, all but two of which have en-suite facilities, and 2 double rooms, which also have en-suite facilities. There are a total of three day/quiet rooms and the home has bathing and toilet facilities, which are provided with aids to enable the needs of the residents to be met. The home has transport available to service users, including two wheelchair accessible vehicles, for visits into the community. Residents have access to a garden and patio area at the front of the building. Weekly fees are £560. Residents pay additionally for newspapers, private chiropody and hairdressing. Basic toiletries are provided. Care Homes for Older People Page 5 of 26 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: For this inspection we (The Commission for Social Care Inspection) visited the home and talked with four residents, two visiting relatives, three members of staff and the manager. We undertook a tour of the building, checked medication recording and storage, and viewed a range of documents. We also received 19 completed surveys from residents, their families and staff working at the home. We have also undertaken two additional inspections at the home following concerns raised under safeguarding procedures. Some information from these inspections is included in this report. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: More should be done to provide genuine and meaningful choice in the food residents eat. Residents should be informed of the menu on a daily basis and then actively asked what they want to eat. Records of how much fluid residents have taken must be added up daily to ensure they are receiving enough. The homes adult protection policy needs to be far more detailed and must reflect current guidance and professional codes of practice. Staff must also have a much better understanding of the adult protection system in their local area and the part they play should the need arise. Notes from interviews with prospective members of staff should be kept to demonstrate fair employment and recruitment practices by the home. Residents must be able to lock their bedrooms so that their privacy and security can be maintained. A review of staffing levels must be undertaken to ensure there are enough on duty at busy times to meet residents needs promptly. Any events affecting the well being of residents must be reported to us so we can monitor their nature and frequency. The manager of the home has come under close scrutiny recently because of concerns Care Homes for Older People Page 7 of 26 about the failure to meet requirements concerning care planning and supervision within the timescales set; the failure to report incidents affecting the welfare of residents; the poor response to adult protection concerns and the poor quality of the initial action plan to address serious care concerns highlighted at recent strategy meetings. As the registered manager they must demonstrate that they take concerns raised about the quality of care provided at the home seriously and ensure they meet legal requirements made of them within the set timescales. 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 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 26 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 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes admission procedures are good ensuring that residents needs will be met there. Evidence: There is a statement of purpose and service users guide that give good information about the home and the services it offers. These are available in each residents bedroom, along with a copy of the latest inspection report. All residents are also issued with a contract that states the terms and conditions of their stay at the home. Residents needs are assessed before they move into the home and files that we checked contained good pre-admission information about them. One relative told us that the manager had visited her husband in hospital so he could assess fully his needs. Prospective residents and their advocates are encouraged to visit the home and one relative we spoke to during our inspection told us that she had visited the home Care Homes for Older People Page 10 of 26 Evidence: several times so she could assess its facilities before her mother moved in. Staff told us that information about new residents is shared at staff handover meetings before the resident arrives so that they are aware of what their needs will be. Care Homes for Older People Page 11 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about residents needs is set out in their care plans and they receive their medication safely, however management of some residents pressure sores has not been adequate. Evidence: We looked at the care plans for three residents which provided adequate information for staff in how to meet residents needs and specific plans were in place regarding, amongst other things, their communication, eating and drinking, pain and medication, personal hygiene, and sleeping etc. The plans had been reviewed regularly to ensure that changes in residents needs were picked up. However, the plans were very clinical and not person centred. For example, one resident was nutritionally at risk but there was nothing about her likes and dislikes concerning food in the plan that could make a difference to how much she eats. In another plan it stated that staff must encourage the resident to communicate non-verbally but gave no information of how they were to do this, or what her non verbal gestures meant. At our inspection of 18/12/2007 we made a requirement that residents must be Care Homes for Older People Page 12 of 26 Evidence: actively involved in drawing up and reviewing their care plans so that they had a say in decisions about their care. When we visited on 15/10/09 we found no evidence of this, despite talking to two residents who were very able to contribute and understand their plans. We sent a warning letter to the manager about this. During this inspection we found good evidence that residents were involved in planning their care and that families had been consulted where appropriate. At our inspection of 15/10/09 we found that residents positional change charts and bowel movement charts were not being completed despite one resident who was at very high risk of pressure sores and who had suffered from diarrhoea. During this inspection we found that these charts were now being completed accurately by staff. We will not therefore take further enforcement action. However, we viewed the weight charts for some residents which were very confusing. In one instance a resident showed a huge fluctuation of weight, gaining almost 20 kg one month, only to lose 10kg the next month. These figures were clearly not accurate but the discrepancy had not been picked up or investigated. We checked fluid charts for another resident: although the amount she had taken was recorded, it was not added up daily to ensure she was receiving enough. There have been 3 meetings held under adult protection procedures in the last few months. Evidence provided at these meetings by a visiting nurse specialist highlighted serious shortfalls in the care for two residents, particularly in respect of how their pressure sores had been managed. The manager was asked to provide a written action plan as to how he was to address these issues as a result. We checked a small sample of residents medication administration records (MAR). These showed that residents were getting their medication as prescribed, that staff were signing accurately to indicate what had been given and that medication was stored correctly and at the right temperature. Care Homes for Older People Page 13 of 26 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 access to activities and entertainment to keep them stimulated however they are not offered genuine choice in what they eat. Evidence: The home employs an activities co-ordinator 3 days a week who arranges a variety of events and entertainment, she also spends dedicated time with residents who are cared for in bed. There have been recent outings for residents to a nearby garden centre, the Hamptons shopping centre and to a local school to see their nativity play. There were a number of forthcoming events including 2 carol services, a Christmas party and Tickled Pink Christmas extravaganza. Residents we spoke told us they were rarely bored and also enjoyed the quizzes and bingo that happen regularly. Lunch on the day we inspected consisted of cottage pie, carrots, swede and roast potato. However the menu was not on display anywhere that residents could see it and neither they, or the staff knew what was going to be for lunch that day. Staff reported that residents are not actively given a choice each day about what they want to eat. One told us she sometimes take food down to residents that require help with eating only to find out then that they dont like it when it arrives. Care Homes for Older People Page 14 of 26 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have access to a complaints procedure however serious safeguarding concerns are not handled well. Evidence: Each resident has a copy of the homes complaints procedure in their bedroom, giving details of how to raise concerns . One resident told us that she had had a problem with one member of staff. Her relative discussed it with the manager who took it seriously and the problem was addressed. Residents we talked to, although not aware of the homes complaints procedure, felt able to raise concerns and identified the manager as someone they would talk to. Staffs knowledge about safeguarding older people was limited and they struggled to tell us about the different types of abuse an older person can face, local reporting procedures and other agencies involved in protecting vulnerable adults. We viewed the homes policy On Abuse and this was also limited. It did not reflect current legislation, professional codes of practice or local adult protection systems and contained no information about other agencies involved in protecting vulnerable adults and how to contact them. There has been one serious safeguarding incident at the home recently. The homes response to this was inadequate: the registered manager failed to suspend the alleged perpetrator immediately he became aware of it and did not contact the residents family to support them or inform them of what action was being taken. As a result the resident concerned has moved to another home, despite Care Homes for Older People Page 15 of 26 Evidence: having lived at Cedar Court for 7 years Care Homes for Older People Page 16 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a comfortable home with access to a variety of communal space however they are not able to lock their bedroom doors for privacy and security. Evidence: The home is purpose built to meet the needs of older people. All but 3 bedrooms have en suite facilities and two have their own shower. There are additional bathrooms and toilets provided throughout the home. There are 2 sitting rooms, a dining room and a conservatory, giving residents a good choice of communal areas to use. Residents also have access to an attractive courtyard garden. The home was clean and free from strong smells on the day we visited. However we noticed the following shortfalls: the sluice room was full of wheel chairs making it very difficult for staff to access; the conservatory was full of boxes, a mobile hoist and weight skills, making it very cluttered and possibly dangerous for residents trying to mobilise, and the main corridor was very dark making it very difficult for residents with visual impairments to see. One resident told us the light in her room was very poor and she couldnt see to read easily as a result. None of the bedrooms we inspected had keys available for residents so they could lock their doors for their privacy and security. None of the bedrooms had a lockable safe place where residents could store money, valuables or medication. At our inspection of 15/10/009 staff showed us they had a good knowledge of Care Homes for Older People Page 17 of 26 Evidence: practical ways to reduce the risk of cross infection. Despite this however, we have evidence that two residents acquired MRSA whilst resident at the home suggesting that infection control is not as robust as it should be. The manager is aware of this and is currently implementing additional measures to improve the situation. We checked the homes policy regarding infection control which provided only basic information on hand washing, procedures to deal with MRSA and cleaning but contained no guidance for staff on issues such as dealing with blood and body fluids, disposal of sharps, catheterisation, staff immunisation and disposal of waste etc. Care Homes for Older People Page 18 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff at the home are well trained, but there are not always enough on duty to meet residents needs promptly. Evidence: There are 4 or 5 carers and one nurse on each morning, and 3 carers and a nurse on each afternoon, to meet the needs of 23 residents currently. One nurse and one carer are on duty during the night. The home was short staffed on the day we visited. One resident told us that staff were good but that sometimes there werent enough around especially in the morning and that she had suffered a few accidents whilst waiting to be taken to the toilet. Another resident we visited told us she had been waiting over two hours for her morning bath. She commented: its shocking they just keep telling me were coming were coming, I reply Christmas is coming too. You can ring and wait ages for the toilet and then they wonder why the bed is wet. We checked this resident who was lying in a wet bed when we spoke to her. Surveys sent to relatives and residents by the home itself also echoed concerns about staffing levels. Comments written included: there could be more staff and mostly enough staff but not at peak times and not enough staff on at week-ends.We noted that at 11:45 a.m three residents were still in bed waiting to be changed and/or got up. Staff told us they had not had time to attend to them yet. During our inspection of 15/10/09 we checked the training files for 3 members of staff Care Homes for Older People Page 19 of 26 Evidence: which showed us they had received training relevant to their role. Staff we spoke confirmed that they received regular training which they found useful. One member of staff wrote on their survey that: the home keeps staff up to date with all required training so that they can cope with residents care needs better. We checked the personnel files for two recently recruited members of staff which showed that appropriate references and CRB checks had been obtained before they started working at the home. However the manager does not record interviews with prospective employees and without these it was not possible to tell if the interviews were conducted fairly and in line with employment legislation. Care Homes for Older People Page 20 of 26 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. Residents live in a home that is adequately managed but serious concerns about safeguarding and standards of care are not always responded to appropriately. Evidence: The manager of the home is a registered nurse and has experience of both owning and managing homes for older people. However concerns have been raised at recent adult protection strategy meetings about his failure to respond appropriately to serious safeguarding issues and the quality of actions plans he has submitted to address highlighted shortfalls in the quality of care to residents at the home. At our last key inspection of 18/12/2007 we made a requirement that all staff must receive regular supervision. When we visited again on 15/10/09 we found that some night nurses had not received any supervision of their working practices and we sent the manager a warning letter about this. During this inspection there was evidence that all staff were now receiving regular supervision which they reported they found useful and that they felt supported by the management team. We will not take further Care Homes for Older People Page 21 of 26 Evidence: enforcement action as a result. At our inspection of 15/10/09 we found that the manager had failed to inform us of significant events affecting the well being of residents at the home: we made a requirement about this. It was not possible to assess if this had been met on this occasion as no notifiable events have occurred at the home since then. We will continue to monitor compliance with this requirement. The manager does send out surveys to residents and their relatives to get feedback about the quality of the service. We viewed some of these and, on the whole, respondents were happy with the service they received. However, they did raise concerns about poor staffing levels, bedroom decor and expressed a desire to see more of the manager. There was no evidence to show what action the manager had undertaken to address these concerns. One resident told us she had completed a survey but had never been told of the results. We viewed records in relation to health and safety matters including fire alarm and emergency lighting testing, portable appliance testing, and water temperature checks which showed us that the home regularly checks these things to ensure their effective operation. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 38 37 You must inform us of any events affecting the well being of residents You must do this so we can monitor incidents 01/12/2009 Care Homes for Older People Page 23 of 26 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 8 12 Residents fluid charts must be added up daily. You must do this to ensure they receive an adequate daily intake of fluid. 21/01/2010 2 18 13 The homes adult protection policy must be expanded and updated to reflect local adult protection arrangements. You must do this so residents are protected. 21/01/2010 3 18 13 You must ensure that staff have a good understanding of the adult protection systems in their local area and the part they play should the need arise. You must do this so that residents are protected 21/01/2010 4 24 23 You must ensure residents are able to lock their bedroom doors. 22/02/2010 Care Homes for Older People Page 24 of 26 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 You must do this to ensure residents privacy and security is maintained 5 27 18 You must ensure there are enough staff on duty to meet residents needs. You must do this to ensure there are enough staff on duty to meet residents needs in a timely manner. 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 21/01/2010 1 7 Care plans should be much more person centred and actively reflect residents individual experiences, and likes and dislikes Residents should be given a genuine choice in what they eat each day. All areas of the home should be kept free from clutter so that residents can mobilise safely. Notes from all interview with prospective employees should be kept to show they have been recruited fairly and in line with employment legislation. 2 3 4 15 19 29 Care Homes for Older People Page 25 of 26 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. Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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!