Inspection on 09/10/08 for Culworth House Nursing Home

This inspection was carried out on 9th October 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Culworth House Nursing Home 19/10/06

Culworth House Nursing Home 22/11/05

Culworth House Nursing Home 12/05/05

Culworth House Nursing Home 25/10/04

Culworth House Nursing Home 29/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 16/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Culworth House Nursing Home Queens Street Culworth Banbury Oxfordshire OX17 2AT     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: Louise Trainor     Date: 0 9 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Culworth House Nursing Home Queens Street Culworth Banbury Oxfordshire OX17 2AT 08453455744 01295768201 martha.cromhout@blanchworth.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Martha Aletta Cromhout Type of registration: Number of places registered: Culworth House Partnership care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: A maximum of 35 residents may be accommodated in the home at any one time. No more residents in the category of OP may be admitted to the home when there are already 35 residents in this category accommodated. No more residents in the category of PD(E) may be admitted to the home when there are already 35 residents in this category accommodated. Date of last inspection Brief description of the care home The Home is situated in 4 acres of secluded gardens in the centre of a rural village. It provides accommodation for up to 35 elderly residents. The accommodation is provided in mainly single rooms with two companion rooms available for those who wish to share. It provides 24 hour nursing and personal care. Care Homes for Older People Page 4 of 28 Over 65 35 35 0 0 Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out in accordance with the Commission for Social Care Inspections (CSCI) policy and methodologies, which require review of the key standards for the provision of a care home for older people that takes account of service users views and information received about the service since the last inspection. Evidence used and judgements made within the main body of the report include information from this visit. This was the first Key Inspection for this year for this service. Regulatory Inspectors Mrs Louise Trainor and Mrs Sally Snelson carried it out on the 9th of October 2008 between the hours of 08:00 and 13:30 hours. Care Homes for Older People Page 6 of 28 The home Manager was present throughout the visit to assist with any required information. Verbal feedback was given periodically throughout the inspection and at the end of the visit. During the inspection the care of three people who use this service were case tracked. This included a recent admission to the home. This involved reading their records and comparing what was documented to the care that was being provided. Documentation relating to: staff recruitment, training and supervision and medication administration, complaints, quality assurance and health and safety in the home were also examined. We also spent some time in the communal areas of the home, talking to staff and residents and observing the care practices, including the service of the midday meal, that were carried out during this five and a half hour inspection hour inspection. Fees in this home range from 427.74 - 700.00 per week, depending on the facilities and service required by the individual. We would like to thank everyone involved for their support and assistance during this visit to the home. What the care home does well: What has improved since the last inspection? There is a new fire policy in place in this home. This is a very detailed document which Care Homes for Older People Page 8 of 28 includes a mobility assessment/ report for all residents, which is on hand for evacuation purposes. This is updated weekly by the manager. Staff are still working long hours, however the manager is monitoring this, and ensures that staff take adequate breaks during each shift. 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 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home understands the importance of having enough information when choosing a care home. Admissions are not made until a full assessments of needs has been completed, so that prospective residents and their representatives can be sure their needs will be met. Evidence: During this inspection we viewed the personal files of three people who were living in this home. The two more recent admissions had pre admission assessments in place. One had been an emergency admission following the closure of another home. This had been completed as well as practicably possible under the hurried circumstances. The second was well detailed and identified the individuals needs and the level of care required. Care Homes for Older People Page 11 of 28 Evidence: The Information documents for this service are held electronically and updated on a regular basis. The manager explained that most initial enquiries are made to the Blanchworth Care head office via the free phone number. An information pack is then sent out. Prospective residents and their families are encouraged to visit the home prior to any admissions being arranged. They are also encouraged to visit the companys website in order to gain as much information as possible about the home and the services provided. All documentation relating to both staff and residents in this home is held on a sophisticated data system electronically that is password protected. During this inspection we were able to view copies of residents contracts. The were clearly signed and dated, and included detailed information relating to fees, terms and conditions. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home has an efficient medication policy supported by procedures and practice guidance, which is reflected in the medication records. Individual care plans are explicit and precise in detail so that continuity of care is maintained for these residents. Evidence: During this inspection we tracked the care of three people who live in this home. The service had recently introduced new care planning documentation that moved the reader from the care plans to the associated risk assessments for each of the activities of daily living. The care plan documents were well organised divided by different colour sheets. 1 for admission and discharge, 2 for care planning, 3 for care plans and 4 for Records. Care plans had been written in explicit detail and ensure that the reader was clear about how to provide the required care. Each plan identified the problem, the objectives, the goal and the action. For example, a plan for eating an drinking Care Homes for Older People Page 13 of 28 Evidence: identified the problem as weight loss and deydration due to refusal to eat and drink at times due to paranoid feelings. Also refusal to be weighed. The objective was for this individual to maintain weight, their appetite to improve and then consequently their weight to increase. The actions outlined how to offer the food, how to present the food, how to point out where food was on the table, when to involve the GP how to make the food more calorific, and how to involve the family. Throughout the documentation we noted that all the ways identified how been tried and documented incluing the GP prescibing food supplements. The care plans were kept under review, and it was apparant that as care needs changed the care plans were altered. When this was necessary, the alteration was dated and signed. In two of the three plans we looked at the family had also signed them indicating their involvement and agreement. The care plans written for one resident covered areas such as safe enviroment, allergies, communication, eating and drinking, personal hygeine, mobility, self-esteem. sleeping, continence, pain control with medication when required, and every resident had a personal emergency evauation plan. Also in the care files were records of calls made to family members and GP visits, and a section where the unqualified care staff could record their observations and interactions. There was a care plan checklist which the manager used for auditing purposes. The home had a good relationship with the local GP and most of the residents were seen at least monthly. More often if there was a problem. There were a number of residents with wound care in progress, many of which were clearly identified as improving and healing. During a tour of the building we noted a variety of different pressure relieving equipment on peoples beds and chairs. A private chiropodist visited regularly, and on the day of the inspection an audiologist was visiting, to carry out hearing tests and advise on new aids where necessary. Staff ensured that people attended medical appointments and would escort them if necessary. A falls co-ordinator had been asked to visit when it was noted that one person was having a number of falls. She had suggested hip protectors and a possible change of medication. We noted that people were wearing their own clothes and looked clean and smart. Even those that had chosen to stay in their room, or in bed were dressed appropriately. People were spoken to in a polite and respectful manner by the staff, and the interaction between the staff and the residents was a pleasure to observe. One resident told us. It is nice here, people are so kind and They all look after me so well. It is nice to look at the garden and know I do not have to worry about it Care Homes for Older People Page 14 of 28 Evidence: The Medication Administration Record (MAR) sheets were examined. Signatures and administration codes had been recorded appropriately, and variable doses identified when given. Generally reconciliation was accurate with the exception of one or two stocks that had not been carried forward from the previous month. This was normally the role of the manager, and had not been carried out thoroughly whilst she had been on leave. She showed us the book where this is generally documented. There was a clear procedure in place to ensure that accurate reconciliation was possible. Controlled Drugs were checked. They were appropriately stored, and records accurately completed. Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents in this home are involved in meaningful daily activities and have the opportunity to join in local community events. People are encouraged to make personal choices about their lives. Evidence: This home has a monthly activity programme in place, and it includes activities related to religious and cultural festivals. We saw the October schedule which identified activities relating to Halloween, Diwalli and the Hindu New Year. The layout of the home allows for people to spend time in their bedroom, in the large lounge, in a smaller lounge, in the conservatory or in the library. Therefore people could met with relatives and visitors in private or join in with more communal activities. One of the care staff is employed to do activity work from 10:00 - 16:00 hours three days a week, and all the other staff are involve on a daily basis, with groups such as armchair aerobics, baking, music and other pass times. The residents had recently had an ale tasting afternoon that had been thoroughly enjoyed by all those that participated. The home also organise trips for the residents to go out to tea rooms, on country drives and shopping trips. There are some activities which involve outside Care Homes for Older People Page 16 of 28 Evidence: entertainers and clothes shows. These are very popular and families are invited to attend and join in. One of the clothes providers, also donates 10 of her sales back into the homes activity fund, enabling them to purchase further equipment or arrange other activities. This home has an eight week menu plan which is produced at Head Office, however this is flexible and can be adjusted to meet individuals needs. The menus were varied and nutritious. On the day of this inspection there was a choice of Coq Au Vin, sausages, fresh vegetables and potatoes, followed by fruit crumble. The daily menu was displayed in dining room. Meals were well presented and any help with eating was offered discreetly. Various drinks were frequently offered throughout the day, and fresh fruit and homebaked cakes are offered with the mid afternoon drink. We observed the manager offering visitors the chance to join their loved one for meal if they wished. The cook who has worked in the home for many years told us that choices are offered each morning for the day ahead, she explained that for those who have cognitive impairment, choices are offered visually as the meal is served. She told us that breakfast is generally porridge, cereals, toast or sandwiches, although a cooked alternative is always available. One or two of the residents enjoy an egg on toast now and again. The home has well stocked cupboards and freezers, and has a twice weekly delivery of fresh vegetables, and a fresh milk delivery every other day. Contents of the fridge had been dated on opening, and temperature records and cleaning schedules were completed indicating that health and safety is addressed and promoted in this home. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure is supplied to everyone living in the home. Staff working at the home understand the procedures for safeguarding, and know when incidents need to be reported externally. Evidence: There is a clear complaints policy in this home. It gives clear timescales of expected responses, and it details contact information for other authorities such as the Commission for Social Care Inspection (CSCI), so that complainants know what to do if they are not satisfied with the way a complaint is managed by the home. Formal complaints are generally managed by the Director of Care at the companys head office. Where investigations are necessary, the related documents are scanned onto the electronic system, where they can be viewed by those with authority to do so. The home has provided us with a password so that we can access this system as and when required. There is a safegurading policy in place, which was reviewed last year. As with complaints, safeguarding referrals are also managed at the Blanchworth Care head office. However we were confident through discussions with the manager that she had a clear uderstanding of what initial steps she should take to safeguard residents should allegations be recieved in the home. Care Homes for Older People Page 18 of 28 Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home provides a clean, and comfortable environment for the people who live here, however some areas would benefit from decorating. Evidence: During this inspection we toured the premises both inside and out. The home was very clean and free from offensive odours. The manager told us that there was a continuous problem in one or two particular areas of the home, caused by the behaviour of one resident relating to continence issues. This is being addressed by the replacement of some carpets. We spoke to the cleaner who had worked at the home 21 years, she told us. I really love my job. Generally the home was in need of some redecoration, bathrooms were bland and in need of updating, however they were clean. There are three bedrooms with en suite showers in the home, and at present this suits the needs of the residents, however this could become problematic if other residents wished to shower rather than bathe and are unable to access these personal areas. Individual rooms are decorated to personal taste and residents are encouraged to furnish their rooms with personal photographs, furniture and ornaments to make it more homely. Generally the communal areas of the home are in need of some decoration, and although they provide a homely environment, because of all the changing levels in the home, it is not particularly suitable for people with physical Care Homes for Older People Page 20 of 28 Evidence: disabilities or dementia. There is a large laundry depatment in this home, which was well organised and appropriately equiped to manage all of the homes laundry needs. The large surrounding gardens are beautifully kept. They are mainly laid to lawn with mature trees and shrubs dividing the garden into smaller secluded areas where residents can relax with visitors more privately. One resident said. It is nice to look at the garden and know I do not have to worry about it. However it would benefit from a pathway that would allow full access for wheelchair users. There is a fish pond in the garden, and one resident had bought gold fish in from her pond at home. She enjoys being able to spend time, watching the fish, as she did at home. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This service recognizes the importance of staff training, and there are sufficient competent and experienced staff to meet the needs of the people who live here. Evidence: This company has a sophisticated electronic data system, which stores all the information relating to staff and residents in this home. This is password protected. We viewed the personal electronic files of three members of staff in this home. All had fully completed application forms including evidence of work history, and proof of identification in the form of passports, birth certificates and other documents, these included home office documents where necessary. Criminal Records Bureau checks, references and Nurse Personal Identification Numbers were all available with check dates.Staffing levels in this home are good with six staff on an am shift, five staff on a pm shift and three on duty at night. These numbers included at least one qualified nurse each shift and ancilliary staff are additional to care staff. Staff that we spoke to indicated that they felt generally well supported. One said. It is a good organisation to work for, you feel included. Staff meetings are held every three months and additional but short meetings are arranged if urgent information needs to be passed on to staff. For example when another local home closed unexpectedly, several residents were admitted to Culworth House, all at once and at short notice. Care Homes for Older People Page 22 of 28 Evidence: We observed the staff to be competent, confident and comfortable in their roles, and interactions with the residents were very positive. There is a training matrix in place which allows the manager to do a monthly review of all the staff training needs, both for mandatory training and other subjects such as wound care and dementia practices. The system flags up reminders for those due to do refresher courses and highlights any one who fails to attend. This programme runs on a continuous basis. Certificates appears in the electronic files for each staff. One member of staff told us. There is so much training, sometimes too much. Previously there had been concerns raised relating to the excessive hours being worked by some staff. We looked at the rota for August 2008, and it indicates that this practice is ongoing in the home. We discussed this matter with the manager who told us, that many of the staff are from overseas and do not have families in this country, some of them live on the premises, therefore they see Culworth House as their home and enjoy spending time with the residents and their families. The manager demonstrated her awareness of the problem, and felt that she was able to observe and control the situation with them working in the home rather than them working extra hours elsewhere for an agency. We are confident that she is managing the situation at present. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager demonstrates a clear understanding of the key principles and focus of this service. She is enthusiastic and is striving to make continuous improvements to promote the health, safety and welfare of the residents who live in this home. Evidence: The manager of this home has been working here for approvimately six years. She is very committed to this home and clearly has a passion for her job. From this inspection it was very evident that she is very focused on an individual approach to care and individual’s choices and preferences are a priority in care delivery, and also involving residents and their families in the planning of their care. Supervision records were examined, and indicated that staff are receiving regular 1:1 sessions of supervision, and annual appraisals with their line manager. Health and safety records showed that fire alarm call point tests are done weekly. Since the last inspection a new fire policy has been developed. This is a very detailed Care Homes for Older People Page 24 of 28 Evidence: document which has been passes by the fire inspection service. This includes a mobility assesment/report for each resident which is attached to the fire panel, and at hand in case of evacuation. Emergency lighting is checked monthly, fridge temperatures daily, and water temperature checks are done in every area every month. We did however noticed that some water temperarures were being recorded as high as 64 degrees. The manager advised us that this has being addressed with head office, a new boiler has been fitted however new thermostats are still required. Accidents and incidents are being recorded and reported appropriately. As an incident occurs, a form is completed in the home by the manager and then forwarded to head office, who send the required regulation 37 form as required. These are audited regularly to identify any trends in falls within the home. Most of the residents in this home have a small amount of money kept in the homes safe. We viewed the account records and funds remaining for five residents. These all balanced correctly and all transactions were signed by two staff members. The company monitors quality assurance, and a report is produced to identify areas requiring change. The report we saw identified that 94 were satisfieds with care the care they recieved. This is up from previous year, however only 55 were satisfied with the environement, which was down on the previous year. Care Homes for Older People Page 25 of 28 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 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 38 13 The registered person must ensure that unnecessary risks to health and safety of residents are identified and eliminated wherever possible. People who live in this home must be protected by appropriate action being taken to ensure that water temperatures are within safe guidance temperatures. 28/11/2008 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 2 19 20 The home should consider a timescale for redecorating. The home should consider making all areas of the garden wheelchair friendly. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!