Inspection on 06/01/09 for Dorrington House (Wells)

This inspection was carried out on 6th January 2009.

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

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

Other inspections for this house

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Dorrington House (Wells) Westfield Avenue Wells-Next-The-Sea Norfolk NR23 1BY     The quality rating for this care home is:   one star adequate 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: Kim Patience     Date: 0 6 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Dorrington House (Wells) Wells-Next-The-Sea Westfield Avenue Norfolk NR23 1BY 01328710861/710178 01328713088 steve.dorrin@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Steve Dorrington,Mrs Lorraine Dorrington Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 38 Number of places (if applicable): Under 65 Over 65 0 38 dementia old age, not falling within any other category Additional conditions: 38 0 The maximum number of service users who can be accommodated is 38 The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Dorrington House, Wells is the newest of Mr and Mrs Dorringtons homes having been registered in May 2008. It is situated close to the town centre and within easy walking distance to Wells harbour which is a very popular seaside resort. It is registered to provide care for 38 older people and older people with dementia type illnesses. The accommodation comprises all single en-suite bedrooms, ranging in size from 13.6 sq Care Homes for Older People Page 4 of 27 Brief description of the care home metres to 23 sq m. Some of the bedrooms enjoy spectacular views over the surrounding country side and are of good size to have their own sitting/lounge area. There are 4 lounge diners all of which have kitchenettes that can be used by residents and visitors and they can make their own drinks, 4 assisted bathrooms, a shower room, 2 laundries (one of which can be used by residents if they so wish), a hairdressing salon with door to patio area, a dedicated scooter/buggy charging room, 2 treatment rooms, 2 lifts and CCTV on the entrances for security against unwanted intrusion. All areas have an aid call system. The fees range from £400.00 - £566.00 per week. Care Homes for Older People Page 5 of 27 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: one star adequate 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 includes information gathered since the home opened in May 2008. In addition we completed a site visit, which took approximately 9 hours to complete. During the site visit we conducted a tour of the premises and viewed the rooms of some residents. We examined records relating to residents, staff and the service. We also spoke with some residents, relatives and staff. The service provided us with an annual Quality Assurance Assessment as requested and some of the information given has been used in this report. Care Homes for Older People Page 6 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 Care Homes for Older People Page 7 of 27 7535. Care Homes for Older People Page 8 of 27 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 27 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. People wishing to live in the home can expect to have their needs assessed prior to moving in and information about the services and facilities to be supplied. This enables people to make a decision about whether the home is a place they would like to live and that the service can meet their needs. Evidence: The home has policies and procedures in place for the admission of new residents. These include providing people with a brochure pack setting out the service people can expect to receive if they decide to move into the home. Prior to any new resident being admitted a pre admission assessment is completed. We spoke with the relative of one person recently admitted to the home. They said they had an opportunity to visit the home and view the accommodation prior to their relative being admitted. In addition, they said that the home made provision for the spouse to stay in the home for a short period of time to enable their relative to settle in. The relative had been Care Homes for Older People Page 10 of 27 Evidence: asked to provide fairly detailed information about the persons needs so the home could ensure that they provided a service in accordance with the persons lifestyle preferences. The relatives had also been involved with the development of care plans. We looked at the records relating to people recently admitted to the home and found that they contained a copy of the homes mission statement, service users guide, complaints procedure and the terms and conditions of residence. These records were kept in the persons room with the intention they and staff have easy access to all the information held about them. Care Homes for Older People Page 11 of 27 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. People can be assured that their needs will be assessed and set out in a comprehensive plan of care. However, the home needs to ensure these are kept up to date as peoples needs change. The home has a system in place to manage peoples medicines safely but some improvements are needed to ensure the system fully safeguards the health and welfare of residents. Evidence: We looked at the care records for two residents in detail and selected others at random. We also made observations of people going about their daily lives. We found that the care records were well organised and relevant information was easy to access. Care records are kept in peoples rooms so that care assistants have immediate access to the information they need. Residents and relatives also have access to the information that is written and an opportunity to contribute to care planning. Care Homes for Older People Page 12 of 27 Evidence: Care plans were being reviewed regularly and the date of the review was written in the daily care notes so it was difficult to establish that monthly reviews were taking place. The quality and accuracy of the information was variable. Some care plans and associated assessments had not been updated to reflect peoples current needs and some lacked guidance for staff on how to support people with behavioural disturbances. For instance, one person was noted to have a change in health resulting in a poor appetite and some weight loss. The nutritional needs assessment had not been reviewed in light of the change and still stated the person was at low risk. In addition, there were changes in the persons continence needs and the assessment had not been updated to reflect this. For another person, a care plan for mental state said maintain routine and remain calm the action plan said I can become verbally and physically aggressive but did not set out what action staff should take to support the person during these episodes. However, when we looked at other records there were records that accurately set out peoples needs and good detailed action plans in place. We also noted that in some cases risk assessments had not been written for all risks associated with behaviours and hazards in the environment. For instance, one resident was walking in and out of other peoples rooms and there were products such as toiletries and denture cleaning tablets that were easily accessible. Another resident was experiencing behavioural disturbances and records did not state how risk should be minimised at these times. Further progress is needed to ensure that care records contain information about peoples social activities, preferences and hobbies. Some of the records contained limited information in this respect. In addition, in one case the activities participated in were recorded in the daily records and showed the person had assisted in setting tables and clearing up after lunch but nothing more. However, we did observe the person engaged in other activities during the visit. The daily care records contained sufficient information to assess what was happening for people on a daily basis with any significant events occurring. Some of the information had not been used to update care records. Some of the daily care records were not in order where dates did not run consecutively. There appeared to be some confusion about where the next entry should be made and this may result in staff not being aware of recent events or changes in peoples needs. We looked at the way in which the home manages peoples medication. We found that the home had suitable storage facilities for medication by way of a treatment room with internal lockable storage cupboards. The home has lockable trollies for the transportation of medicines around the home. During the visit the treatment room was found to be unlocked and prescribed creams were easily accessible on the table within. In addition, prescribed creams were found in peoples rooms and the home did not Care Homes for Older People Page 13 of 27 Evidence: have suitable secure facilities in rooms for the storage of these medicines. This was raised during the inspection and the home took immediate action to remove the creams and place them in the treatment room. We examined the medication administration record (MAR) charts and found that each resident had a MAR chart in place with an identifying photograph and a pain assessment where necessary. The charts were in reasonable order with no gaps noted. Most of the medicines were supplied by the pharmacy in a 28-day monitored dosage system. These medicines were booked in on the charts also supplied by the pharmacy. However, where medicines were supplied in their original packaging they were not, in all cases, being booked in. Therefore we were unable to audit these medicines effectively.The manager said home has their own system of auditing in place and medicines have also been audited by the PCT pharmacist. Gp reviews are also taking place. It was noted that when medicines were being returned to the pharmacy for destruction they were placed in individual bags with the corresponding residents MAR chart. There was no other system in place for recording what medicines had been received, administered and returned. We raised this with the home during the inspection and they took immediate action to ensure that records in this respect were retained in the home when the medicines were returned and that only copies of the MAR charts would be sent to the pharmacy in the future. We observed the senior care assistant administering medicines at lunchtime. The care assistant was seen to check the MAR charts to ensure that the correct medicine was given, handle the medicines safely and take precautions to ensure the trolley was secured when left unattended. However, we also observed that liquid medicines were given to one resident and the pot containing some of the medicine remained on the table next to where the resident was sitting. This was pointed out to the home owner and another care assistant, not authorised to administer the medicines at that time gave the remaining medicine to the resident on a spoon. During the visit we observed staff to treat residents with respect and kindness. Efforts were made to maintain dignity and people were addressed as individuals. Care Homes for Older People Page 14 of 27 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. People living in the home can be assured that the home will provide them with activity, stimulation and occupation but this may not always be based on peoples previous life experiences. Meals provided are varied and nutritious to meet peoples individual needs and choices. Evidence: As written in the health and personal care section, the quality of the information contained within the social care plans is variable. This appears to be dependant on the level of information given by relatives. Some records contained very little relating to social needs whilst others were detailed. It was difficult to find clear records of activities undertaken and some of the information was contained within the daily care records. During the visit we observed residents and staff engaged in activities, some on a one to one and some group activities. We were told by the home owner that the home has outside entertainers coming into the home and relatives often get involved in sing alongs. In addition, the home has recently organised a friends of Dorrington House group again to increase social contact and activities. The home also has frequent input Care Homes for Older People Page 15 of 27 Evidence: from the churches from various religious denominations. The home has made efforts to place items around the home that will provide stimulation and occupation. For instance, a chest of draws with items within that can be folded or tidied up. There are a range of pictures and photographs in the corridors that may stimulate interest and conversation. Some residents also have access to the laundry facilities so that they can get involved in assisting staff with laundry duties. The mealtime experience was observed. We found that each wing of the home has a lounge/dining room, which is comfortable and homely. The dining room area was nicely set out and conducive with dining. The home employs a fulltime cook and kitchen assistant. The menus appeared varied and offer choice of different food over the week. Alternatives are offered where requested. The cook maintains records of peoples special dietary requirements and dietary intake. The home owner said that the home has been doing some research about meal planning for people with dementia and had recently visited another home to look at best practice. It is intended that further improvements will be made to the meals on offer. The meal for the day was written on a blackboard and some residents referred to it when asked what they were having for dinner. The meal served looked appetising and people appeared to enjoy it. Some residents were able to say they liked the food served. We observed staff supporting people with their meals and this was done in a discrete and sensitive manner. Care Homes for Older People Page 16 of 27 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. People are provided with information about how to make a complaint and can feel assured that they will taken seriously and handled appropriately. Staff are trained in safeguarding and know how vulnerable people should be protected from harm. Evidence: The home has recently up dated policies and procedures in place for handling complaints and information about how people are able to raise concerns and complaints is contained within the residents records stored in bedrooms. The home has received 4 minor complaints that have been handled appropritely in accordance with the complaints procedure. All complaints are investigated by the homes consultant. The Commission has not been informed of any safeguarding concerns since opening in May 2008. All staff are trained in Safeguarding adults. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are provided with an overall good standard of accommodation that has been designed taking the needs of older people and those with dementia into consideration. Some further improvements could be made to risk management. Evidence: This home opened in May 2008 and was purpose built to a high specification. The home is well designed and there are small living areas each with a lounge and dining room. These areas are equipped with a kitchenette so that residents and relatives can make their own drinks. Private accommodation is comfortable and homely. Rooms are in excess of the minimum size and are all ensuite. The larger rooms of 23sqm include their own sitting area where guests can be entertained in private. There are four assisted bathrooms in the home. During the visit it was noted that there were a number of products in peoples rooms, such as denture cleaning tablets and toiletries that could be hazardous if accidently consumed. There were no lockable facilities for safe storage of these items and no risk assessments in place. The home has been furnished with older style furniture to make the surroundings more familiar to people. There are also items of interest to encourage conversation, stimulation and occupation. Some items also help people to find their way around the Care Homes for Older People Page 18 of 27 Evidence: home by acting as signposts, and there is additional signage to assist people to find their way around. There are two laundry rooms one of which is accessible to residents so that they can engage in laundry duties if they wish. On the day of the inspection visit the home was clean and tidy throughout. The appearance of the home is bright and airy with lots of space. Additional care staff are employed to keep the standard of hygiene and cleanliness to a good level and there is a handyman to deal with maintenance tasks. Care Homes for Older People Page 19 of 27 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. People living in the home can be assured their needs will be met by sufficient numbers of trained staff. Evidence: On the day of the site visit we were informed that the home was accommodating 24 residents, 17 of whom have dementia. There were 5 care assistants on duty working a 12 hour shift. In addition, there was an extra member of staff working 7.30 - 2.30 to cover domestic duties and 3 care assistants cover the night shift. A cook and kitchen assistant are employed but the home has had some difficulty in appointing domestic staff so these duties are covered by extra care staff until this is resolved. All care staff have been trained in moving and handling, first aid, medication administration, dementia awareness and care planning. The home was in the process of preparing the training plan for 2009. There are 17 permanent staff employed and 14 of those have completed an NVQ 2 or above. Staff files were examined and found to be in good order. Each member of staff has been provided with an induction training book, which they are working through with an Care Homes for Older People Page 20 of 27 Evidence: assigned mentor or senior member of staff. A programme of staff supervision is in place. Care Homes for Older People Page 21 of 27 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. People can be assured that the service has systems in place to ensure the home managed in a way that promotes the care, health and well being of residents. Evidence: Since the home opened in May 2008 the service has reorganised its management structure so that they have a manager, deputy and four senior staff. A manager has been appointed and will be submitting an application for registration in the near future. The service is still in the process of appointing a deputy manager and once that has been achieved the intention is that the manager and the deputy will work together to ensure that there is always management presence in the home. Monthly managers meetings are held and weekly conference calls. This enables the home owners to monitor the services and to discuss policy and procedure developments to drive improvement. Care Homes for Older People Page 22 of 27 Evidence: There is a quality assurance process in place, however the annual quality assurance audit has not been completed yet. The home owners say this will be completed by the consultant when the home has been operating for a year. The consultant has completed one Regulation 26 visit and will continue to carry out these visits on a monthly basis. The home does not handle any money for residents. There were no significant health and safety issues identified during this visit, however the service needs to ensure that products in peoples rooms are risk assessed and appropriate action is taken to ensure peoples safety. In December 2008 the home reported an incident that compromised the health and safety of a resident. As a result of this, the first hour of the site visit was attended by an officer from the Health and Safety Executive to investigate the matter and to ensure that steps had been taken to prevent the same incident occurring again. The outcome of the discussion was satisfactory and no further action is required in this respect. The home was visited by an Environmental Health Officer in August 2008 and some requirements were made. A follow up visit took place in December 2008 and the majority of the work required had been completed. There was an outstanding issue relating to the examination of the lifts and the home owner provided documentary evidence that arrangements had been made for the lifts to be inspected. The home has a fire safety risk assessment and fire safety procedures in place. Staff have also been trained in fire safety. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 The home must ensure that risks to peoples health and well being are identified and action is taken to ensure risks are minimised or eliminated. So that the health and welfare of residents is safeguarded. 02/03/2009 2 9 13 The home must make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines in the home. So that the health and welfare of residents is safeguarded. 02/03/2009 3 19 13 The service must carryout risk assessments for the products stored in people rooms and take action to reduce or eliminate risks to their safety 02/03/2009 Care Homes for Older People Page 25 of 27 So that the health and welfare of residents is safeguarded. 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 7 It is recommended that staff are provided with guidance on the daily recording system so that they are making records in an orderly manner. It is recommended that the home continues to develop care plans and associated assessments so that they contain relevant, accurate up to date information about peoples holistic needs. It is recommended that the home develops a clearer system by which they can idenitfy when care plan reviews have taken place. It is recommended that the home considers the principles of the Data Protection Act when storing records in residents rooms. It is recommended that the home continues to develop individualised plans to meet peoples social and psychological needs. It is recommended that the home introduces a clear system for recording activities so that they can demonstrate that peoples needs are being met in this respect. It is recommended that the home continues to make efforts to appoint designated domestic staff. 2 7 3 7 4 7 5 12 6 12 7 27 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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!