Inspection on 08/01/09 for Eastry House

This inspection was carried out on 8th January 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Eastry House 29/01/07

Eastry House 13/09/05

Eastry House 16/05/05

Eastry House 27/01/05

Eastry House 26/07/04

Eastry House 20/01/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Eastry House High Street Eastry Sandwich Kent CT13 0HE three star excellent service The quality rating for this care home is: 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: Julie Sumner Date: 0 8 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. They reflect the things that people have said are important to them: 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 Adults (18-65 years) 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. 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. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Eastry House High Street Eastry Sandwich Kent CT13 0HE 01304 613791 01304 612411 rosemarychapman@fchltd.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Family Care Homes Ltd Name of registered manager (if applicable) Miss Rosemary Chapman Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 22 0 care home 22 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 22 The registered person may provide the following category of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Learning disability - LD Date of last inspection 2 9 0 1 2 0 0 9 A bit about the care home Eastry House is a big old house in the centre of Eastry village. Up to 22 people with learning disability live there. People have their own bedrooms and there is 1 shared room. There are slopes and a lift in the home for people with wheelchairs to be able to live there. The home has a minibus. There is a bus stop near the house and buses run regularly through the village. Sandwich train station is a few miles down the road. The village has some shops, a post office and 2 pubs. It costs between £330 and £1600 to live there. 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home We said hello and talked to the people that were in the home. We talked to the staff and the deputy manager and registered manager. We spoke to the GP when he visited. We walked around the home and had a look to see what it is like. We looked at the new care plans. We looked at the medicines and the records. We looked at some of the policies and procedures in the office. Policies are rules about how to do things. Procedures tell people how to follow the rules. What the care home does well People are supported well to make choices and say what they like. What they say is listened to and included in the plans for improvements to the home. People are supported very well with their health and personal care. Staff have had training to help people with their health. This has helped people who have been ill and getting old. There are good records so that other professionals can see how the person is being supported and if they need specialist help. This has helped the GP and epilepsy nurse. The home lets everyone know what is happening. A newsletter called Eastry Matters is given to families and other people who are interested. The home is well organised. People have been involved in choosing what they want in their bedrooms and how they want them to look. Staff have good training. This includes training that has been specially designed to support the needs of the people living in the home. The home is well managed. What has got better from the last inspection New plans are being written with each person. They have simple questions and pictures to help people understand and say how they want to be supported and what is important to them. A lot of the plans have been written in now. Each person also has a health action plan. These are also being filled in with the key worker. If a person needs support with a health condition the staff receive training so that they understand it better. There have been major improvements to the building. The lounge is bigger and lighter. There is a dining room downstairs. Two of the bedrooms have the original windows put back in. The home now has a new kitchen. The home asked people what changes they wanted in the home before anything was done. What the care home could do better The home is being managed very well. The registered manager and deputy manager have listened to the people living in the home and have decided what needs to improve. They have plans to do this. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Julie Sumner The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 moving into the home can be confident that a competent person will assess their needs and that their care and support will be tailored to meet them. Evidence: The statement of purpose and service user guides have been updated so that the format is easier to understand. These were looked at and discussed with the manager. The service user guide can have pictures included. Three people have moved in since the last inspection visit. Two assessments were looked at and there was clear information about the persons needs and wishes. The assessment process has been improved so that the person and their family can be involved in the whole process. Support networks were established to provide all relevant information with the health professions, as there were health needs being presented as well as learning disability needs. Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 service recognises the right of individuals to make their own decisions and supports people in a positive way. Evidence: Each person has a support plan. The format of the plans has been redesigned so that it is person centred and easier to understand. Two plans were looked at and discussed with one of the senior staff. Each person has a key worker. The staff involve the person by talking about their needs and what is important to them in a way that they understand. Some people have written in their plans and signed them. Risk assessments are also included in the plans. These are clearly written with guidelines for staff. Some of the risk assessments have been copied from the previous style plan and are going to be re-written. All information that had been reviewed was in the plan. Some of the information is printed which is done at the head office so there are hand written entries for information to the staff while they are waiting for the printed version to be sent to the home. The staff said they thought the plans are a good design and easy access to the information they need to support each person. One of the staff spoken to had been working in the home for a few days and said he had been reading them as part of his induction. Risk assessments cover all relevant aspects of the peoples lives that actually happen rather than anticipate general accidents. These included activities and support with mobility. There are one-to-one talk times with the person and their key worker. This gives each person the opportunity to say how they want to be supported and what they want to do. People are helped to make decisions about how they want to spend their time, who Evidence: they see and keep in touch with, what they want to eat and when they have baths and get up. There is a reminiscence group where individuals are building life storybooks. There are groups like committees for making decisions in the home and other parts of the homes in Eastry. People living in the home spoke to us and also filled in some surveys for us and their comments indicated that they are well supported to make their needs known and are listened to. Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 people living in the home are able to enjoy a full a stimulating lifestyle with a variety of options to choose from. Evidence: A range of activities are provided and are tailored to individual needs. One to one meetings are held with each persons key worker to talk about what they like and what they want to do. Many of the people in the home are older and there is more emphasis on their health and personal care and less on developing independent skills but people can do this if they want to. The independence that people have achieved is maintained and written into their support plan. There is an arts and crafts area in the home. Some people were in there and there were puzzles and other games that they were participating in with the staff. The companys day centre is near the home in the same grounds. People can participate in drama, arts and crafts, computer and information technology skills, literacy and numeracy and cooking. There is also a sensory room and people can have massage and beauty therapy. Some of these activities are also available in the home. People talked about what they like to do. One person came in from the day centre and talked to us. He said that he had been cooking and that he also goes to the college for literacy and numeracy lessons. He also talked about the pantomime that he had seen the previous evening. He was very positive about his experiences. One person spoke about going to the local tea dance and was looking forward to the next one. Evidence: There is a reminiscence group who meet every week. They have turned part of the garden into a vegetable plot and recently had a good crop. They have had taste and smell sessions where they try out flavours and scents that they may associate with the past like humbugs and lavender. We saw that they are currently compiling life storybooks. Activities are also planned in the evening. People said they like karaoke. They play bingo and also go out to the pub. Some people like to go to their rooms in evening and some watch TV in lounge. Each person is supported to maintain contact with their family and friends. People who are important to them are written in their support plan. Visitors can visit at any reasonable time and do not have to give notice but may need to make sure that the person is in. The home hold events that peoples relatives are invited to. The news magazine Eastry Matters provides all relatives, visitors and interested people up to date with what is happening in both Eastry House and the other Family Care homes nearby. Every six months they have a meeting with the cook and staff about the menus and come up with some different ideas, get rid of the meals they are fed up with or do not like any more and keep the favourite ones. They have tried a picture menu but the manager said there are so many different meals that you needed so many pictures and no one found them very useful. They look at pictures in magazines and cookbooks when they are planning the menu. They have ordered two new cookbooks that they found recently and thought would be useful, a diabetic cookbook and a soft diet cookbook. Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Personal support is responsive to the varied and individual needs and preferences of the people who live in the home. Medicines are handled safely. Evidence: Staff have got to know each person very well and have found out how they like to be supported with their personal care. Routines have been established for them and guidelines have been written for the staff so that everyone is doing the same thing. The manager said this has reduced peoples behaviours and anxiety. The people living in the home are supported to access the local health care facilities. All are registered with a GP in the village. All the people living in the home are registered with a dental department as some people required specialist treatment through the department who specialise for learning disabilities. People attend appointments in the village or local towns but specialists are also available to come to the home for dental, chiropodist and optical care. We saw that the staff have prepared health plans and records. Each person has a health action plan. This includes all the health needs they have and the support they need. People who have epilepsy have an epilepsy survey and chart which gives all relevant information on how the condition presents in the individual so that if they need to go to the GP or epilepsy specialist all the information is there. Staff are given specialist training to support individuals health needs. Bespoke training in Dementia was provided for all staff, as recent changes in some individuals required specialist interventions to best support them. This also gave staff the time to discuss issues on an individual basis. Evidence: A variety of specialist equipment is provided to support each person. These include specialist beds, hoists and standing aids. People are assessed to see if they would be able to manage all or part of their medication themselves. The people who currently live in the home have their medication given to them by staff. One of the senior staff showed us the where the medication is stored and the records for when it is given. She also explained the procedures for how medication is given and checked. The home has a clinical room with a hand wash basin, surfaces and locked cupboards. There is a medication fridge. We saw that the prescriptions, instructions and records are clear and well organised. There is information for the staff about the medication that each person is taking. There is also information about the possible side effects to look out for and what to do. Controlled medication is stored securely. And there is a separate procedure and record for when people are prescribed this. All staff who give medication have had training. And there is a good checking system by staff when giving the medication and this is followed up by the deputy manager. All the medication storage and administration is checked by the registered manager and also by the operations manager during the company monthly monitoring visits. This outcome group has been rated excellent because the registered manager and deputy manager have made sure that each persons needs have been properly assessed and have provided the health care, staff training and support to meet their needs. Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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 . The home has an open culture that allows people to express their views and concerns in a safe and understanding environment. People in the home are protected by the homes policies and procedures. Evidence: The company provides the complaints procedure in various formats to help people with disabilities to use it. A copy of the complaints procedure provided with widget symbols is displayed in the home for all to see. Families are also aware of the procedure and there is reference to it and how to give feedback in the company newsletter. People said they speak to their key worker or manager if they have a problem. Staff said that their key worker supports people with communication difficulties. We saw descriptions of how each person communicates and how to interpret behaviour for individuals is in their care plan folder. Staff said they get to know individuals with communication difficulties and respond to signs, behaviour and facial expressions to gain understanding of what is being communicated to them. We saw that staff are responsive to the people in the home and take time to understand people expressing themselves. The company have reviewed the safeguarding procedures and provided a flow chart of what staff are to do. There is also a new whistle blowing policy for the staff. All the information is kept in a folder and staff know where to find it. Staff said they found this helpful and know who to contact and what to do if they suspect abuse. Safeguarding and POVA training is provided to all staff. 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home is clean and comfortable and suitable for the needs of the people living there. Evidence: We walked around the home with the deputy manager to see what it is like. This is a big old house and the staff are making it as homely as they can. We spoke to some of the people in the home in their bedrooms. Their rooms have been decorated and furnished in the way they like and to suit their needs. One person has adaptations to assist because he cannot see very well. The home has a handy man who used to be a carer so he knows the people who live there. He talks to the people because he knows them and they know him and establishes what they would like in their room and what colour scheme. Then he does it. The home has quite a lot of work done. There is now a dining room downstairs. This leads outside and provides a good place to eat which can extend to outside in the warmer weather. During the day this is also used for activities and during the visit the reminiscence group were having a meeting. The lounge looks much lighter and more spacious since it has been opened up with the divider having been removed. The people living in the home have been involved in the planning of the new areas and said that they were happy with the rooms. The kitchen has also been completely refurbished and looked clean and practical. The bathrooms are next on the plans for refurbishment. The deputy manager explained how she is going to make them more homely while they are waiting for the improvements to be made. Evidence: The staff training certificates are displayed in the corridors up the stairways. This is because there are too many certificates to fit in the office. We talked about this because we did not feel this was very homely. And maybe it would be better for the certificates to go in display folders. The deputy manager agreed to talk about this in the next meeting with the people who live in the home to see what they think. The home has a housekeeping team who keep the home clean and do the laundry. We saw that the home looked clean and well organised. The odours in the home from it being old and the management of incontinence were being kept under control. The staff have worked hard to find appropriate flooring, cleaning equipment and air fresheners to maintain a fresher smelling environment. Staff have attended infection control training and protective equipment is provided. 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 have confidence in the staff that care for and support them. Evidence: The company have a recruitment procedure, which includes all safety and identity checks required by law for care homes. New staff have induction training that includes the Skills for Care common induction standards. One of the new staff was having their induction training at the time of the visit and another new staff was also working at that time. They both spoke to us about their experience so far. One staff said he had worked in one of the other homes in the company but had still had another induction at Eastry House because the training is tailored to each home. He said he was enjoying his work. Staff do not work alone and unsupervised until their criminal records bureau check has been processed and they have had essential training for health and safety. A good range of training is provided by the company. We looked at the training records and discussed them with the manager. All essential training for the health and safety of the people living in the home and the staff working in the home is provided. More than half of the staff team have achieved the national vocational qualification. Staff have recently attended person centred planning training, hearing impairment and learning disability and a course in dementia that was designed specifically for the people living in Eastry House. Staff talked about their roles in the home. We saw that there are enough staff to support the people in the home and so that people can do different things. We saw that staff are motivated and there is a good community spirit in the home. Staff meetings are held for discussion about how to improve the service and what is going well. Staff have supervision by the deputy manager to discuss their personal development and work. We had a discussion with the deputy manager about staff appraisals because the company do not currently use these. The deputy agreed that Evidence: she would consider this as part of the supervision process to round it up at the end of a year cycle and discuss it in one of the staff meetings. Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The manager and deputy manager are able to describe a clear vision of the home and a clear sense of direction. They have good people skills and understand the importance of person centred care and effective outcomes for the people who use the service. Evidence: Eastry House is one of a group of 5 homes on the same site overseen by the same registered manager. The manager is registered with the commission and has the skills and experience to run the home. Eastry House has a deputy manager who is based in the home and carries out the management of the home under the direction of the registered manager. The deputy manager has also completed management training and has the skills and experience to run the home. Both the deputy manager and the registered manager participated in the visit as part of the inspection. The company have been developing their quality assurance monitoring systems. The home have surveys that are sent out to people who are involved in the service including relatives and other professionals. The manager showed us the quality monitoring file. Since the last inspection visit, a operations manager has been employed and she oversees the management of the homes within the company. The operations manager visits the home and carries out the monitoring visits that are required by law. There have been major improvements to the environment with further improvements planned. The managers and team are responsive to the changing needs of people living in the home and have provided specific training for the staff to meet these needs. They have also recognised that the majority of the people living in the home are getting older. Their predominant needs are of those associated with old age rather Evidence: than learning disability. In response to this the managers have made sure there are good links with community health care services, appropriate equipment available and staff are provided with appropriate training. We saw that there are clear records in the home that are easy to find in the office. The staff know where the policy file is to refer to when needed. The home has risk assessments for the building and working practicies. Staff receive necessary training for the health and safety of the people living in the home and working in the home. Records are kept for precautions regarding fire safety and for environmental health. The last environmental health report was positive about the new kitchen refurbishment. This outcome group has been rated excellent because the registered manager and deputy manager have made sure that each persons needs have been properly assessed and have provided the health care, equipment, activities and support to meet their needs. They have also demonstrated that they are committed to reviewing and improving the service provided to the people living in the home. Are there any outstanding requirements from the last inspection? Yes  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 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 Description 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 Description Timescale for action 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 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web:www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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