Inspection on 17/12/08 for Elmbank Residential Care Home

This inspection was carried out on 17th December 2008.

CSCI found this care home to be providing an Good 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

Elmbank Residential Care Home 04/12/07

Elmbank Residential Care Home 23/10/06

Elmbank Residential Care Home 20/04/06

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Elmbank Residential Care Home Elmbank Woodham Road Woking Surrey GU21 4EN     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: Mavis Clahar     Date: 1 7 1 2 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 24 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Elmbank Residential Care Home Woodham Road Elmbank Woking Surrey GU21 4EN 01483765984 02085783890 elmb4nk@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Elmbank Residential Care Home Ltd care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Elmbank is a detached property in a residential area of Woking. One of the proprietors is also the registered manager and operates the business with an employed staff team. The home provides 24-hour care and accommodation for 14 older people, up to four of whom may have dementia. Twelve of the bedrooms are single and one is used as a double room. There are no en suite facilities but each room has a hand basin. There is a communal lounge, conservatory and dining room. The home has its own garden which is accessed from inside the home. There is car parking to the front of the home and in the side road. 0 0 Over 65 4 14 Care Homes for Older People Page 4 of 24 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: The last Key Inspection was carried out on 4th December 2007. Fees are in the range of three hundred and ninety five pounds to four hundred and twenty pounds per week and does not cover the cost of hairdressing, chiropody, dry cleaning, taxi service,newspapers and personal toiletries. This unannounced site visit, which forms part of the key inspection undertaken by the Commission for Social Care Inspection, (CSCI) was completed by Mrs Mavis Clahar on 17th December 2008and lasted for six hours , commencing at 09:05 hours and concluding at 15:20 hours. Both the manager of the home and the deputy manager assisted in the inspection. Care Homes for Older People Page 5 of 24 The first part of the visit was spent with the manager and deputy manager of the home, discussing and agreeing how the inspection process would be conducted. This was followed by discussion about the Annual Quality Assurance Assessment (AQAA) she submitted to CSCI, the training needs of the care workers and how these needs were being identified and met, and employment and induction of new care staff. A review of the requirements given at the last inspection was undertaken and these were all completed within the agreed time scale. A random sample of service users files and care workers records was undertaken and all found to be in good order. The second part of the visit was spent reviewing selected residents care plans, which were up to date and sampling selected policies and procedures. This was followed by a tour of the home, and it was observed that service users bedrooms were kept in very good condition, both decorative and clean and tidy. The bedrooms are attractively presented. Generally, the home presents as clean and tidy. The information contained in this report is gathered from service users notes and records kept by the home, from information contained in the AQAA, from relatives and service users feedback in the pre inspection questionnaires and from discussions with residents. Information was also gathered from direct observation by the inspector, along with discussions with care workers. The third part of the inspection was spent visiting and discussing with rservice users and observing lunchtime activities. Service users were enthusiastic about their home and the service they receive. Service users spoken to said they enjoyed their lunch, which was prepared freshly in the homes kitchen. Time was spent observing the presentation of the meal, care workers and residents interactions and to obtain feedback on the meal, its suitability, taste, texture and amount. The inspector observed that portions were varied to suit the appetite of the service users and that they all ate their meal in a very social gathering, all sitting at tables which were laid for four, or two. Service users commented positively on their meal, and the food served at the home in general. CSCI (we) would like to thank all the residents and care staff who made the visit so productive and pleasant on the day. The final part of the visit was spent giving feedback to the manager and deputy manager about the findings of the visit. 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.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 7 of 24 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 8 of 24 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. Prospective service users and their relatives have the information needed to choose a home, which will meet their needs Evidence: A random selection of service users files were reviewed and it was noted that service users received a needs assessment prior to moving into the home to ensure the home is able to meet their identified needs. This initial assessment is carried out by social services and the home receives a copy of the care plan, following which the registered manager conducts her own assessment of the service user to ensure the home is able to meet the identified needs. For all privately fee paying service users the manager completes a similar assessment followed by a health needs assessment completed by an outside health care professional. Health needs assessments are carried out by social services on all other service users in the home. We were told wherever possible the home encourages and enable prospective service users to spend time at the home Care Homes for Older People Page 9 of 24 Evidence: before making a decision to move in. Furthermore, the first four weeks is used as a trial period for both new service users and the older service users, to ensure the new service user is comfortable on all counts in the home. It was also noted that service users are given a contract of residency, and this contract is signed either by the service user or their representative.This was verified in discussion with the service users. Standard 6 does not apply to this home. Care Homes for Older People Page 10 of 24 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. The home has a good and clear care plan in place for residents, which also includes appropriate risks assessments. This forms the basis for care based on the agreed care needs of the service users and demonstrated that health and personal care needs were met.Care staff receives training to meet the assessed care needs of the residents ensuring that competent staff supports residents and their health and care needs are met.The homes medication policy on receiving, storing and administering and return of medication was in place and being adhered to thereby ensuring the safety and protection of the residents.Residents are treated with respect and are encouraged to maintain their dignity and privacy when receiving personal care. Evidence: The randomly selected care plans were clear and easy to read, identifying potential and actual risks to service users, with risk assessments completed as required. The Annual Quality Assurance Assessment (AQAA) informs care plans are reviewed on a regular basis and residents and or their families sign the care plans to demonstrate their participation and agreement with the plan of care. This was supported by the Care Homes for Older People Page 11 of 24 Evidence: review of the care plans, in discussion with care workers and with the manager. Review of the daily work sheet along with discussion with service users demonstrated that service users care needs are fully met. Care Plans reviewed demonstrated that residents care needs are identified and are being met.Service users spoken to, rated the personal care they receive at the home as very good; they said they are contented; they had contact with their General Practitioner (GP) once a fortnight and more often if required. They told us they also have the District Nurses and the chiropodist come to see them on a regular basis. Opticians and Dental care are also available for them to use in the home or for those who wish still keep their own Optician and Dentist.No service user at the time of inspection was responsible for his or her medication. We were shown a sample of risk assessment for service users who wish to self-administer. It was noted that both the service user and their General Practitioner (GP) are requested to sign these risk assessments. The manager told us that any service user who wishes to self-administer their medication can change their mind at any time and the staff will administer their medication to them. Good clear records are kept of medication receipts, storage, and administration and returned. There is a list of staff trained and assessed as competent to administer medication and this is kept on the medication trolley at the front of the medication charts. In discussion with care workers assessed as competent to administer medication it was evident they were working within the homes policy and procedure on administration of medicines, which include using the Medication Administration Record (MAR) Sheet.We spoke with five service users, and they told us the staff treated them very well. One service user said, the staff are so kind. They will come to you at the drop of a hat. Care workers were observed interacting with service users in a friendly but respectful manner. Care Homes for Older People Page 12 of 24 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. Service users lifestyles matched their needs and preferences and where possible they are able to maintain contact with family, friends and the local community.Service users are able to make choices in accordance with their abilities and were provided with a balanced diet in pleasant surroundings and in an unhurried way. Evidence: Service users spoken to say they were able to go to bed and get up when they choose, take part in activities as they wished and consulted on how they would like to spend their time. This statement was supported by the deputy manager in discussion and from comments made to us in the Pre Inspection Questionnaires residents completed prior to the inspection of the home. The Annual Quality Assurance Assessment (AQAA) stated the home has employed an Activity Coordinator and that social activities are ongoing. On the day of the visit a local choir was visiting singing Christmas Carols with the service users in the afternoon. We were told that following having initially ascertained the interests and preferences of both male and female service users, a programme of regular weekly activities of broad appeals (topical quizzes and competitions and games for mental stimulation) was designed to suit the individual service user. Random review of service users activities records supported these Care Homes for Older People Page 13 of 24 Evidence: statements.During the tour of the home we were shown where they intend to place the wide flat screen TV that will be more suitable for film shows.We were told the service users have monthly Holy Communion offered by the Church of England Vicar and they have access to the Roman Catholic Priest as well. We were told service users who wish to continue to worship at their previous place of worship are encouraged and enabled to do so and service users who are not of the Christian faith would be provided with opportunities to practise their faith both inside and outside of the home. Pre inspection questionnaire received by CSCI indicated that both service users and relatives are contented with the care offered by the home. No visitor to the home on the day of the inspection wished to speak with the Inspector. Service users told us their relatives and friends are able to visit when they wished, and the number of visitors to the home evidenced this on the day of the inspection as seen in the visitors book. They further told us they are treated with respect and they have their privacy respected and maintained at all times. In discussion with service users, five in total, it was clear that not all of them were capable to be involved in the running of the home; those who had capacity were motivated and involved and were in control of their lives . However they all had choices which they exercised. We randomly chose these service users to speak with on the day of the visit. On the day of inspection service users were observed enjoying their food. The menu is four weeks rotating, and review of service users personal folders revealed monthly nutrition screening is carried out with appropriate actions taken. Catering facilities are managed and carried out by a Cook employed by the home. In discussion with service users we were told that the food is good, and in discussion with the Cook, it was apparent she had a good knowledge of the dietary needs of the service users. The inspector did not sample the meals, but the service users spoken to all said the food is good, the texture just right and the amount was what they ordered. Care Homes for Older People Page 14 of 24 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 home has a satisfactory complaints policy and procedure and training in place that evidenced that residents and relatives concerns are listened to and acted upon.Robust Safeguarding adults policies are in place to protect the service users from abuse. Evidence: The home has a complaint policy, which outlines the processes the home undertakes to respond to complaints received. There was no complaint logged in the complaints book since the last key inspection. CSCI have not received any complaints about the home. The deputy manager told us issues raised are dealt with instantly before they spiral into a complaint. Both service users and their relatives in their reply to the complaints question in the Pre inspection questionnaire said they knew how to complain but have not had any reason to do so. There are a number of thank you notes and letters of appreciation from grateful relatives to the whole staff team praising their work with their relatives.All staff as evidenced in the training record and substantiated in discussion with care staff, has completed the Safeguarding Adults Course, which is based on the local authority (Surrey multi-agency Policy). In discussion with care workers they were knowledgeable about whistle blowing procedures of the home, how to report an accident or incident occurring in the home. Care Homes for Older People Page 15 of 24 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. The physical design and layout of the home enables service users to live in a safe, well- maintained and comfortable environment, which encourages independence, and protect their privacy and dignity. Evidence: The management and staff encourage service users to see the home as their own home. It presents as a comfortable, attractive home, which has all the specialist adaptations, needed to meet the service users needs. We were told the home had installed a new call bell system and we observed that call bells were left within reach of each service user and service users asked, said the bells are answered promptly. The home has a very small attractive garden, which appears well maintained and there is good access to the garden from the home. Some service users told the inspectors that they try to go out to the garden daily in the summer, but not now when the weather is not so good. We observed that service users were able to personalise their bedrooms with small items of furniture, paintings on the wall and many family photographs. Generally the home has undergone massive refurbishment to include new carpets and redecoration of bedrooms and this is still occurring. Generally, the home presents as clean, safe, pleasant, hygienic and tidy and free from offencive odours. We were told that intensive one to one care for specific service users with urinary incontinence has enabled the home to maintain fresh and pleasant Care Homes for Older People Page 16 of 24 Evidence: surroundings free from any offencive odours. Random review of care workers training record demonstrated they have had training in infection control and this was evident in the storage of waste. The AQAA informs the home is kept clean, hygienic and free from offencive odours, and systems are in place to control the spread of infection. Laundry facilities are provided and designed to ensure that soiled articles are not taken through areas where food is prepared and served. Care Homes for Older People Page 17 of 24 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. Staff in the home are trained, skilled and in sufficient numbers to fulfil the aims of the home and meet the changing needs of the service users. Evidence: The staff rota demonstrated the number and grade of staff on duty to provide care and attention to service users for any twenty-four period was sufficient to meet the assessed care needs of the service users. Review of training records indicated all staff assessed as capable to administer medication has undertaken the medicine training. Care workers have undertaken training and updating in Manual Handling, Dementia care, principles of care and all staff files sampled contained record of having undertaken a period of induction during the first three months of appointment. Random review of care workers files indicated that the home complied with the regulation regarding employment of staff to work in the care home. The records contained evidence that care workers attended all training offered. Recruitment to the home is through a process of equal opportunity and in accordance with the code of conduct and practise set by the General Social Care Council (GSCC). Staff records sampled indicated all staff has Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) checked prior to commencing employment, and they are in receipt of terms and condition of employment as evidenced in their randomly selected files. During discussion with the manager it was stated that staff are regularly Care Homes for Older People Page 18 of 24 Evidence: supervised. This was supported in discussion with care staff spoken to on the day and by records kept by the home.There was evidence that newly appointed staff undertook a programme of induction and care workers in discussion supported this. Documented evidence indicated that the home ensures that care workers undertake the mandatory training with yearly updates as necessary to maintain their competency to fulfil their duties. This was evidenced through discussion with the deputy manager and care workers. Care Homes for Older People Page 19 of 24 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 has the experience to run the home and works to continuously improve services and provide an increased quality of life for the service users. There is a strong ethos of being transparent and open in all areas of running the home.The views of service users and their relatives are actively sought in the running of the home. Service users financial interests are safeguarded.The service provides training on health and safety issues for all staff and service users are involved in the running of the home. Evidence: The manager has demonstrated in discussion that she has kept herself updated on issues relating to care of the service users and staff in her charge. She has attained the Registered Managers Award and is a registered nurse currently live on the Nursing and Midwifery Council register. In discussion with the manager it was evident she was knowledgeable about the care needs of the service users and the training needs of the care workers to meet these identified needs. There are clear lines of accountability Care Homes for Older People Page 20 of 24 Evidence: within the home, each member of staff spoken to on the day of inspection aware of their role and responsibilities.We were told regular residents meetings take place and minutes of the meetings were made available to us for review. We were told the manager who is also the owner will action requests as soon as possible. Also she is in attendance at the home on twenty-four hourly bases, and is able to monitor the running of the home through interaction with service users, relatives and care workers. The home does not become involved with service users finance, except for small amounts of spending money for which records are kept of all expenditures and were made available on the day of the visit. The manager told us she ensures the views of service users and their relatives underpin changes occurring in the home by the use of questionnaires. It was apparent through discussion that the results of the questionnaires analysed were not being fed back to the service users or relatives and we agreed that inclusion of the questionnaires results in the homes news letter would be a good way of disseminating this information and showing people who participated that actions are being taken as a result of their suggestions. Review of documented records demonstrated that health and safety checks are routinely carried out at the home. All equipment examined on the day was properly maintained. Random sample of care workers training files demonstrated that up to date and relevant training were carried out by care workers to protect service users health, welfare and safety. In discussion with care workers they discussed their understanding and implementation of appropriate procedures to safeguard service users. Further more they spoke about their understanding of promoting safe working practises based on their health and safety training. Throughout the service there is a highly evolved understanding of the equality and diversity needs of the individual service users. Care workers are confident in delivering high quality outcomes for service users in the areas of age, sexuality, gender, disability and belief. Although the care workers are knowledgeable about issues relating to race and equality and diversity, they are not able at the moment to put this knowledge into practise, with the current service users are all Caucasians. However, the staff rota demonstrated a good mix of ethnicity and the manager told us this is one area she has developed through discussion with the care workers. Care Homes for Older People Page 21 of 24 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 22 of 24 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 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 Care Homes for Older People Page 23 of 24 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. Care Homes for Older People Page 24 of 24 - 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. 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