Inspection on 23/10/08 for Ersham House Nursing Home

This inspection was carried out on 23rd October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ersham House Nursing Home 26/10/07

Ersham House Nursing Home 03/11/06

Ersham House Nursing Home 13/01/06

Ersham House Nursing Home 19/09/05

Ersham House Nursing Home 06/02/05

Ersham House Nursing Home 09/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 05/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ersham House Nursing Home Ersham Road Hailsham East Sussex BN27 3PN     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: Deborah Calveley     Date: 2 3 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Ersham House Nursing Home Ersham Road Hailsham East Sussex BN27 3PN 01323-442727 01323849900 ershamnh@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Sharon Sugars Type of registration: Number of places registered: Lakeglide Limited care home 41 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability terminally ill Additional conditions: Service users may have a physical disability and be aged forty-five (45) and over on admission. Service users must be aged sixty-five (65) years and over on admission. The maximum number of service users to be accommodated is forty-one (41). The maximum number of service users to be accommodated with a terminal illness is four (4). Date of last inspection Brief description of the care home Ersham House is registered to provide nursing and supporting care for forty-one service users who meet the registration category of elderly, terminally ill and physically disabled. It was opened eighteen years ago and is set in gardens of approximately one Care Homes for Older People Page 4 of 27 Over 65 41 0 0 0 41 4 Brief description of the care home acre, on the rural outskirts of Hailsham with extensive views to the South Downs. The gardens are rustic and well tended and easily accessed by the service users. The accommodation offered is thirty-nine single rooms, twenty three with ensuite facilities and one double room with an ensuite bathroom. The home offers communal areas, which are light, homely and tastefully furnished throughout the home, there is the main lounge/dining area which is central in the home, two further small lounge areas on each floor and an activities room. The bedrooms have been designed and decorated to a high standard. Residents are encouraged to personalise their rooms with small pieces of furniture and pictures. There are ample bathing facilities available which have the necessary equipment to meet the needs of the residents living in the home. The lift ensures that there is level access to all parts of the home. There is a reception desk and office and receptionist that works full time Monday to Friday, thus releasing staff from answering phones and enabling them to concentrate on the needs of the service users. Copies of inspection reports and the homes Statement of Purpose are made available on request. Intermediate care is not provided. 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: 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 reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at Ersham House will be referred to as residents. This was a key inspection that included an unannounced visit to the home and follow up contact with residents representatives and visiting health and social care professionals This unannounced inspection was carried out over 7 hours on the 23 October 2008. There were 41 residents living in the home on the day of which five were case tracked Care Homes for Older People Page 6 of 27 and spoken with. During the tour of the premises eight other residents both male and female were also spoken with. The purpose of the inspection was to check that the requirements of previous inspections had been met and inspect all other key standards. A tour of the premises was undertaken and a range of documentation was viewed including the Service Users Guide, Statement of Purpose, care plans, medication records and recruitment files. Four members of care staff a domestic and two activity co-ordinators were spoken with in addition to discussion with the provider and the registered manager. The registered manager is referred to as matron in the report as that is the title the residents and visitors refer to her as. Telephone contact was made with visiting professionals following the visit and their views and comments are incorporated into the report along with the information received verbally during the site visit. An Annual Quality Assurance Assessment was received from the Manager completed in full prior to this key inspection. Fees charged as from 1 April 2008 range from 545 pounds to 850 pounds per week, which does not include toiletries. Additional charges are made for hairdressing, chiropody, newspapers and outside activities such as visits to the theatre. What the care home does well: What has improved since the last inspection? What they could do better: This was a positive inspection with few areas identified for improvement. Activities are provided and appreciated by many of the residents, however there is little documented for those residents who are not able to attend the sessions organised. This needs to be developed to ensure that the home is meeting their social needs. Care Homes for Older People Page 8 of 27 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 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 10 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. The home provides prospective residents and relatives with a good level of information about the home its facilities services and the costs involved. Pre admission assessments are completed competently which ensures the home can meet the needs of prospective residents, and they are encouraged to visit the home. Evidence: There is a range of well-documented information about the home and the services it provides Since the last key inspection the home have updated the presentation of their documentation. The Statement of Purpose and Service Users Guide are more user friendly and colourful and include photographs of the home and staff. The brochure also includes a sample menu, activity programme, the last CSCI report and the rates charged for rooms and additional charges. Copies of these are available on request from the receptionist. Care Homes for Older People Page 11 of 27 Evidence: A resident who is relatively new to the home stated that the information provided helped her to choose the home and she felt that the contract was clear and easy to understand. The pre-admission format has changed and was found to be more informative and person centred and relevant to the admission process. Three admissions to the home were identified and this included the latest respite admissions. The records relating to the admission procedures followed were reviewed and were found to clearly identify the prospective residents needs and expectations. The assessments are completed by the registered manager matron and it was confirmed that these are used to ensure new admissions to the home are appropriate and that the home have the staff equipment and environment to meet their care needs. As before all prospective residents are seen either in their home or hospital before admission and the input from relatives and other professionals is used whenever possible. This information is now clearly recorded on the assessment documentation and demonstrates the procedures followed. It was confirmed that the home now confirms having regard to the assessment that the home can meet the assessed needs of the prospective resident. Matron was able to verbally demonstrate her knowledge and awareness of the different specialities required in the home and continues to ensure that all staff receive the necessary training to care for the people who live in the home Trial visits respite visits to the home can be arranged residents are invited to a trial period to ensure suitability of the home this is clearly stated in the Statement of Purpose and in the statement of terms and conditions Care Homes for Older People Page 12 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care documentation provides a good framework for the delivery of care with robust systems for risk assessment to ensure individual person centred care is delivered. The homes practice ensure residents medicines are stored and administered safely and residents are treated with respect and have their privacy and dignity maintained. Evidence: As part of the inspection process five residents care plans were identified for viewing. There has been a definate improvement in the quality of the documentation and the level of information recorded. The documentation was found to include plans of care, personal histories and health related risk assessments. The care documentation demonstrated that the care was reviewed and evaluated regularly and evidenced consultation with the resident where possible. Risk assessments for the residents health needs were completed and followed through with a plan of action where necessary these included nutritional, moving and handling, Care Homes for Older People Page 13 of 27 Evidence: dependency and tissue viability risk assessment tools. The residents safety was seen to be considered and risk assessments for call bells, bed rails and self administration of medicines were in place with guidance for staff to follow. The records evidence the contact with other health professionals. The staff all receive an update on individual residents when they come on duty and confirmed that they read the care plans time allowing. The clinical room on the ground floor was clean and well organised. The medication administration records (MAR) seen were found in the main to be accurate and the storage areas were found to be appropriate and well managed. There are recommendations of good practice and these were discussed with the matron during the inspection: these included: some gaps identified, verbal/handwritten orders need to be signed and dated to provide an audit trail and when medication is not administered the back of the residents chart needs to be completed. The interaction between the residents and staff was seen to be positive, comments received from the residents included: the staff treat me well they look after me not bad and they are always patient and kind. 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. Social activities and meals continue to be creative and provide daily variation and interest for people living in the home. Residents are able to make a range of choices about their lives as well as maintaining links with friends and relatives. Evidence: The home employs five activity co-ordinators and they work, Monday to Friday 1030 am until 3 pm. The programme of activities provided in Ersham House is varied and from direct observation enjoyed by the residents who join in. There were two different activities being held on the morning of the inspection, some residents were doing a word game and another group were making Halloween pictures. Discussions with residents confirmed that they joined in activities only if they chose to do so, some residents do prefer their own company and spend their time in their own rooms. The care plans evidenced those residents that are unable to attend group activities but little is documented and this needs to developed. The activity co-ordinators keep a record of who attends the group activities, but not how the interaction went and this would be beneficial as it will give an overview of what is enjoyed and the level of participation. Care Homes for Older People Page 15 of 27 Evidence: Resident’s rooms were found to be individual and personalised and each resident has their preferred term of address recorded in their care documentation and this preference was respected. Residents were seen to have their choices respected through out the day with decisions being responded to. The atmosphere in the home is positive friendly and welcoming and that is valued by the relatives and visitors. The chef was on holiday and there was a relief chef working. The menus demonstrated a well thought out nutritious and varied diet offering a vegetarian choice daily. The mid day meal was observed and was seen to be organised and well managed, ensuring that those residents needing assistance were given time and able to have the assistance that they needed in an unrushed manner. The residents choose where they take their meal and some residents preferred to eat in the smaller dining area as it was cooler. All tables now have a call bell placed on it to ensure that if they require assistance they can ring. Menus are used and circulated on the day prior to the meals being provided and records are kept on what food is eaten by each resident. All feedback about the food was complimentary and included good wholesome food lovely food always hot and tasty. the quality of the evening meal has improved and residents had no complaints. The dining area is pleasant and well furnished with natural light The kitchen was inspected by the Environmental Health 12/11/07 and the report was complimentary. The residents are served their meal from a hot trolley and the senior nurse on duty serves the meals. This allows residents to request a change or a smaller/bigger portion 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. The home has a formal complaints system with evidence that residents feel that their views are listened to and acted upon. Staff receive appropriate training to protect residents from abuse Evidence: The home continues to promote a robust complaint process. The home has a written complaints procedure and this is displayed in the home and provided within the Service Users Guide. The procedure followed on receipt of a complaint evidenced the investigation undertaken with an outcome recorded and the action taken. All records were clear and kept in a way that promotes peoples confidentiality. There have been no complaints received since the last key inspection. Relatives and visiting professionals said that they were confident that the management of the home would respond positively to any concern raised Everyone spoken to confirmed that if they had any concerns or complaints they would not hesitate in talking to either the Matron or a senior staff member of the home. The home has relevant guidelines on the protection of vulnerable adults and staff have all received appropriate training. The management team has a clear understanding of adult protection guidelines and are aware of how to initiate an investigation if required. Care Homes for Older People Page 17 of 27 Care Homes for Older People Page 18 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. Ersham House provides a comfortable clean and safe environment for those living there and visiting Residents and their families are enabled and encouraged to personalise their room and rooms are homely and reflect the resident’s personalities and interests Evidence: The tour of the premises demonstrated that all parts of the home continue to be well maintained, comfortable and well furnished with good quality co-ordinated furniture. The home has attractive communal areas, a large dining/ sitting area, a smaller lounge which lead on to a patio and water feature,and a further smaller dining area/ activity room on the ground floor and a small sitting area/quiet area on the first floor. There is an on-going maintenance programme that ensures that the home is maintained to a high standard. The residents are encouraged and enabled to personalise their rooms with furniture and pictures. All personal items are listed in the individual care plans. Residents are offered the choice of having a lock and key for their bedroom and risk assessments are in place for this. There are adequate communal bathrooms and shower rooms in the home with Care Homes for Older People Page 19 of 27 Evidence: specialist equipment which enables frail residents and those with a physical disability to enjoy the facilities available. Specialised equipment to encourage independence is provided, handrails in bathrooms, hoists wheelchairs and lifts to all areas of the home. The home was found to be warm and comfortable with good levels of natural light and ventilation. Pre-set values regulate hot water supplies to areas accessible to residents. Outlets checked showed that hot water was delivered within the safe temperature range. Hot water is stored and distributed at temperatures that reduce the risk of Legionella, and the home have an appropriate policy in place. On the day of the inspection the home was found to be clean and free from offensive odours. Staff ensure a high standard of hygiene and cleanliness and there are procedures in place to ensure that these standards are maintained throughout the home. All equipment was clean and hygienic. Suitable laundry facilities are available which meet the required standard all of which appeared in good working order. Adequate provisions of protective clothing are made available and suitable arrangements are in place for the disposal of clinical waste. There is written guidance for staff on control of infection. The staff were observed using good practices whilst caring for the residents. It was noted that there are waste bins in use without lids in sluices and bathrooms and this was discussed. Care Homes for Older People Page 20 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. Robust recruitment procedures are in place to protect residents and the staff training provided ensures they are aware of their roles and are able to provide the support and care the resident’s requires. Evidence: The staffing rota was viewed and for the 41 residents living in the home at present there are nine carers and two Registered Nurses (RN’s) in the morning and 7 carers and one RN’s in the afternoon and one RN and four carers at night. The afternoon staffing provision has been increased since the last inspection, which staff say has enabled them to work more proficiently. Verbal feedback from the residents and staff and written feedback from surveys did not raise any concerns regarding the staffing levels. The matron confirmed that that there is flexibility of the staffing levels and they are adjusted according to the changing needs of the residents. A selection of staff recruitment files were viewed and demonstrate that a robust recruitment process has been maintained to protect residents and contained all the relevant information required. There was evidence of health questionnaires, Criminal Record Bureau checks, two references, a resume of previous employment and work permits where necessary. All the paperwork is kept within a locked room. The induction training is very thorough and staff are supervised closely during this period Care Homes for Older People Page 21 of 27 Evidence: to ensure they are competent for job they are to undertake in the home. The training programme in the home continues to cover a wide variety of training. The training co-ordinator is dedicated to her role and works alongside during the new staff during their induction. Staff interviewed confirmed a high satisfaction with the training provided and stated that recent training was interesting and informative . Staff and records seen confirmed that they had undertaken compulsory training such as moving and handling, safeguarding vulnerable adults, first aid, food hygiene, fire safety and Infection control. In addition specialist training in understanding dementia, challenging behaviour, palliative care, wound care, and catheter care updates are also provided. Ersham House is OCN Registered and is an accredited Approved Training Centre able to award a Vocational Qualification Level 2 Direct Care Award NVQ. At present 70 of staff have an NVQ qualification. Care Homes for Older People Page 22 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. The overall management of this home is good with effective systems in place to protect residents. Evidence: The Registered Manager is a Qualified Registered General Nurse, and has the experience to run the home effectively with support from the provider and the senior staff in the home. The management structure of the home is strong competent and has clear lines of accountability. During the inspection visit there was no doubt that the manager had a good working relationship with everyone in the home and everyone spoken to said that she was approachable fair and responded to issues raised quickly. The atmosphere of the home is pleasant and inclusive with positive interaction observed between the residents and staff. Care Homes for Older People Page 23 of 27 Evidence: There are systems in place to monitor the quality in the home and include the use of questionnaires. The matron confirmed that the surveys are audited reported on and responded to. It is recommended that the use of questionnaires is expanded to staff and visiting professionals and the results of the audits displayed in the home. Regular staff and resident and relative meetings are held and records of the meetings are kept and the registered provider performs an unannounced regulation 26 visit once a month. These also form part of the quality assurance systems in the home. Residents financial interests are safeguarded by the homes policies and procedures and records are kept and maintained appropriately. All staff now receive regular formal supervision, it was confirmed that supervision has been allocated out to other staff. Ersham House continues to be well maintained and systems are in place to report any problems to the maintenance person that need attention. Certificates relating to Health and Safety in the home were reviewed and found current. Full records of hot water checking are kept, there are measures in place to prevent Legionnaires disease, the health and safety policy is up to date and the environmental risk assessments are fully recorded. There are first aid boxes in the home, most were well stocked , however the kitchen one was virtually empty. Good practice was observed throughout the inspection in respect of promoting and protecting thesafety and well being of the people living and working in the home. Care Homes for Older People Page 24 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 25 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 12 16 That the registered person 30/12/2008 ensures that those service users who are unable to attend the organised activities receive one to one interaction and this is clearly recorded. To ensure that all service users receive appropriate social interaction. 2 38 13 That the registered person ensures that all first aid boxes are well stocked and ready for use. This refers to the kitchen area. To enable first aid to be applied as required. 30/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 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!