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Inspection on 13/10/08 for Fordlands Road (1) Residential Elderly Persons Home CYC

Also see our care home review for Fordlands Road (1) Residential Elderly Persons Home CYC for more information

This inspection was carried out on 13th October 2008.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People are not admitted into the home without their needs being known, this makes sure that their needs can be met. People receive the care they need and their privacy and dignity is respected. They said that their medical needs were met and this ensures that peoples health is protected. There is a varied and extensive programme of activities provided, which every member of staff takes part in to make sure that people have their social needs met. People are protected from abuse and they feel any complaints raised would be dealt with. Staff receive training and are kept up to date with the care needs of people they are looking after. Staff work flexibly to make sure people receive the help they need when they need it. The home is managed well by an experienced manager who has the best interests of the people who live at the home at heart. Staff feel well supported and guided by her and all the staff work well as a team to make sure people receive the care and support they want.

What has improved since the last inspection?

There were no requirements or recommendations made at the last inspection.

What the care home could do better:

Some care documentation should be completed more timely for new admissions to make sure staff are aware of how best to help them. The laundry requires some repairs to floor coverings and wall tiles to make sure infection control measures remain effective.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Fordlands Road (1) Residential Elderly Persons Home CYC 1 Fordlands Road Fulford York North Yorkshire YO19 4QT     The quality rating for this care home is:   three star excellent 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: Denise Rouse     Date: 1 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: Fordlands Road (1) Residential Elderly Persons Home CYC 1 Fordlands Road Fulford York North Yorkshire YO19 4QT 01904630048 01904658426 ephfordlands@york.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Maureen Carr Type of registration: Number of places registered: City of York Council care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 1 Fordlands Road is a care home run by City of York Council. It is registered to provide a service for 31 older people, of either gender aged over 65 years, who do not have any specialist requirements. The home is situated in Fulford within easy access of the local village amenities. There is a large parking area to the front of the home with garden areas to three sides. The accommodation is provided on two floors. The upper floor is accessible via vertical passenger lift and there are two staircases. Bedrooms are not en-suite but do have sinks and vanity units. The accommodation is arranged in separate wings with a large communal sitting room. Each wing has its own bedrooms, kitchenette, sitting/dining areas, bathroom and toilets. All the bathrooms have assisted bathing facilities. Information is available in the last inspection report and service user guide to tell people about what the home can offer them. Care Homes for Older People Page 4 of 27 0 Over 65 31 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: three star excellent 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 quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. The evidence used in this report has included: A review of the information held on the homes file since its last inspection. Information submitted by the registered provider in the Annual Quality Assurance Assessment AQAA. Surveys received from 10 people living in the home, 7 relatives, 5 staff and 2 health Care Homes for Older People Page 6 of 27 care professionals. An unannounced visit to the home which lasted 5 hours 15 minutes, undertaken by one inspector, which included a full tour of the premises. Evidence gained by direct observation during the site visit. This involved talking with people living at the home, talking with senior care staff and the administrator. Inspection of records, including care profiles, medication administration records, staff files and some of the homes policies and procedures. We have reviewed our practise when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations. But only when it is considered that people who use the services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The fee charged at the home on the day of the site visit was 457.74 per week for all occupants. 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 8 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience good quality outcomes in this area. We have made a judgement using a range of evidence, including a visit to this service. People are assessed so that their needs are known and can be met. Evidence: People who are considering moving into the home are invited to come and look round and spend the day there with their relatives. Information is available in the last inspection report and in the service user guide, which help people decide if the home has the services they are looking for. An assessment of peoples needs is undertaken by competent, staff, which makes sure that peoples needs are known and can be met. Information from discharging hospitals and the care management team is also gained before an assessment occurs so that the manager has all the information needed, to Care Homes for Older People Page 10 of 27 Evidence: decide if a place at the home can be offered. Short trial stays are offered to help people experience the care and services available to them, or people can just stay for a meal. Once admitted a review is held six weeks later to see how people are settling in, and to make sure they are happy with the services they are receiving. Emergency admissions are not undertaken unless an assessment has occurred. This helps to make sure that people who may not be appropriate are not admitted. Intermediate care is not provided. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service experience excellent outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their health care needs met, and their privacy and dignity is respected. Evidence: People have their needs recorded on care plans, these are updated when peoples needs change and they are reviewed monthly by staff. This makes sure that people receive the care they need. However one person who had been admitted into the home recently had some relevant care documents which were not completed timely. The manager made sure that these documents were completed on the day of the site visit to make sure staff were fully aware of how the person could be helped when mobilising or being helped to transfer from bed to chair, and that their special needs to look after the integrity of their skin was recorded for staff to follow. People who are at Care Homes for Older People Page 12 of 27 Evidence: risk of falls have risk assessments in place which are updated and reviewed as necessary, this helps keep people safe. People are encouraged to maintain their independence and staff help them with areas of care which people find difficult to do for themselves. This maintains peoples self esteem. Staff address people by their preferred name and knock on their bedroom doors before entering. Doctors see people privately in their bedrooms, to make sure their privacy and dignity is respected. Other health care professionals visit the home as necessary to make sure people receive all the medical services they need to maintain their health. All ten people who live in the home said in surveys they completed that they always received the medical care they needed from the staff and the medical profession, this ensures their needs are met. A health care professional said in their completed survey My visits to Fordlands Road are rare and relete to one or two individuals, but I have been impressed by the level of care given, the knowledge shown by the staff in relation to these clients and the attention to detail given in their care. The consistancy in the personelle is noticable. Five staff who work at the home also completed surveys they said We give the residents 100 care fullfiling all their needs to meet the quality of life they wish for. Medication systems in operation in the home are thorough and protect people who live in the home. People who want to have their medication and take it themselves are assessed to make sure they are safe to do this. They have a lockable drawer in their bedroom where their medicines can be stored safely to maintain their independence. People who live in the home said You feel safe and well looked after And The staff are doing a great job here I realise that its not a nursing home, the staff can meet the needs I have. Care Homes for Older People Page 13 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have an excellent programme of activities available to them, provided by dedicated staff. People receive a nutritious diet. Evidence: Peoples preferred activities are recorded when people come into the home. Information about their family history and working life is also recorded, to help staff understand people as individuals and help them to reminisce and settle into the home. people can choose when they want to get up and go to bed and follow their own chosen routine. A wide variety of activities are available to people, the manager and staff are creative to help keep peoples interests alive. On the day of the visit a quiz took place and people were seen taking part in group singing. Other activities which are have been Care Homes for Older People Page 14 of 27 Evidence: provided include staging a Wimbledon Tennis Tournament, this was played by the staff with residents watching whilst enjoying strawberry teas. The seaside was brought to the home, people made hats out of hankys, a paddling pool and sand was provided, gazebos erected and fish and chips were provided. Staff invited their children along to make it a family affair and this was enjoyed by people living in the home. A Halloween party is being organised. A competition for best Halloween costume is to be held and familys are invited as well as staff. Hot dogs and jacket potatoes are to be provided and bobbin for the apple and pass the parcel will be played. The home take people to take part in the local Fulford show, and many prizes have been gained for entrys made into the baking section of this event. The home had 3 stalls this year, and took people to the show to sell their home made cakes and man the Tombola stall. Donations of bottles and chocolates were provided by staff and relatives for this stall. These activities help to raise money for the residents fund which pays for people living at the home to go out on trips and have pub lunches without having to pay for them. This is commendable. Local links with the community are strong. The Beavers visit and the local school choir attend the home at Christmas time to sing to the people living there. People are taken into York to the Harlequins, Victoria Vaults in York to see entertainers and have lunch. They have been their on a Sunday afternoon to watch an Irish comedian and enjoy a drink. Trips to the Designer Centre and to a local bowling club take place. They are also taken at Christmas to a garden centrer to see the Christmas decorations. People spoken with said they were very happy with the activities being provided and that they could choose to take part if they wished. They were gratefully to the manager and staff for providing such an extensive programme of activities which they could enjoy. All the staff from the manager to the cleaners help with activities which makes sure there is a real family feel to the home. people said The entertainment and activities are good, we have sing alongs, I have no complaint whatsoever. Theres always something going off, they are providing a very essential service here. Another person said I have been doing the exercises and then I am doing a quiz, I choose the bits I want to take part in. there are enough activities I dont feel board, I also like to sit in the television room with others for company. Peoples religious needs are known and are met by clergy visiting the home. A hairdresser visits the home as well as a private chiropodist so that people do not have to go out to receive these services. Visiting is open and people can go out with their relatives and friends at any time. There are a variety of dining areas available. Some food is provided from the local hospital, however this service is has nearly stopped as most food is cooked in house. Care Homes for Older People Page 15 of 27 Evidence: People have a choice of food and peoples special diets are catered for. Supper is provided and there are small kitchens available throughout the home for people to make drinks and relatives can use these also. People said the food was good and The food is very good, I havent got much of an appetite, I get sufficient for what I need. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service experience good outcomes in this area. We have made a judgement using a range of evidence, including a visit to this service. People are given information about how to make a complaint, and they are protected from abuse by the policies and procedures in place at the home. Evidence: Information about how to make a complaint is given to people in the councils leaflet. People said they felt comfortable to raise any issues they may have and felt issues would be dealt with. This helps people to feel valued and at home. A safeguarding policy is in place. Staff have received training about how to recognise abuse, those staff spoken with knew what action they should take if they suspected abuse was occurring. This helps to protect people. New staff have all necessary pre employment checks undertaken before they start work at the home. This includes police checks. This helps protect people from staff who may not be suitable to work in the care industry. Care Homes for Older People Page 17 of 27 Evidence: People said I have no worries or concerns, if I had I would speak to someone and I feel things would be sorted out. And The staff are very good they listen, I have never had any cause to complain. 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. People who use 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 live in a home that is maintained, however there were some shortfalls relating to the laundry, which should be adressed to help maintain infection control Evidence: The home is maintained and is comfortable for people who live there. A secure door entry system helps keep people safe and there is a small homely conservatory at the entrance where people sit to watch visitors and staff coming and going. There are a variety of lounges and dining areas with some kitchenettes available throughout the home for people to use. There is a lift to help people gain access to all areas of the home. Gardens are accessible by ramps and there is garden furniture for people to use. Handrails are available throughout the home to help people who have poor mobility to get around. The laundry was inspected. Infection control measures are in place for handling any soiled linen. However there was a buildup of dust behind the washers and dryers which Care Homes for Older People Page 19 of 27 Evidence: should be removed. Boxed in pipes behind the washers were uncovered as the boxing had come out of place. There were 2 broken tiles under the washers and more tiles that were broken on the corners of the plinth the washers were stood on. The lino had some small holes in it near the washers and under the hand wash sink. These issues should be addressed to make sure the laundry can be thoroughly cleaned and help protect people from cross contamination. Hand wash facilities are available throughout the home and helps to make sure people are being protected from cross infection. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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. People are looked after by well trained staff, who are flexible with their working patterns to ensure peoples needs are central to their work. Evidence: Staff come in early and work flexibly supported by the manger to make sure peoples care and social needs are met. Staff are dedicated and try their best to be accommodating to meet the homes needs, tailoring the staffing resources to make sure peoples overall needs are met. All staff have name badges so they can be easily identified. Staff take pride in their work and see the people who live at the home as an extension of their own family, which is very apparent when people visit the home, and in the activities that are performed by the staff. The 3 care leaders have one day a week where they are all on duty together and this is used to discuss any issues, or carry out assessments or undertake training. This helps the care leaders work as a strong team. Care Homes for Older People Page 21 of 27 Evidence: There are team building exercises and company newsletters are provided to staff who are given regular training to make sure they feel valued and supported in their work. Supervision and appraisals take place to make sure staff can receive one to one support and gain any extra training they may need. Recruitment checks undertaken before a new member of staff starts work at the home are thorough. This helps to protect people from staff who may not be suitable to work in the care industry. The home has 65 of care staff who have gained a National Vocational Qualification in care. This helps to make sure that staff have the knowledge to help them provide good care. The home has a training champion in place to help update the staff with mandatory training to make sure they can deliver god care and are safe to do so. External training is also provided by distance learning courses in a variety of subjects to make sure staff have the skills they need. People said I think staff do everything well, the staff are very caring, they are very kind to everyone. Another person said Staff are very nice you couldnt ask for anybody better. And The staff are exceptionally good , they help you whenever they can, staff would do anything I ask. Staff spoken with said they were happy working in the home. One said I am happy at Fordlands Road and I get nothing but satisfaction in my job. I have been here for 13 years. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use 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. People live in a home that is well managed, People are protected from financial abuse. Evidence: The home is run by an experienced manager who works hard to make sure the home has the funding needed to provide the services that people need. She has a clear vision and is focused on providing an excellent service to people who live in the home. She is always thinking of how the service can be improved. The manager provides an excellent role model to the staff and leads her team well, especially in relation to the activities being provided. She undertakes different courses to make sure her Care Homes for Older People Page 23 of 27 Evidence: knowledge is up to date so she can effectively support the staff. Quality assurance systems are in place. People who have been admitted for a short stay are asked to fill in a questionnaire about the service they have received. People who live at the home are about to be sent a survey to fill in to gain their views about the home, this is sent out each year. Residents meetings are held to gain peoples views.The manager also has a questionnaire that people fill in at their initial 6 week review following their admission, 10 questions are asked and any issues raised from any of these audits or surveys is then adressed to make sure people continue to be happy with the service being provided. People living in the home said in surveys they filled in they were happy with the services they were receiving. A relative said Fordlands road is excellent my mum is happy and all the staff are caring and loving, my relative could not be in a better place. Another relative said Because my mum is so well looked after I dont need to worry anymore. Another commented Fordlands Road has a happy atmosphere throughout . People at the home who do not wish to look after their own money can open a personal allowance account. The system for recording transactions is thorough and receipts are kept. Personal allowance accounts are regularly audited, this makes sure that peoples finances are safe and they are protected from financial abuse. Health and safety checks are undertaken to make sure that the home remains a safe and pleasant environment for people to live in. The shortfalls found relating to the laundry should be addressed. (See environment). 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Care documentation about how to safely help new people being admitted into the home to walk and transfer should be completed timely to help protect people. Also skin integrity records should be completed as soon as possible for people who have special needs in this area. To make sure their needs are known and can are being met. The laundry should be cleaned behind the washers and dryers. Broken tiles should be replaced and the holes in the lino floor should be repaired. To make sure that the laundry can be thoroughly cleaned to make sure infection control measures are in place. 2 26 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!