Inspection on 13/11/08 for Grenham Bay Court

This inspection was carried out on 13th November 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

Grenham Bay Court 13/11/07

Grenham Bay Court 22/08/06

Grenham Bay Court 17/11/05

Grenham Bay Court 08/06/05

Grenham Bay Court 20/04/05

Grenham Bay Court 07/03/05

Grenham Bay Court 06/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Grenham Bay Court Cliff Road Birchington Kent CT7 9JX     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: Eamonn Kelly     Date: 1 3 1 1 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 © (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 27 Information about the care home Name of care home: Address: Grenham Bay Court Cliff Road Birchington Kent CT7 9JX 01843841008 Telephone number: Fax number: Email address: Provider web address: vanessa.cornfoot@highmeadow.co.uk Name of registered provider(s): Name of registered manager (if applicable) Grenham Bay Care Ltd Type of registration: Number of places registered: care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 34. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home The service provides accommodation and support for older people. Bedrooms are situated on the ground and first floors and a passenger lift is available for residents. A number have en-suite facilities. There are several lounge areas and residents may choose which to use. Residents have the use of a garden. The premises provides views accross the bay described by residents as relaxing and interesting. Car parking is available at the front of the premiese. The service has a minibus to help residents get 0 Over 65 34 Care Homes for Older People Page 4 of 27 Brief description of the care home to local shops and other places of interest. Weekly fees and other charges made to residents may be obtained from the manager. 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 quality rating for this service is 2 Star. This means that people who use the service experience good quality outcomes. The inspection took place on 13 November 2008. The methodology used to produce the report includes reference to the AQAA (annual quality assurance assessment) submitted by the manager, meetings with the manager, commercial manager and members of staff and meetings with or observation of most residents. The profiles of four residents were assessed in some detail and the relevant care plans were seen. The inspection included a visit to most parts of the premises. Some records used for supporting residents were checked. Three visitors also provided views about how the service is conducted. Care Homes for Older People Page 6 of 27 The outcomes of the previous inspection report were checked. Checks were also made of information known to the Commission about the service. In keeping with the Commissions policy of looking closely at specific regulations and standards from time to time some emphasis was placed on this occasion on how well the service meets Standards 18 and 29 (protection and recruitment). The previous report contained requirements relating to the need for better care plan information and staff recruitment procedures. Progress has been made in addressing these areas of practice. This report contains no requirements or recommendations although the manager undertook to improve the support for residents whose needs were more closely reviewed during the inspection. The AQAA submitted by the previous manager of the service outlined some of the areas that have been improved for the benefit of residents and areas of practice that need further development. The Commission expects a more realistic and accurate reflection in AQAAs of how support needs are met and how improvements are planned for the coming year. 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. Prospective residents and their supporters receive initial advice and guidance to help them assess the facilities and suitability of the home. This includes provision of a residents guide that describes services and facilities. Evidence: Prospective residents and their representatives receive assistance and guidance to help them decide if the home is able to meet their support needs. They receive a written guide that contains information about services and facilities. All new residents receive a personal contract that contains relevant information on the rights and responsibilities of both parties. The manager carries out an assessment of prospective residents support needs with assistance where necessary from Social Services care managers. Many residents have Care Homes for Older People Page 10 of 27 Evidence: support needs associated with the onset of dementia as well as substantial mobility problems and other disabilities. The care plan record begun at this stage outlines the support needs of the prospective resident and how these needs would be met. Two visitors provided useful insights into how residents are supported at this stage of admission. They were satisfied with the support given then and subsequently to their relatives. There was evidence that the homes Statement of Purpose is changed when conditions require that prospective residents and their advocates need new information at that stage. An example is that residents who smoke are subject to continuing risk assessments so that residents and others are not placed at unacceptable risk. At the time of the inspection four residents from another home in the group had transferred temporarily and there was evidence that the needs of these residents had been assessed and they were receiving good support. This conclusion was reached on the basis of information contained in their personal files and from their individual testimony. In one instance the manager and commercial manager undertook to look more closely at the need for additional support for a resident who had temporarily transferred and for residents personal files to be appropriately updated at the right time. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive good healthcare and personal support and care planning procedures contribute to meeting their support needs. Evidence: There is good information about each residents background in individual care plans. According to the manager, care plans are an increasingly effective operational tool for staff. The evidence is that, as the manager gradually updates and reviews them, members of staff are using care plans to identify the changing needs of residents and record how support should be provided. Residents care plans have a great deal of information about their support needs. Risk assessments in each residents personal file identify the relevant issues associated with the residents continuing support and, in the examples seen, have recently been updated. The manager is aware that, from April 2009, care home services will need to take account of Deprivation of Liberty (DoL scheme) regulations which are part of the Mental Capacity Act. She is preparing to inform members of staff about how the regulations affect residents and part of this is likely to include an information sheet. Care Homes for Older People Page 12 of 27 Evidence: During the inspection visit, members of staff treated residents with understanding and respect. Discussions about the profiles of four residents and how they are supported also indicated a level of understanding of and respect for clients. There was evidence that care managers are involved in reviews of residents although these may not always be at the required frequencies. The levels of required staff intervention in two of the four instances chosen for further observation during the inspection did not meet the standard that would normally be expected. The manager immediately undertook to fully review both instances and to provide better levels of support. This lack of support, whilst now to be addressed by the manager, need not have occurred if the manager and members of staff picked up the issues, if care plans had been maintained properly and staff had received the necessary support in addressing the issues. Please also refer to the section on Staffing in this report. The new manager said that these reviews and, for example, provision of the necessary chiropody assistance would contribute to the future need for assessing, re-assessing and meeting residents needs. Residents have good access, according to profiles of residents discussed during the inspection, to local NHS community services. There is close contact with local PCT nurses who, for example, provide and change dressings. A visitor who has a long-term association with the service said that residents receive good social and healthcare support. She also said that carers have an understanding of the effects of dementia and how to provide the personal support needed. However, there was evidence during the inspection that staff are not receiving the level of support necessary to give them a fuller knowledge of the consequences of dementia. The manager said she would implement a programme of substantial training in this area of support for staff and residents. Residents have good access to dentists, chiropodists and opticians according to current care plans. The manager said that only those members of staff who have received specific training are allowed to administer medication and update MAR sheets. Medication records are completed when administration takes place. The manager said she would update arrangements for administration of controlled drugs by following the latest advice contained in Royal Pharmaceutical Society guidelines. The AQAA states that residents weights are recorded monthly or more often if necessary. GP or dietician involvement is sought where there are concerns. The manager said she is making end of life care one of her priorities when updating care plans and, as part of this initiative, is taking into account procedures currently Care Homes for Older People Page 13 of 27 Evidence: available from the Commissions website. 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. Residents receive support in keeping physically and mentally active. Evidence: A visitor who has a longer term association with the service said that residents are supported in keeping physically and mentally active althogh this testimony was qualified by stating there are significant pressures on members of staff in providing the levels of support that would normally be expected. Residents may receive visitors at any reasonable time and the service encourages this continuing contact. The AQAA states that efforts are continuing to be made to involve residents family and friends in helping with day-to-day activities. Some residents have the onset of dementia and mental health difficulties such as depression and other health problems. In some of the profiles discussed during the inspection, it was clear that members of staff would benefit from gaining relevant experience in working effectively with people who need specialist support. Some of this knowledge and experience is likely to be enhanced from achieving significant training via, for example, the Certificate in Dementia Care. Care Homes for Older People Page 15 of 27 Evidence: Members of staff have a reasonable understanding of each residents personality and disabilities. Where residents have significant physical disabilities or mental health difficulties members of staff communicated well with them although relevant aspects of how good support should be provided had not been recently reviewed and his/her support plan updated accordingly. This was the evidence from the care plans seen and observation of residents to whom they referred. The AQAA states that residents and family members are encouraged to say what they feel and to give their views about any issue they feel affects them. Residents gave examples of particular activities promoted by the service. There were a number of examples seen during the inspection that suggested they are helped in a number of ways to remain mentally and physically active. This included staff assisting residents on a one to one basis, helping them to walk about the premises including using the stairs and stair lift, provision of books and newspapers, talking to them, providing music and helping residents visit the garden. Care plans have been extended to include activities most likely to interest residents and efforts are made to provide these activities. A member of staff engaged with each resident to obtaining his/her decision of the evening meal and following days meal. This was viewed by residents as a useful afternoon intervention. An activities co-ordinator attends on Tuesdays and Thursdays. A notice board outlined planned activities and proposed outings over the coming weeks. Residents referred to the good work the activities co-ordinator does with them. During the inspection there were six carers on duty and the activities co-ordinator was not present on the day due to other commitments. There was a positive atmosphere and carers were working actively with residents when they were not engaged in household activities. There are several communal areas throughout the premises and residents may choose to use quieter or, as in the case of the main lounge, noisier areas. Some communal areas have views accross the bay that some residents said they appreciated. A member of staff showed how residents are offered a good choice for evening tea and lunch next day and how a careful record is made of these choices. Residents and visitors spoke highly of the quality of meals provided to residents. 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. Residents are protected from abuse by the vigilance of staff and through the support provided by the company to all members of staff. Evidence: The AQAA states that residents, visitors and relatives are involved in saying how improvements would be of benefit to residents. It states that use is made of quality assurance questionnaires sent to families, friends and advocates. According to the manager, visitors have been made aware of the complaints procedure and a copy is made available in the written guide to the service. Member of staff receive training in matters associated with POVA (protection of vulnerable people) and the manager said she is confident support workers would understand if abuse is occurring and how they should report it. She said that she and senior members of staff have a good knowledge of adult protection procedures followed by Social Services departments. The Commission received no complaints about the service during the past year and the manager confirmed that no safeguarding issues are currently in progress. The annual quality assurance assessment (AQAA) states that members of staff are aware of all the necessary procedures relating to protection of residents. Specific Care Homes for Older People Page 17 of 27 Evidence: training on the wider implications of POVA (protection of vulnerable adults) forms part of the improvements in staff training and development being put in place. The manager said she is aware of the circumstances where events affecting residents (ie. notifications under Regulation 37) must be reported in writing to the Commission and some such notifications have been received. 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. The premises are suitable for use by frail older people. Residents live in a comfortable and well maintained environment and benefit from the ongoing improvement programme of redecoration and routine maintenance. Evidence: Most bedrooms are single although the current registration allows for some to be used as shared facilities. The garden is suitable for use by frail older people. There are a number of communal areas that residents, visitors and staff may use and dining areas are comfortable and well maintained. Radiators are covered for the safety of residents. Hot water outlets accessible to residents are temperature controlled and are manually checked, the manager said, each week for safety reasons. The AQAA contained declarations relating to safety checks and associated safety certificates being up-to-date. TV reception is poor on some channels; this is an area that will be improved for the benefit of residents according to the manager. Some residents have bought Freeview converters. Work is underway on the installation of a new passenger lift. The AQAA states that considerable work has taken place to upgrade the premises including for example redecoration of the main lounge and dining area, new tables, chairs, table linen and Care Homes for Older People Page 19 of 27 Evidence: window dressings and refurbishment of some bedrooms. The manager said she is confident that good procedures are in place to prevent the spread of infection and protect residents. These include proper clinical waste disposal, a sluice machine for the cleaning of commode pans, an industrial washing machine with sluice cycle and water-soluble bags for soiled articles. The AQAA and training record indicate that most members of staff have undertaken infection control training. Communal areas and all bedrooms were visited as part of the inspection. Lounges, dining rooms and bedrooms are decorated and furnished to a reasonable standard. Building maintenance is ongoing. All parts of the premises at the time of the visit were clean, odour-free and in a reasonable state of repair. Residents met on this occasion said they like their bedrooms which are all individual and personalised. The majority of bedrooms are on the ground floor and most have ensuite facilities. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are in the care of a staff group that is committed to the task of supporting them. Carers are not yet receiving the levels of personal developmental support they need to ensure that residents needs are met in full. Evidence: The staff rota indicates that six carers are on duty in the mornings and four in the afternoons plus a housekeeper and laundry assistant weekday mornings and additional staff on duty every day for cooking. An activities coordinator attends on two days a week. The manager is supernumerary and has the support of a part-time administrator. A maintenance person attends five days a week. The manager said that the needs of residents are met by the current level of staff even though there is a sharp reduction in numbers in the afternoon. Some visitors referred to the committment of staff on duty but also stated that they are generally under significant pressure to meet the full needs of residents. Earlier in this report, reference was made to the residents whose profiles were discussed in some detail and whose care plan records were checked. The manager undertook to make improvements to how they are being supported and there was a specific committment by the manager to improve the lives of the residents concerned. Care Homes for Older People Page 21 of 27 Evidence: There was some evidence that the full support needs of those residents were not being addressed. The manager said that these issues would be addressed through the formal supervision procedure and through further training and support for staff. The staff training position inherited over the past two months by the new manager of the service is a little at odds with the broad statements in the AQAA submitted by the previous manager. The AQAA suggested an up-to-date training regime for all members of staff but this was agreed with the new manager as not being the case. The manager agreed that all members of staff have not yet received the developmental support they need. The Commission expects the AQAA to have statements about the present and the proposed position described more accurately. The manager has, as an interim measure, concentrated on ensuring sufficient support for staff is put in place for fire safety training and POVA (protection of vulnerable people). She said she will then concentrate on enabling staff to achieve a qualification in care such as an NVQ and then enable staff to achieve other training they need to provide the necessary support for staff. As the support needs of residents is high and increasing, the manager said she intends to introduce a programme of training in dementia care such as the certificate in dementia care. Staff currently receive an introduction to this subject by the company. The central recruitment section undertakes, according to the manager and commercial manager, full recruitment activities including the taking up of references and CRB/PoVA checks. In the case of three staff files checked, there was evidence that full recruitment checks including CRB checks are carried out. The manager and commercial manager outlined how High Meadows, the owner organisation, has a central recruitment and training framework. They undertook to ensure that the necessary improvements discussed are achieved as soon as possible. The AQAA makes no reference as to whether adequate one to one staff supervision is conducted. As stated previously, the AQAA overall does not constitute a comprehensive attempt to assess the level of current services for residents and how these may be improved. The new manager outlined how she is prioritising the main issues to be addressed and how she is putting a formal staff supervision system in place. 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. Residents have the benefit of living in a service that is well managed. Evidence: A new manager recently took up her post but is not yet registered with the Commission. The manager has identified a number of areas that need improvement. These have been referred to earlier in this report and the manager said there is a commitment to quality assurance measures to improve the comfort of residents and their longer-term care and support. She said she is confident of success in improving and developing systems that monitor practice and compliance with the plans, policies and procedures of the service. One of the new areas where development work is needed and which the manager is addressing is the DoL scheme (Deprivation of Liberty) which is part of the Mental Capacity Act. The manager is confident that she will have the necessary framework in place by April 2009. This is one of the areas where the manager indicated she is Care Homes for Older People Page 23 of 27 Evidence: developing policies and procedures for the benefit of staff and ultimately for the benefit of residents and their advocates. She described during the inspection visit how the owner organisation is implementing quality monitoring procedures. She outlined the advantages accrueing from, for example, questionnaires given to residents and visitors, a newsletter, residents meetings, staff meetings and unannounced visits by the owners representative. Previous inspections confirmed that procedures are in place to record any monies held on behalf of residents including details of expenditure and that these are audited by an independent source within the company. The manager outlined how these checks are continuing. A declaration was made in the AQAA that carers and other staff are trained in safe working practices and that the homes equipment has been serviced and all maintenance and safety checks/certificates are up to date. 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 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 © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!