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Inspection on 03/12/08 for Hatzfeld House Care Home.

Also see our care home review for Hatzfeld House Care Home. for more information

This inspection was carried out on 3rd December 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

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

Nine people living at the home were spoken with. All of their comments were positive and included; "It`s smashing here, staff are wonderful" "The manager is very good, she takes time to listen to you" "The staff are very good, they cheer me up" "I am well cared for" The interactions observed between staff and people living at the home appeared positive and inclusive. Staff treated people with respect and shared conversation and laughter was heard throughout the visit. Assessments were carried out prior to admission to make sure all needs could be met. Each person had a care plan to set out their individual needs. Health care was monitored and access to health professionals was provided to maintain health. An open visiting policy was in operation so that people could maintain contact with family and friends. The routines at the home were flexible to promote choice. A varied diet was provided to promote choice. The complaints procedure in operation made sure peoples concerns were listened to and taken seriously. The home appeared comfortable and well decorated. Some training was provided to staff so that they could meet peoples needs.

What has improved since the last inspection?

Medication administration records were only signed once staff had witnessed the medication had been taken, so that safe procedures were followed. Records of meals eaten were kept as part of monitoring health. Damaged tiles in one bathroom and worn enamel on the base of a hoist had been repaired to maintain good standards in the environment. Staff had been provided with training on diabetes and catheter care to update their skills.

What the care home could do better:

Care plans must fully describe the actions required of staff so that peoples individual needs and preferences can be met.Care plans must be regularly reviewed so that they are kept up to date. Further activities should be provided to improve choice. All staff must be provided with Safeguarding Adults training to keep people safe. The stair carpet must be cleaned or replaced to maintain standards in the environment. Radiators must be risk assessed and appropriate action taken so that risk is minimised and people are safe. Thorough recruitment procedures must be adhered to so that people are protected. The quality assurance system must incorporate sending surveys to people and publishing the results of these so that peoples views are obtained and acted upon. Staff should be provided with supervisions at the recommended frequency to ensure they are appropriately supported and appraised. Fire systems must be checked more frequently, in line with written procedures to keep people safe. All staff must be provided with statutory training at relevant intervals to maintain their skills.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hatzfeld House Care Home 10b Mansfield Road Blidworth Nottinghamshire NG21 0PN     The quality rating for this care home is:   one star adequate 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: Janis Robinson     Date: 0 3 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things 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 28 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 28 Information about the care home Name of care home: Address: Hatzfeld House Care Home 10b Mansfield Road Blidworth Nottinghamshire NG21 0PN 01623464541 01623465508 hatzfeldcareltd@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Roger Willis Name of registered manager (if applicable) Tracey Julia Graham Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 23 The registered person may provide the following categories of service only:- Care home only - Code PC To the 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 - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Hatzfeld House is a converted property, set in its own grounds in the centre of Blidworth. It is within walking distance of all the local amenities and on a public bus route. Service users are accommodated in one double and twenty-one single bedrooms with a communal lounge, dining room and conservatory. Disability equipment in the home includes a passenger lift, ramped access to the building, grab rails in bathrooms/toilets, handrails in corridors, mobile/bath hoists and raised toilet seats. A Care Homes for Older People Page 4 of 28 care home 23 Over 65 0 23 23 0 Brief description of the care home call system is available in all the rooms, including communal living space. Written information about the home in the form of a service user guide, and a copy of the most recent inspection report, are available from the home. Care Homes for Older People Page 5 of 28 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: one star adequate 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 1 star. This means that people who use this service experience adequate quality outcomes. This was an unannounced inspection carried out by Janis Robinson, regulation inspector. Prior to the visit the manager had completed an Annual quality Assurance Assessment (AQAA), which detailed what the service was doing well, what had improved since the last inspection of 11/09/2007, and any plans for improving the service in the next twelve months. Care Homes for Older People Page 6 of 28 On the 3rd of December 2008, a day was spent at the home talking to people living there, staff and the manager. Two staff were formally interviewed about their skills and experience. An inspection of parts of the environment was undertaken. A selection of records was examined, including two peoples care plans and records related to the running of the home. At the time of this inspection fees ranged from 355 to 405 pounds each week. What the care home does well: What has improved since the last inspection? What they could do better: Care plans must fully describe the actions required of staff so that peoples individual needs and preferences can be met. Care Homes for Older People Page 8 of 28 Care plans must be regularly reviewed so that they are kept up to date. Further activities should be provided to improve choice. All staff must be provided with Safeguarding Adults training to keep people safe. The stair carpet must be cleaned or replaced to maintain standards in the environment. Radiators must be risk assessed and appropriate action taken so that risk is minimised and people are safe. Thorough recruitment procedures must be adhered to so that people are protected. The quality assurance system must incorporate sending surveys to people and publishing the results of these so that peoples views are obtained and acted upon. Staff should be provided with supervisions at the recommended frequency to ensure they are appropriately supported and appraised. Fire systems must be checked more frequently, in line with written procedures to keep people safe. All staff must be provided with statutory training at relevant intervals to maintain their skills. 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 28 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 28 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. Peoples needs were assessed prior to moving in to the home to make sure these could be met. Evidence: The manager was asked about the assessment process. She confirmed that no person would be admitted without an assessment taking place. Three peoples care plans were checked. Each contained a copy of the assessment carried out by the homes manager. Information from the assessment was reflected in the care plan. Copies of social workers assessments were obtained where available. These were also seen in the files checked. Care Homes for Older People Page 11 of 28 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. Care plans did not include sufficient information for staff to ensure individual needs were met. Safe medication systems were adhered to so that people were protected. Staff were inclusive and positive towards people so that they felt respected. Evidence: Two care plans were checked in detail. The plans contained a range of information and detailed peoples hobbies, likes and dislikes and preferred routines. Whilst care needs were identified, there was limited information on the staff actions required to meet identified needs. For example, plans stated One carer to assist with personal care. There was no guidance on how this assistance was to be carried out, or how people would prefer to be assisted. Both care plans checked had not been consistently reviewed on a monthly basis to make sure they were up to date. Care Homes for Older People Page 12 of 28 Evidence: The records seen and interviews with staff showed that peoples health care was monitored and met. Records showed regular contact with health care professionals and staff seemed clear about how to contact relevant support. The staff spoken with could describe individuals needs. People spoken with felt well cared for. Comments included; Its smashing here Its marvelous, the girls (staff) do a good job. I can see my doctor when I want Ive been here six years and its alright up to now A medication policy was seen to be in place. Medication systems were discussed with the senior on duty and part of a medication round was observed. Medication was administered safely and staff made sure all tablets had been taken before Medication Administration records (MAR) were completed. Medication was stored securely. MAR sheets were sampled, these were all up to date and had been fully completed. The sampled MAR sheets tallied with the drugs held. From observation of care practices and talking to people it was clear that staff were respectful towards people. Shared conversations and laughter was heard throughout the day. All of the people spoken with felt that staff were polite and respectful. Staff evidenced close communication and a commitment to people living at the home. People said that they were happy. Care Homes for Older People Page 13 of 28 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. People were supported to make decisions so that they had some control over their lives. Limited activities were offered to people, which restricted their choice. A varied diet was provided to respect preferences and maintain health. Evidence: Some activities were offered to people. Care staff said that these usually took place in the afternoons, when they were available. People said that activities such as quizzes, bingo, crafts, music, gardening and manicures were offered. The manager said that since the last inspection she had employed Motivation and Co,a company that provided activities. They visited the home every four weeks. Records were kept of the activities provided to people. Some people said that they would like the activity company to visit more regularly. Some staff said that this would benefit people, as their capacity to provide activities was limited. People spoken with said that there was an open visiting policy and their relatives could Care Homes for Older People Page 14 of 28 Evidence: visit at any time. People said that they could see their visitors in private in their own rooms if they wanted to. Throughout the day staff were seen to offer people choices and respect their decisions. People were free to choose to spend time in communal areas, or have privacy in their own rooms. People spoken with said that they could go to bed and get up as they wished. Care plans contained some detail of preferred routines. Weekly menus were sampled and part of the mid day meal was observed. The cook was aware of special diets and confirmed that alternatives to the menu were always available. There were plentiful supplies of food in the kitchen and fresh fruit was provided in communal rooms. Staff said that they had access to food at all times so that they could prepare a snack if people were hungry. The menu appeared varied. All of the people spoken with said that they enjoyed the food and confirmed that choices were offered. The mid day meal was a social occasion that appeared to be enjoyed by people. People said The food is good and we get a choice Its a nice place to eat. If you dont want your meal staff will get you something else Care Homes for Older People Page 15 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A complaints procedure was in place to make sure peoples concerns were responded to. Gaps in Safeguarding Adults training did not fully protect people. Evidence: A written complaints procedure was in place and seen. A record of any complaints was kept, which detailed the action taken and the outcome of the complaint. Staff spoken with were clear of the complaints procedure and knew to record any complaint received, however minor. People spoken with said that they had no worries or concerns, and were confident that the staff and manager would listen to them. Comments included; I have no worries or concerns, I am happy here If I was worried about anything I would go to Tracy (manager) and Im sure she would sort it out Tracy and the staff are very good. They take time to listen to you A Safeguarding Adults procedure was in place. Records seen showed that Safeguarding Care Homes for Older People Page 16 of 28 Evidence: Adults training was provided to staff. However, some staff had not undertaken this training. All of the people spoken with said that they felt safe at the home. Care Homes for Older People Page 17 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was in the main, well maintained and decorated so that people had a safe and pleasant home. Some radiators were uncovered, which created a potential risk. The stair carpet was marked and dirty,which detracted from the well maintained appearance of the home. Evidence: A tour of the environment was undertaken. The home was well decorated and well maintained, on the whole. Communal areas appeared comfortable, ornaments and pictures were in place to create a homely environment. Peoples bedrooms were well personalised and contained personal possessions, which evidenced that people had some control over their personal space. The home was clean and fresh smelling. However, some bedrooms had hot radiators that were not covered. Chairs were placed in front of some uncovered radiators which posed a further risk if people slipped whilst trying to get into their chair. Whilst the majority of the home was clean, the main stair carpet was very stained and dirty and did not reflect standards in the rest of the home. People spoken with said that they were comfortable with the accommodation provided. Care Homes for Older People Page 18 of 28 Evidence: Comments included; My room is lovely, I have everything I need I am always comfortable here. I like to spend time with other people in the lounge, but can spend time in my own room if I want. Its lovely Care Homes for Older People Page 19 of 28 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. Sufficient staff were provided to meet peoples needs. Inadequate recruitment procedures placed people at risk. Staff training and induction was provided to equip staff with relevant skills. Evidence: The staff rota was checked which showed that staffing levels were maintained. All of the people spoken with felt there was enough staff to meet their needs. In the AQAA the manager stated that of the 20 care staff, 5 had achieved National Vocational Qualifications (NVQ) at level 2 in care. A further 4 staff were working towards this qualification. Two staff files were checked. Neither contained all of the required information. One file did not have an application form, but contained an Application of interest for position of care assistant, which did not ask for any details of previous employment. One file did not contain any proof of identity or a photograph. Both files contained two references and evidence that a Criminal records Bureau (CRB) check had been completed at enhanced level. Care Homes for Older People Page 20 of 28 Evidence: Training records and discussions with the manager and staff showed that formal induction training took place. The induction training took place over 6 days and included topics on dementia awareness, diabetes and dealing with challenging behavior. Records showed that a programme of ongoing training was provided to staff. Care Homes for Older People Page 21 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples views were not formally obtained so that these could be acted upon. Records of peoples finances were not available so that these could be monitored, checked and inspected. Staff were not provided with regular supervision and training to make sure their skills were updated. Insufficient fire training and system checks took place to make sure people were safe. Evidence: The manager was experienced and qualified. People living at the home and staff spoken with said that the manager was approachable and supportive. It was evident from observations that peoples views and opinions were sought on a Care Homes for Older People Page 22 of 28 Evidence: daily basis. However, discussions with the manager showed that no formal surveys had been sent to people and their representatives to obtain their views and act upon these as part of a quality assurance procedure. Whilst a system to keep peoples monies safe was in operation, records relating to this were not available at the home. Head office kept computerised accounts of all spendings. The manager kept a petty cash amount and any monies spent for individuals, for example on hairdressing, was logged and sent to head office. Any spending would be billed to relatives. The manager had no access to full records and was unaware of the amounts people had. Whilst the staff spoken with confirmed that they received supervision, the records examined showed that individual supervisions did not take place at the recommended frequency. Staff said that there were regular staff meetings where they could voice their opinion and felt listened to. A range of policies and procedures were in place and seen. Some polices had not been reviewed for a number of years. A health and safety policy was in place. Systems were checked and serviced. However, the records examined showed that weekly fire alarm checks had not been undertaken consistently. The last recorded fire drill took place in December 2007, and stated that six staff had participated. There was no system in place to monitor this and ensure all staff participated in a drill. Mandatory staff training records were checked. These showed that some staff had not been provided with all statutory training at relevant intervals. Some staff had not been provided with food hygiene, moving and handling and health and safety training since March 2006. Care Homes for Older People Page 23 of 28 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 35 17 Ensure that records are 11/10/2007 completed appropriately and available for inspection at all times in relation to: Service users finances Records of the above are required by regulation for the protection of service users. PREVIOUS TIMESCALE 04/07/07 NOT MET. URGENT ACTION REQUIRED. Failure to comply with this regulation is an offence. Care Homes for Older People Page 24 of 28 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 7 15 Care plans must fully 28/02/2009 describe the actions required of staff so that individual needs can be met and preferences respected. 2 18 13 All staff must be provided with Safeguarding Adults protection training to keep people safe 28/02/2009 3 24 23 The marked stair carpet 31/03/2009 must be cleaned to eradicate stains, or replaced so that the home is clean and well maintained 4 25 13 All radiators must be risk assessed and appropriate action taken to eliminate risk 28/02/2009 5 29 18 Staff files must contain proof 28/02/2009 of identity and a photograph so that full and safe procedures are adhered to Care Homes for Older People Page 25 of 28 6 29 18 Full application forms, which 28/02/2009 detail employment history, must be obtained for every member of staff and potential care worker so that full procedures are adhered to and people are kept safe 7 33 12 The quality assurance 31/03/2009 system must include sending surveys to people. The results of surveys must be audited and published so that relevant information is available to people. 8 35 17 Records of peoples finances must be available for inspection so that these can be checked 28/02/2009 9 38 13 Fire alarms must be regularly checked, in line with written procedures so that people are kept safe 28/02/2009 10 38 13 All staff must participate in a 28/02/2009 fire drill at regular frequencies, in line with written procedures so that they know how to respond in an emergency 11 38 18 All staff must be provided with statutory training at relevant intervals. Staff must be provided with moving and handling, food hygiene and health and safety training 31/12/2008 Care Homes for Older People Page 26 of 28 to update their skills and knowledge 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 2 12 28 Further activities should be available to people so that they have more choice. Fifty percent of the staff team must be qualified to NVQ level 2 in care so that appropriately skilled staff are provided. Supervisions should take place at leat six times each year so that staff are appropriately supported and appraised. All written policies and procedures should be audited and reviewed where necessary so that they are up to date. A system to monitor statutory training should be implemented so that staff are provided with training at relevant frequencies to maintain their skills. A system to monitor staff participation in fire drills should be implemented so that all staff are provided with this training at relevant frequencies. 3 4 5 36 37 38 6 38 Care Homes for Older People Page 27 of 28 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 28 of 28 - 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!