Inspection on 02/02/09 for Hollie Hill Care Home

This inspection was carried out on 2nd February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hollie Hill Care Home 07/02/07

Hollie Hill Care Home 25/01/06

Hollie Hill Care Home 16/06/05

Hollie Hill Care Home 13/01/05

Hollie Hill Care Home 30/07/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hollie Hill Care Home Durham Road Stanley Durham DH9 6QZ     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: Sam Doku     Date: 0 6 0 2 2 0 0 9 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 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: Hollie Hill Care Home Durham Road Stanley Durham DH9 6QZ 01207280948 01207280946 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Tamaris Healthcare (England) Ltd Name of registered manager (if applicable) Mrs Janis Watson 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 physical disability Additional conditions: People with dementia over the age of 65 years of age to be accommodated within the 32 bedded unit for older people with dementia. These beds are not registered for the provision of continuous nursing care. The home may accommodate two service users under the age of 65 with a Physical Disability to reside in the general older persons unit. Date of last inspection Brief description of the care home Hollie Hill is a purpose built home that was opened in July 1996. Built to a high specification, it provides each resident with an individual room with its own en suite toilet and hand wash facility. The home is tastefully decorated throughout and residents are encouraged to bring their own pictures and small pieces of furniture to make their rooms more homely. Each section of the home has its own dining facilities Care Homes for Older People Page 4 of 27 0 0 2 Over 65 32 30 0 care home 62 Brief description of the care home and separate lounge. Bathrooms, showers and additional toilets are located throughout the building and all are fitted with special aids. The philosophy of care is based on 6 key principles: privacy, dignity, independence, choice, rights and fulfilment. The home is registered primarily for two groups of service users: 30 Older people with or without nursing care needs, and 32 people over 65 with dementia who do not need nursing care. These two groups are accommodated in two separate units. Hollie Hill aims to ensure that service users will receive the level of care that their own situation requires, to satisfy physical, personal, social, spiritual and emotional needs. The fees charged are between 417 and 477 Pounds per week, which does not include hairdressing and personal newspapers. 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: 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 of this service is 1 Star. This means the people who use the service experience adequate quality outcomes. The inspection was unannounced and commenced on 2 February and completed on 6 February 2009. Before the visit the inspector looked at: Information we have received since the last inspection visit on 30 January 2008. How we dealt with any complaints and concerns since the last inspection. Care Homes for Older People Page 6 of 27 Any changes to how the home is run. The views of the people who use the service through talking to them. During the visit the inspector did the following: Talked to the people who use the service, the acting manager and the care staff. Looked at information about the people who use the service and how well their needs are met. Looked at other records which must be kept. Checked that staff have the knowledge, skills and training to meet the needs of the people they care for. Looked around the home to make sure it is safe and secure. Checked what improvements have been made since the last inspection. The inspector told the manager what he found. We have reviewed our practice 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. What the care home does well: What has improved since the last inspection? What they could do better: The staff indicated that there is very limited storage space in the home. This has led to a number of rooms having no space to store inco-pads and these were fully on display in some of the bedrooms. This compromises the dignity of the residents who live in those rooms. Staff morale appears very low and staff commented on the divisions between staff teams and how this is having a negative impact on the care that is delivered. Some staff commented on what they described as bad attitude of some of the care staff who want the home to be run to suit them. The staff supervision notes that were examined should no details of any discussions between the supervisor and the person doing the supervision. Some of the supervision Care Homes for Older People Page 8 of 27 notes were not dated nor signed by the carer or the person doing the supervision. Furthermore, most of the supervision records that were examined only dated from between July and November 2008, and not all staff have received regular supervision. The care plans that were viewed lacked detail of how some specific care needs are to be provided. For example, one care plan tells staff to prevent X from getting bored whenever possible. There was no further information for the staff to follow on how to prevent him from becoming bored. There were similar examples of lack of details to the care plans. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is good information about the home, including invitation for prospective residents to visit the home, and to use the occassion to assess the home for themselves before making up their minds about coming to live at Hollie Hill care Home. Furthermore, assessments are carried out for all new residents to make sure that the home has the necessary skills and facilities to meet their needs and to promote their health and welfare. Evidence: The manager spoke with a number of residents who confirmed that the home supplied them with information about the home when they were looking for a place. All the residents have been given a copy of the service user guide and some had these in their rooms. Information about the home is also available in the reception area for residents and visitors to see. Care Homes for Older People Page 11 of 27 Evidence: The acting manager and the staff confirmed that it is the policy of the home to invite prospective residents to the home and to use that opportunity to meet with the staff and the residents. Four of the residents who were spoken with confirmed that they had the opportunity to visit the home. Two residents said that they and their relatives came to look around the home and they found the experience extremely helpful. It is the homes policy to receive an assessment from a social worker or a nurse assessor before admission is arranged. The home also carries out their own assessment before confirming a place. A number of files were examined and there was evidence of social worker assessments and also of the homes assessments. A senior staff stated that these assessments are used to devise the care plans for the residents when they first come into the home. The home does not provide an Intermediate Care service. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal and healthcare needs of the residents are met, and care plans have been put in place to help staff address their needs. However, some of the care plans lack details and would need to be more specific to reflect the specific care needs that individuals may require. The residents are generally treated with dignity and their right to privacy is upheld. Evidence: Residents confirmed that they have access to healthcare facilities including GP support and other healthcare professionals. Residents gave examples of how the nursing staff regularly arrange for them to visit their GPs when required. The residents files provide details of the healthcare support that each individual resident gets. The care notes show entries of visits to or by healthcare professionals, including district nurses, psychiatrist, community psychiatric nurses, optician, chiropodist and dentist. Six residents care plans were examined as part of the case tracking. The quality of the Care Homes for Older People Page 13 of 27 Evidence: care plans are variable. Some of the recently formulated care plans are well written and provide good information for staff to follow when providing specific care tasks. Of the six care plans that were examined, one stands out as a good example of the good care and attention that residents receive. This particular care plan is one of the newly developed ones called Care and Health Assessment Profile (CHAP). The care plans are very general and do not provide the same level of details that the CHAP care plans have. Care plans relating to peoples psychological social care needs should be more specific so that staff would know exactly what is expected of them when carrying out that task. For example, in one case the care plans simply stated that staff should try to prevent the resident from getting bored whenever possible. The plan did not state what staff should do to avoid boredom for the resident. The home has policies on the storage and administration of medicines. The nurse in charge confirmed that the nursing staff and the senior care staff who are responsible for the administration of medicines have received up to date training in safe handling of medicines and follow the homes medication policies. A random check of the medicines administration system was undertaken by the inspector. There were no discrepancies noted, and the administration sheets have been signed and dated as required. The staff were observed to relate very well with the residents and there was obvious respect between staff and the residents. Two relatives were spoken with and they confirmed that the staff treat residents with respect and dignity. The staff were polite, courteous, friendly and professional in the way they interacted with the residents. Staff were also noted to respect the privacy of the residents. Staff were observed to knock on bedroom doors before making entry. However, from the responses from the residents questionnaire one resident was critical of some of the care practices in the home. These issues are being dealt with separately through the safeguarding of vulnerable adults route. 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. The home provides activities that are enjoyed by the residents. Furthermore, families and friends are encouraged to contribute to the residents sense of wellbeing by being supported and encouraged to visit regularly. The residents are provided with good variety of wholesome and nutritious meals, which promotes their health and wellbeing. Evidence: Residents stated that the activities organiser is very proactive in ensuring that there is always something for them to do when she is on duty. The residents described the activities that are organised for them. They include gentle exercise activities, bingo, card games, sing-a-long, films and outings. They commented that they always look forward to organised activities and praised the activities coordinator for her commitment. At the time of the inspection, a small group of residents were engaged beauty therapy acivities. The staff commented that having access to the minbus provides the opportunity for outings with small groups of people at a time, including wheelchair users. Care Homes for Older People Page 15 of 27 Evidence: Residents confirmed that they get up and go to bed when they want. One resident said at my age I like to have an easy life and the staff dont bother me if I decide to have a lie-in. At the time of the inspection, there were a number of residents who were having their breakfast in their rooms. Residents said they are provided with cups of tea when they first get up in the morning. The dinning areas are pleasantly decorated and furnished to a good standard. The inspector had his lunch with the residents on the dementia unit. The tables were appropriately set and residents had their meals in pleasant and comfortable environment. The residents were given plenty of time to enjoy their lunch and people who require help from staff with the meals were given that support in ways that preserved their dignity. Residents said they like the food and that there is always plenty to eat. They described the food as excellent and they commented on the choice of menus that they get. However, one residents said although he does not like some of the foods provided, on the whole they get good variety and plenty to eat. Smoking is only permitted in the designated smoking room on the first floor. Residents can also smoke in the back garden if the weather permits. One resident commented that he would prefer to keep his own cigarettes on him as he feels it is most inconvenient for him to ask for a cigarette whenever he wants one. 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 and relatives have information about how to make a complaint thus promoting the residents right to express their views about the service. Staff are aware of safeguarding adults procedures and have received suitable training which help safeguard the residents from any form of abuse. Furthermore, there are suitable arrangements in place for accounting for the residents personal allowances. Evidence: The home has a complaints procedure and a copy of this is posted in the reception area for residents and visitors to see. A summary of the complaints procedure is also included in the service user guide. The inspector spoke with residents and relatives about the complaints procedure and they all said that they are aware of the procedure and feel confident about raising any concerns with the staff if they were unhappy about anything. Staff members were also spoken with about the homes complaints procedure. Staff showed good knowledge and understanding of the complaints policy and procedure, and knew how to support residents if they wish to make a complaint. The acting manager confirmed that all the staff have had training in safeguarding adults and arrangements are being made to provide a refresher training to some of Care Homes for Older People Page 17 of 27 Evidence: them. The training plan for 2009 confirms the arrangements that are in place for further refresher training on safeguarding veneralble adults. The home has a good system in place for accounting for the residents personal allowance. Receipts are available for purchases made on the residents behalf. A random check of the accounts showed no discrepancy in the amount of monies held for the individuals. 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 home provides safe, secure, clean, warm and provides a pleasant environment for the residents to live in. Evidence: The home is clean and maintained to a good standard. Individual bedrooms that were visited were clean, appropriately furnished and maintained to a good standard. However, some of the furniture are beginning to suffer from wear and tear. The dinning room tables in the dementia unit are also suffering from wear and tear. The residents have been encouraged to bring into the home their personal items such as pictures, photographs and small items of furniture to furnish their rooms with. As a results some bedrooms look homely and reflect individual tastes and preferences. All radiators have protective coverings and windows have restrictors on to stop intruders and to ensure the safety of the residents. Bedroom doors have magnetic devices on to hold the bedroom doors open for those residents who wish to have their bedroom doors open. The communal areas were clean and pleasantly furnished. People who were visiting the home stated that the home is always clean and has never had bad odour. Comments from the service user surveys were complimentary about the cleanliness of Care Homes for Older People Page 19 of 27 Evidence: the home. The kitchen was well ordered and clean. The kitchen staff have maintained good hygiene standards. The maintenance man has a record of all the work that he does in the home to keep it in a good state of repair. There are written policies covering all aspects of the running of the home, including health and safety. 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. The staffing numbers are satisfactory and promote the safety and welfare of the residents. However, concerns have been raised by some staff members about the poor attitude and uncaring nature of some staff, which negatively impact on the welfare of the residents. The home adheres to good recruitment practices, which safeguards the welfare of the residents. Evidence: The home employs sufficient number of staff to meet the needs of the residents. There is a registered nurse on duty at all times including night duties. Staff were spoken to about the staffing levels in the home. They all said that the staffing levels are always adequate. Most of the staff who were spoken with expressed concerns about the management leadership in the home and felt that the lack of a permanent manager is having negative effect on the moral of the staff team. This sentiment was also expressed by a relative and one other resident. Some staff described the present staffing situation as staff belong to different camps. Staff described the attitude of some staff as disruptive and sometimes uncaring. One staff member described how some care staff can be overpowering and wanting Care Homes for Older People Page 21 of 27 Evidence: everything to be the way they want it. Another staff member described some unnamed staff members as a click and being a law unto themselves. The acting manager confirmed that the staff have received training in moving and handling, first aid, protection of vulnerable adults, fire safety, food hygiene and health and safety training. The nursing staff continue to receive refresher training to update them on nursing practices. Staff records show the training that they have received. Four staff files were examined to check on the recruitment process by the manager. The files show that the home has been following good recruitment procedures. All the files contain completed job applications, copy of job description, appropriate references, evidence of CRB checks and record of induction and training. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the absence of a permanent manager, there is a lack of continuity of management oversight, which appears to have an adverse effect on the quality of the service provided. Evidence: At the time of the inspections visits, the home was being managed by a peripatetic manager who was taking temporary charge of the home untill a new manager is appointed. Staff and relatives commented that the lack of a permanent manager was having an adverse effect on the moral of the staff. Some staff felt that they are not getting the leadership that they need to bring stability to the home. However, they commented that the temporary manager has been doing a very good job in ensuring that the home continues to operate and provide care that meets that needs of the residents. By the time this report was completed, the inspector was infromed that the newly Care Homes for Older People Page 23 of 27 Evidence: appointed manager taken up her position ans is now working in the home. Examination of staff records show that staff supervision is not taking as regular as they should have been. The records show supervisions as taking place between July and November 2008. The quality of the supervision notes were poor, and some supervision sessions have not been dated or signed. The providers Health and Safety policies remain in place. These cover policy areas such as fire prevention and Care of Substances Hazardous to Health (COSHH). There is evidence that staff adhere to the policies as set by the provider. Servicing and maintenance records show that all portable appliances have been tested. A record is maintained of regular water temperature in bedrooms, toilets and bathrooms. Regular servicing of fire equipment, passenger lift, bath lifts and hoists, gas and electrical appliances have been carried out by the contracted companies. All the servicing records that were examined were up to date. The homes fire risk assessment is up to date. Records examined indicate that fire precautions relating to weekly fire alarm testing and record of inspection takes place. There are records in the home indicating fire drills and fire instructions with staff. The acting manager confirmed that all staff have received up to date fire safety training and further training has been planned for those who require refresher training in fire safety. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 All the residents care plans must be reviewed and updated to refelct teh needs of the residents and how those needs are to be addressed by the staff. The care plans lack details of how specific care should be provided. 13/04/2009 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 10 The display of inco-pads in residents bedrooms should be urgently reviewed and suitable a arrangement made to store these appropriately to preserve the dignity of the residents concerned. All staff should receive regular one to one supervision. These should be properly documented, dated and signed. 2 36 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!