Inspection on 20/01/09 for Hollybank Nursing Home

This inspection was carried out on 20th January 2009.

CSCI found this care home to be providing an Adequate 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

Hollybank Nursing Home 20/01/10

Hollybank Nursing Home 28/05/08

Hollybank Nursing Home 31/05/07

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hollybank Residential Care Home 211a Bolton Road Radcliffe Manchester Lancashire M26 3GN     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: Michael Murphy     Date: 2 0 0 1 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: Hollybank Residential Care Home 211a Bolton Road Radcliffe Manchester Lancashire M26 3GN 01617235756 01617249693 hollybankdualreg@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : QNS Residential Limited care home 30 Number of places (if applicable): Under 65 Over 65 30 old age, not falling within any other category Additional conditions: 0 The registered person may provide the following categories of service only. Care home only - code 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 - Code OP, The maximum number of service users who can be accommodated is: 30 Date of last inspection Brief description of the care home Hollybank is operated by QNS Residential Limited. The home provides 24-hour care for up to 30 older people. The property is on Bolton Road Radcliffe and is about one mile from the town centre. There is a bus stop on the main road close to the home and there are shops nearby. The accommodation is provided on two levels with a lift giving access to the first floor. The home has fourteen single bedrooms and eight rooms that are shared. Thirteen bedrooms have an en-suite toilet and hand basin. There are two lounges and there is a separate dining room. Toilets and bathrooms are provided on both floors. Care Homes for Older People Page 4 of 27 Brief description of the care home The home has a garden area with seating that can easily be reached from the conservatory. A Service User Guide that describes the homes services is readily available in the home and the staff give other information about the home to new and prospective residents and their families verbally. A copy of the latest inspection report, the homes Statement of Purpose and copies of the homes policies and procedures are also displayed in the home. At the time of this inspection the weekly charge for accommodation and services range from 364.95 pounds to 384.95 pounds with additional charges being made for hairdressing and chiropody services. 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: This inspection included an unannounced visit to the home on the 22nd of January 2009 between 9am and 530pm. During the visit we talked to residents, relatives, staff, the acting home manager and the owner of the home. We also looked at documents and records the home have to keep such as residents care records, medicine records, written policies and other records. Care Homes for Older People Page 6 of 27 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 7 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 8 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. Peoples needs are assessed before they move into the home to ensure that their care needs can be met. Evidence: Before being admitted prospective residents are assessed by senior staff from Hollybank. The purpose of this assessment is to make sure the home can look after them properly by meeting their care and support needs. Prospective residents and their family said they were actively involved in these assessments and that their views were taken into account. The assessment before admission is used to develop the plan of care to be developed following admission to the home. Additional information is also obtained from assessments that have been done by social workers. All newly admitted residents have their placement formally reviewed within about 6 weeks of admission. Care Homes for Older People Page 9 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs so they receive personal care in a way they prefer and in a way that shows respect for their privacy and dignity. Evidence: The way care records are kept have been reviewed and (as we required) improved since the last inspection. The care records of 4 residents were inspected during the inspection. These contained care plans that describe how each individual resident needs to be supported and cared for properly. The care plans also identified what residents could do for themselves, which helps them maintain their independence. Care records also identified what areas of risk were an issue for individual residents and how such risks could be reduced. For example identifying the risk of poor mobility and describing what to do to maintain mobility as safely as possible. Care records looked at were being reviewed regularly and up to date. However it is recommended that the daily progress notes made by staff are all timed to ensure a completely accurate record is made. Residents were registered with a local GP and were accessing Care Homes for Older People Page 10 of 27 Evidence: health care services such as those provided by opticians, chiropodists, district nurses and other specialists. Residents medicines were in the main looked after properly. They were kept securely and residents medicine administration records were properly documented. However there was no written record of medicines that were returned to the chemist. To maximize the safety of medicines in the home the need to address this was discussed with the home owner on the day of inspection. Medicines were looked after and given to residents by senior care staff who have had appropriate training in doing so. Residents and visitors spoken to said that staff were respectful to them and sought to protect the privacy and dignity of residents at Hollybank. Comments included that staff were very good and very helpful, they are very nice, whenever I have been to the home (and this is supported by other members of the family and friends) the staff have always been respectful with everybody and respect their dignity, I like it here and am well looked after. Care Homes for Older People Page 11 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. Whilst social and leisure activities are provided for residents these need to be reviewed and amended to ensure the times these are available are extended and more flexible. Residents dietary needs were being appropriately met and they were able to make personal choices in their daily life. Evidence: A range of leisure and social activities were being provided and included bingo, boardgames, armchair exercises, singsongs, music and discussions about times gone by. However whilst such activities appeared to be appropriate for and enjoyed by residents it was noted such activities were organized each day between 1pm and 2pm. It is recommended that the arrangements for residents social and leisure activities are reviewed and amended to ensure the times these are available are extended and more flexible. This can only increase for residents opportunities for stimulation through leisure and recreational activities. There have been no outings organized for residents over the winter period (the weather has been particularly bad) but we were informed it was planned to organize appropriate outings for the spring and summer. The home was well provided for in respect of televisions, DVD players, music centers, radios and books/magazines. Care Homes for Older People Page 12 of 27 Evidence: Home routines although fairly structured appear to be as reasonably flexible as is practical in a care home setting. Care records detail individuals preferences, choices and interests. Discussion with residents, relatives and staff indicate that residents are enabled to maintain contact with family and friends and there were no unreasonable visiting restrictions, Residents can receive their visitors in private - either in their own room or a quieter lounge area in the home, one visitor commented that when they have visited (at a variety of unannounced times) there has never been a problem with visiting, they have always been made welcome by staff and privacy was ensured. Discussion with some residents, relatives, staff and inspection of care records indicate that residents are encouraged and enabled to make choices and exercise control over their lives, whilst at the same time being kept safe. The dining room was a pleasant, suitably heated, well lit and ventilated room. It was suitably/appropriately furnished, tables were appropriately set and the room overlooks the well maintained gardens. Menus were varied, balanced and provided choice. Mealtimes were reasonable and as flexible as possible in a care home setting - especially breakfast when residents are provided with their breakfast as they get up. Lunch was observed on the day of this unannounced inspection. This was a hot substantial 3 course meal, good portions were provided and the meal was well presented. Residents were seen to enjoy this meal. Staff served and assisted residents appropriately and sensitively. Meals are prepared by a qualified cook. Care staff did not prepare meals - although they do prepare light snacks snacks outside main meal times as required. Residents spoken to and comments from visitors and staff indicate food is of a consistently good quality, alternatives to the menu can always be had and snacks and drinks are provided at all times. Care Homes for Older People Page 13 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an accessible procedure in place to deal with complaints. There are also procedures in place that describe how to protect residents and keep them safe. However although some staff have received safeguarding training this needs to be extended to all staff. Evidence: There is a procedure in place for any complaints that are made to be recorded and investigated. The procedure was prominently displayed in the home and was accessible to residents, relatives (and other visitors to the home) and staff. There were no complaints recorded since the last key inspection in May 2008. Residents and relatives spoken to indicated that issues raised are addressed promptly by the owner and rarely need to be formalized as complaints. One comment made was they listen if you have a problem and do something about it quickly and that gives me confidence in them. There are policies and procedures for safeguarding residents (these, along with other policies and procedures in use at the home were being revised at the time of this inspection. Staff on duty were aware of the importance of keeping residents safe. Whilst arrangements had been made (as required at the May 2008 key inspection) for some staff to receive safeguarding training this needs to be extended to all staff. This was discussed with the owner of the home on the day of inspection. They indicated that this would be addressed promptly. Also (as detailed in the staffing section of this Care Homes for Older People Page 14 of 27 Evidence: report) the staff recruitment process needs to be tightened up to improve protection of residents. Care Homes for Older People Page 15 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 provided a clean, pleasant, comfortable and suitably adapted environment for residents. Evidence: The building appeared to be in a good state of repair and decoration. The lounges and dining areas were clean, appropriately and adequately heated, comfortably and appropriately furnished and provided a suitable environment for residents to be cared for and supported properly. Televisions, music centers and other leisure equipment were available throughout the home. Suitably adapted bathing and toilet areas were provided. The home has generally been suitably adapted and equipped to meet the needs of residents. For example there is an adequate provision of hoists, grab rails, a passenger lift and other equipment. Individual residents specialist needs are met after referral to the appropriate health care worker for assessment. Residents bedrooms that were inspected were clean, suitably furnished and equipped and personalized. However not all bedrooms are provided with a lockable space for residents use. The owner of the home recognizes this and informed us that this issue was being addressed. The home was very clean and odors were managed well. Suitable arrangements were in place to manage residents laundry needs. And appropriate measures were being Care Homes for Older People Page 16 of 27 Evidence: taken to minimize the potential spread of infection within the home such as adequate hand washing facilities and the provision of protective clothing for staff as well as appropriate cleaning practices within the home. Care Homes for Older People Page 17 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. Adequate numbers of staff appeared to be provided to support residents however the procedure for the recruitment of staff needs to be improved to ensure as far as possible residents are being supported by suitable people. Also staff training needs to be improved to ensure they have all the skills to support residents properly. Evidence: Staffing arrangements at the home appeared to be supporting residents and ensuring their needs were met. There was always a senior carer on duty who leads a team of carers. Discussion with residents (and relatives) revealed they were of the view sufficient staff were available to make sure they were looked after. There are also appropriate arrangements in place to ensure there were sufficient staff in respect of the administration, catering, laundry and housekeeping functions of the home. However improvements need to be made in respect of the home recruitment process. This is important to ensure residents are being cared for and supported by suitable people. The recruitment process included the submission of a written application, seeking proof of identity (including a photograph of the applicant), obtaining written references, making police checks and another check regarding the suitability of the applicant working with vulnerable people. However of the three staff files inspected none contained a declaration in respect of the applicants health status and one lacked any explanation for a considerable gap in the applicants previous employment history. Care Homes for Older People Page 18 of 27 Evidence: In order to maximize the protection provided for residents it is required these omissions are rectified. The arrangements for training staff to ensure that residents care and support needs are being met by competent staff have improved since the last inspection. However the lack of a home manager since September 2008 has meant that the focus on staff training has lessened. The owner of the home has told us a new manager has been recruited (to commence the week following this inspection) and one of their first priorities will be to review the existing training plan and ensure staff receive updates to relevant training in the near future, for example in respect of safeguarding and fire safety. However over 50 of the care staff have obtained a national qualification in care (NVQ). The remaining carers were undergoing this training or expected to do so in the near future. Care Homes for Older People Page 19 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. Whilst the view was expressed that the owner and senior staff were available and responsive to issues the home did not have a registered manager at the time of this inspection. A number of management and administration issues were identified that needed to be addressed. Evidence: The position of home manager has been vacant since September 2008. Since then the home has been managed by an experienced senior carer and the home owner. We were informed during this inspection that a new manager has been recruited (to commence the week following this inspection). The legal requirement and importance of having a registered manager in post was discussed with the home owner. We are of the view that the issues identified in this report - in respect of staff training, health and safety issues and recruitment process, and the checking of quality within the home- need to be addressed through effective and consistent management. However residents, relatives and staff said that the home owner and senior care staff were Care Homes for Older People Page 20 of 27 Evidence: easey to get hold of, listened to what they had to say and took action in response to their issues. The home does survey residents and relatives in respect of their satisfaction about the service and support provided. However there was no evidence that the way things are done in the home are regularly reviewed. For example to measure the quality of the service provided regular checks should be made to establish how effectively care and support is provided and how the home is being managed. Regularly assessing the quality of the service provided is important in helping to ensure that the home is run in the best interests of residents. Residents and relatives are encouraged to control residents finances where possible and at the time of this inspection the home only managed a small amount of personal allowances for five residents at the home. The arrangements for this were secure and appropriately documented. Staff training had been provided since the last inspection in May 2008 in respect of moving people and objects safely. Whilst a fire safety procedure was in place and staff were able to describe what to do in case of a fire we could not establish when fire safety training had been provided for staff or when a fire safety drill had last been conducted. Other aspects of maintaining fire safety such as regular checks on fire fighting equipment (including the fire alarm) and the means of escape had been recorded. The way food is handled and prepared appeared to be satisfactory. Appropriate measures were in place to prevent the spread of infection such as the provision of suitable hand washing facilities, protective clothing for staff, suitable laundering procedures and arrangements to keep the home clean. The arrangements to securely store cleaning and other potentially hazardous substances were satisfactory. Written records and certificates showed that gas and electrical systems within the home had been serviced/inspected regularly. Hoisting and lifting equipment had also been serviced and inspected regularly. We were informed by the home owner that to prevent scalding hot water temperatures(in resident areas of the home) are close to 43 degrees centigrade. Whilst we were informed hot water temperatures in resident areas are regularly monitored no written records of this were being kept. It was also noted that whilst a number of central heating radiators in resident areas were covered a number had not been. We were informed that those not covered were mainly those replaced when a new gas boiler was installed. The home owner stated they were aware of the need to ensure that heating radiators were either covered or have guaranteed low temperature surfaces and were assessing the risk each uncovered radiator presents. Documentary evidence of the servicing of laundry and kitchen was seen. The building and the home grounds appeared to be regularly maintained. Security at the home appeared to be appropriate and staff answer the door to all callers to keep an eye on who is coming into the home. Care Homes for Older People Page 21 of 27 Evidence: A range of health and safety policies were being operated. We were informed that these were in the process of being reviewed (as were the other policies and procedures of the home). Care Homes for Older People Page 22 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 23 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 9 13 That a record is maintained of all medicines destroyed/returned to the chemist. To ensure an accurate account of all medicines is maintained to ensure they are being safely managed. 28/02/2009 2 16 13 Arrangements are made to ensure that safeguarding training is provided to those staff who have not been provided with such training since the last inspection. To ensure that residents are cared for and supported safely by staff who are appropriately trained in safeguarding issues. 28/02/2009 3 29 19 That all prospective employees provide an explanation of any gaps in their employment history and make a declaration in respect of their physical and mental health. 28/02/2009 Care Homes for Older People Page 24 of 27 To ensure as far as possible that residents are being supported and cared for by suitable people. 4 30 18 That arrangements are made to ensure that staff are provided with ongoing relevant training. To ensure that residents are cared for/supported properly by competent staff. 5 33 24 That a system is established and maintained that evaluates the quality of the service provided at the care home. To help ensure the home is run in the best interests of residents. 6 38 13 That arrangements are 28/02/2009 made to ensure pipework and radiators are guarded or have guaranteed low srface temperature surfaces. to minimise unnecessary risks to the health and safety of residents. 7 38 23 Make arrangements for persons working at the home to receive suitable training in respect of fire prevention and undergo fire drills. To ensure that fire safety precautions in the home are adequate and appropriate. 28/02/2009 28/02/2009 28/02/2009 Care Homes for Older People Page 25 of 27 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 7 12 That to ensure records are fully accurate all daily progress entries in the care records should be timed. That the arrangements for residents social and leisure activities are reviewed and amended to ensure the times these are available are extended and more flexible. That to enhance residents privacy a lockable space is provided in all residents bedrooms. That a record is kept in respect of the checks made on hot water temperatures that are conducted in resident areas of the home. 3 4 24 38 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!