Inspection on 23/02/09 for Hourigan House

This inspection was carried out on 23rd February 2009.

CSCI found this care home to be providing an Good 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

Hourigan House 28/02/07

Hourigan House 15/02/06

Hourigan House 14/09/05

Hourigan House 17/01/05

Hourigan House 17/08/04

Hourigan House 21/01/04

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 06/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hourigan House Myrtle Avenue Leigh Wigan Greater Manchester WN7 5QU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Debbie Corcoran     Date: 2 3 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 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Hourigan House Myrtle Avenue Leigh Wigan Greater Manchester WN7 5QU 01942672922 01942672104 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) : CLS Care Services Limited care home 40 Number of places (if applicable): Under 65 Over 65 40 8 old age, not falling within any other category physical disability Additional conditions: 0 0 The home is registered for a maximum of 40 service users to include:- up to 40 service users in the category of OP (Older People) up to 8 service users in the category of PD(E) (Adults with Physical Disability over 65) The service should employ a suitably qualified and experienced Manager who is registered by the CSCI Date of last inspection Brief description of the care home Hourigan House is a two-storey building with well maintained garden areas, situated in the middle of a housing estate, half a mile from Leigh town centre. It is close to shops and other local facilities and is well served by public transport. The Home is spacious with several lounges. All bedrooms are single and some have an ensuite toilet facility. There are ample communal toilets and bathrooms situated throughout the home. Hourigan House provides personal care and support for forty people over the age of sixty five years. The home is owned and managed by CLS Care Services Limited who Care Homes for Older People Page 4 of 28 Brief description of the care home have 40 plus homes around Cheshire and the Wigan area. The fees for residing at the home range from 440 pounds to 455 pounds per week. 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The visit to the home was not announced beforehand. During the visit the majority of residents were met and a number were spoken with either on a one to one basis or a small group basis. A sample of residents records were looked at. Other records looked at include medication administration records, staff files, staff training records and health and safety checks / records. A tour of the home was carried out which included all areas. Care Homes for Older People Page 6 of 28 Discussions took place with the manager, two members of care staff and a number of domestic staff. The manager returned a self assessment of the service prior to this visit. The self assessment enables the service provider to inform us of what they do well, where they have improved and where they can improve in the future. It also includes information on how they promote equality and diversity, how they seek the views of residents and includes data on staffing and health and safety. The self assessment is referred to as an Annual Quality Assurance Assessment (AQAA). Some of the information in this has been used to inform the findings of the inspection. What the care home does well: What has improved since the last inspection? There have been improvements to the home environment since the last inspection visit. There is a continous programme of maintenance and upgrading of the home. Improvements over the past twelve months include redecoration of lounges and bedrooms, new furniture in two lounges, improvements to the outside areas, new garden furniture has been provided and new electrical appliances have been purchased. Care Homes for Older People Page 8 of 28 A higher percentage of staff have attained a relevant qualification. There has been minimal staff turnover and therfore minimal use of agency staff. The manager has reported many more improvements in the Annual Quality Assurance Assessment including; improvements to mealtimes so that they are more peaceful and enjoyable to residents, improved contacts with the local community, more user friendly paperwork, more inclusion of residents in making decisions about the home, better auditing systems, better induction and mentoring opportunities for new staff, the implementation of new care planning, updated policies and procedures, and the provision of specialised training, for example, training in suppporting people who have dementia care needs. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.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. Residents are provided with the information they need to make an informed choice about moving to the home. Residents are only admitted when there is confidence that their needs can be met at the home. Evidence: There was an information pack available in each of the residents rooms and this included a service user guide which describes the services offered at the home. A member of staff stated that these are provided to all residents and would be provided to prospective residents prior to moving it. A number of residents records were looked at and these showed that an assessment of needs is carried out with the resident and their representatives before they move to the home. The assessments cover issues such as the persons understanding, hearing ability, eyesight, communication styles, mood and behaviour, personal care needs, Care Homes for Older People Page 11 of 28 Evidence: nutritional requirements, dental care, dietary needs, medication support needs, sleep patterns and needs, and preferred activities. The manager reported that the referring agency, for example Social Services, are asked for assessment information when a new person is referred to the home. Prospective residents and their relatives or representatives are invited to visit the home and spend some time there before deciding whether or not to move in. This was confirmed during discussions with residents. Care Homes for Older People Page 12 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. Residents are well supported with their health, medication and personal care needs and feel that their privacy and dignity is protected. Evidence: Each of the residents has a care plan. The plans for five of the residents were looked at in some detail. The care plans were easy to read and some were written in the first person. The care plans provided information on meeting the residents needs in areas such as their mental health, communication needs, eating, drinking and nutritional needs, personal cleanliness and dressing, mobility and moving and handling needs. Care plans were found to have been signed as agreed by the resident and had been reviewed monthly. It was reported by a member of staff that care plans are completed when a resident arrives at the home. However, there was one example whereby a resident had been at the home for almost 2 weeks and there was no care plan for this person. When this was discussed with the manager she stated that this was an exception to the rule and would be adressed. Care Homes for Older People Page 13 of 28 Evidence: Feedback from residents about their support with their health and their personal care was good. One resident stated staff are very good and they look after us well. Another resident said theyre very good if you need to see a doctor they get it sorted straight away. Residents said that they felt respected by staff and that their privacy was upheld when they were being supported with personal care. During interviews with staff they were able to give examples of how they maintain residents privacy and dignity when supporting them by always knocking on doors, ensuring doors are locked and ensuring the appropriate use of garments and towels. During discussions with one member of staff they stated that there were clear standards to be maintained when supporting people with their personal care and that these are always maintained by staff. Risk assessments are carried out where a resident is thought to be at risk of harm. These include risks such as falling or not eating a nutritional diet. Residents are well supported with their health care needs. Residents records showed that they are regularly supported to see their GP, nurse, optician. During discussions with residents they reported feeling well supported with their health. However, the residents care plans do not reflect what their health needs are and how these need to be met. Some of the residents had health issues which were evident when looking at GP and nurse visit contact sheets or in medication administration records, but these were not reflected in the persons care plan. Some care plans contained a health section but this was being used for an overall statement regarding the persons independence. This was discussed with the manager who stated that she was aware that this is an issue and it was because a new health section had been included in the care plans and staff were still in the process of developing the information in this. The manager has been adressing the issue in staff meetings and this was confirmed in minutes of the meetings. Alongside the lack of information on health needs was a lack of information on medication needs. The manager confirmed that this is an area which she is addressing with the development of the health section in residents care plans. A sample of medication adminstration records and medication in stock was checked. These showed that medication is recorded and administered appropriately. The storage of medication was appropriate with the exception of the storage of some eye drops and creams. A number of these were found to be being kept on a shelf in the medication room when the storage instructions directed that they should have been stored in a refrigerator. Medication is only administered by senior members of staff who have been provided Care Homes for Older People Page 14 of 28 Evidence: with training in administering medication. A member of staff stated that the residents are asked if they want to administer their own medication and that when this is the case a risk assessment is carried out for this. However, there were no residents who looked after their own medication at the time of this visit. The manager carries out an audit on medication on a 3 monthly basis. Care Homes for Older People Page 15 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. Residents have good opportunites to get involved in activites and to remain independent and exercise choice. Residents are provided with a choice of good quality food and catering arrangements are well organised. Evidence: Residents gave good feedback on activites at the home and forthcoming activities were well advertised. There is an activities organiser employed at the home and it was evident during discussions with residents that this person is valued in her role. Discussions with residents, records and observations indicate that the residents are supported to be involved in regular activities including bingo, karaoke, dominoes, entertainment, outings, films, use of computer and internet, religious services. The manager also reported good links with the local community and occassions when local people have been invited to the home. A number of residents will choose not be included in group activities and their choice to do this is clearly respected. Residents are encouraged to make choices at the home. Many of the residents are well able to express their needs and preferences and to contribute to changes at the home. Residents are given their post directly and are supported to manage their own money Care Homes for Older People Page 16 of 28 Evidence: and medication when they wish to and are able to. During discussions with residents they stated that they are free to make their own choices about things such as when to get up, where to spend the day and their own routine. Resident meetings take place on a monthly basis. The minutes of these meetings are made available in large print and written in plain language. Residents records included information on the persons previous experiences of work, leisure, likes, dislikes, history and pastimes and information on activities which they are keen to continue. This information was referred to as My Life Profile. It was noted that there was some difference in the level of information contained in these but in essence they provide staff with information on what has been and what continues to be important to the person concerned and how they can maintain their individuality. Residents records also included a consent form. These indicate that residents have been asked to give their consent to issues such as access to their records, self administering their medication and creating their care plan. Residents gave good feedback on the quality and quantity of meals and food provided. Residents have been consulted on meals and mealtimes and a working group has been set up to look to improve these. Mealtimes are arranged so as to have few interruptions and the dinning tables are set nicely so as to make mealtimes more enjoyable for residents. Residents are given a choice of two hot meals at lunchtime and the option of having a sandwich if preferred. Residents have the choice of a cooked breakfast every day. The cook asks residents each day what they want from the choice of menu. The cook is provided with information as to any specail dietary needs which the residents may have and was able to give examples of how these are accomodated. The kitchen was found to be clean, well organised and well stocked. Care Homes for Older People Page 17 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are safeguarded through appopriate policies, procedures and practices being in place for dealing with complaints and for protecting residents from abuse or neglect. Evidence: The home has a complaints policy and procedure which is time scaled appropriately and includes contact details for CSCI. Residents who were asked about complaints said that they would let staff know if they were not happy about something and that staff would then address their concerns. Information on how to make a complaint is provided to residents in the service user guide or information pack. A log of complaints is maintained. This showed that there have been no complaints made since the last inspection visit. Previously made complaints have been investigated and responded to. An adult protection policy and procedure is in place. This outlines responsibilities for responding to an llegation of abuse and any subsequent investigations. Staff recruitment includes checks against the Protection of Vulnerable Adults register and crimininal records bureau checks for new members off staff. It was reported that staff cover adult protection issues in the staff induction and training records showed that a number of staff have been provided with adult protection training but this has not been extended to all care staff. The manager reported that a rolling programme of training in adult protection was in place and this would ensure all staff are provided with the training in the near future. During discussions with staff they were able to explain what course of action they would take in the event of an Care Homes for Older People Page 18 of 28 Evidence: allegation of abuse being received. Accidents and incidents are appropriately recorded and audited. Care Homes for Older People Page 19 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with a clean, safe, well maintained and comfortable home environment. Evidence: The home was purpose built as a care home and was previously used by the Local Authority. It is a two storey house situated in well maintained grounds. The home is located within approximatley 1/2 mile from Leigh Town Centre and is well served by public transport. The home is spacious, clean, well maintained and well presented. There are several lounge areas, a conservatory and large dinning room. All areas of the home were found to be appropriately decorated and furnished. This included the sample of residents rooms which were checked. There is a continous programme of maintenance and upgrading of the home. The manager reported in the homes self assessment (AQAA) that there have been numerous improvements to the home environment over the past twelve months including redecoration of lounges and bedrooms, new furniture in two lounges, improvements to the outside areas, new garden furniture has been purchased and new electrical appliances have been purchased. Care Homes for Older People Page 20 of 28 Evidence: Many of the residents bedrooms were personalised with their own belongings. Bedroom doors were fitted with locks and with a knocker as you would have on a front door. During discussions with residents they were generally happy with their accomodation. A small number of issues were raised of how it could be improved. These were discussed with the manager and it is recommended that residents meetings are used to provide residents with an opportunity to feedback on the home environment on a regular basis. There were numerous domestic staff on duty at the time of the visit ensuring that the home was clean. The home is fitted with aids and adaptations such as hoists, handrails and bathchairs so as to assist residents to move and transfer safely. Records showed that these are regularly serviced. A maintenance person checks the safety and maintenance of the home on a daily basis and carries out additional safety checks on a regular basis. Care Homes for Older People Page 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by staff who know them well and who are appropriatley recruited and well supported. Evidence: At the time of the visit there were 35 people residing at the home. There were three care staff on duty from 8am until 10pm plus a team leader. From 10pm until 8am there are two members of staff on duty to support up to 40 residents. The manager and members of the staff team felt that the over night staffing was sufficient and the manager reported that additional staffing are brought in if the needs of the residents are such that additonal staffing is required. The manager reported that a contingency plan is in place to deal with all emergencies and this includes dealing with emergencies at night with the current staffing levels. The manager also reported that staffing levels are reviewed on a regular basis so as to ensure staffing is sufficient for the safety and welfare of residents. Monthly staff meetings take place and these are minuted. Staff are provided with regular supervision meetings and have personal development plans. Staff reported feeling well supported by the management arrangements at the home and by the organisation. Care Homes for Older People Page 22 of 28 Evidence: Staff turnover has been low since the last inspection visit and the use of agency staff has been minimal. During discussions with members of the staff team they reported team spirits to be good, staff moral to be good and management support to be very good. Staff were observed to interact with residents with warmth and familiarity. Residents gave good feedback on the staff team. One resident commented theyre very good another resident said that they couldnt fault the staff, theyre very kind and helpful. Staff files were looked at for the newest member of staff and for two longer term members of staff. Staff recruitment and selection practices are in line with protecting residents and checks and references are carried out appropriatley. A sample of training records were looked at. These showed that care staff are provided with regular training in topics such as fire safety, moving and handling and first aid. There were some gaps in staff training in topics such as adult protection and food hygiene. The manager is aware of this and has planned for training for the future. The manager reported that approximatley 70 of care staff have attained a relevant National Vocational Qualification (N.V.Q) and additional staff are working towards this qualification. Domestic staff are provided with a good level of training as appropriate to their role. Care Homes for Older People Page 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home which is well managed and run in their best interests. Residents health and welfare is safeguarded by appropriate procedures and practices. Evidence: The home is well managed and staff roles and lines of accountability are clear. The home is visited by a representative of the organisation on monthly basis and a report of the findings of these visits is made. These reports were available for inspection. Further checks and audits are in place to ensure that the service is aiming to meet the required standards. Residents are regularly surveyed on the quality of the service and their feedback is used to contribute to the development of the service. It was reported that residents have the opportunity to manage their own money when Care Homes for Older People Page 24 of 28 Evidence: appropriate and in line with their wishes. Where a resident needs support with their money then a record of all money received and spent is maintained and receipts are kept wherever possible. It was reported that residents monies are checked / audited on a regular basis. Staff meet twice per day to handover information. There appears to be good communication between the staff team. Staff are provided with one to one supervision meetings and team meetings take place on a regular basis. Health and safety policies, procedures and practice are in place to safeguard the well being of residents, staff and visitors. Health and safety records were checked. These showed that fire safety checks are in place and fire alarm tests are carried out regularly. Safety and maintenance certificates which were checked were up to date. However, an electricity safety certificate could not be located. The manager agreed to follow this up. A health and safety manual was available and this included numerous policies and procedures for managing the home safety. Care Homes for Older People Page 25 of 28 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 26 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 Each resident must have a care plan. To ensure that care staff are aware of how to meet the needs of the resident. 23/03/2009 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 2 3 7 9 18 The manager should ensure that care plans are continued to be developed to cover all aspects of health care. Audits of medication should include how medication is being stored. The programme of training in adult protection should continue to be provided to ensure that all care staff have been provided with this. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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!