Inspection on 30/07/09 for Hunningley Grange

This inspection was carried out on 30th July 2009.

CQC found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hunningley Grange 30/03/10

Hunningley Grange 17/02/10

Hunningley Grange 24/11/09

Hunningley Grange 11/07/07

Hunningley Grange 10/07/06

Hunningley Grange 30/11/05

Hunningley Grange 25/05/05

Hunningley Grange 23/09/04

Hunningley Grange 21/07/04

Similar services:

Snydale Care Home

Abbey The

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for older people Name: Address: Hunningley Grange 327 Doncaster Road Stairfoot Barnsley South Yorkshire S70 3PJ     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Valerie Hoyle     Date: 3 0 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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: Hunningley Grange 327 Doncaster Road Stairfoot Barnsley South Yorkshire S70 3PJ 01226287578 01226245348 none NONE Mr Azad Choudhry care home 36 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) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Hunningley Grange is a detached residence with a purpose built extension, registered to provide personal care for 36 residents. All accommodation and services are on the ground floor. The home is located in the centre of Stairfoot, approximately two miles from Barnsley Town centre and situated on a main bus route. The home is within walking distance of a full range of shops e.g. chemist, newsagent, hairdressers, dentist, supermarkets, post office, health centre, cafes and fast food outlets. There is car parking at the front and side of the home. The home provides information to people and their relatives prior to admission into the home. Service User Guides are available in all bedrooms or on request from the manager. The last published inspection report is available on request and a copy is available in entrance for visitors to read. Care Homes for Older People Page 4 of 28 Over 65 36 0 Brief description of the care home Information gained on the 30th July 2009 indicates the current fees are 356 pounds and 51 pence. Additional charges include private chiropody, hairdressing, newspapers and transport. 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: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 0 star. This means that the people who use the service experience poor quality outcomes. An Annual Service Review was undertaken on the service on 25th June 2008, to assess the progress of the service. The outcome of the ASR confirmed the service continued to provide a good standard of service to people. This unannounced inspection took place over 8.5 hours starting at 09:00 finishing at 17:30. The visit included a partial inspection of the home. Five people who use the service, the operations managers, four staff and five relatives were spoken to during this inspection, their views are included within this report. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous reports may have been deleted or Care Homes for Older People Page 6 of 28 carried forward into this report as recommendations but only when it is considered that the people who use the service 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. Occupancy at the home shows 21 beds occupied. The operations manager told us that occupancy had been affected by an voluntary agreement with social services to stop admissions into the home while they were undertaking an investigation. The stop on admissions has now been lifted. Three peoples care plans were looked at. Policies relating to medication, complaints, protection and handling of peoples money were looked at. Five recruitment and training records were looked at to assess how people were protected. Procedures and risk assessments relating to health and safety were looked at and discussed with the operational managers. The manager was unavailable to assist with the inspection, although operations managers Pat smith and Christine Dorber were available to assist with the process. The AQAA was sent to the home for the manager to complete. This was not received in a timely manner due to the absence of the manager. An Annual Quality Assurance Assessment is a self-assessment and a dataset that is filled in once a year by all providers whatever their quality rating. It is one of the main ways that we will get information from providers about how they are meeting outcomes for people using their services. The AQAA also provides us with statistical information about the individual service and trends and patterns in social care. Care Homes for Older People Page 7 of 28 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 Care Homes for Older People Page 8 of 28 following this report, you can contact them using the details 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service were assessed before moving into the home. Information available to people should be updated to reflect changes to the management arrangements. Evidence: The home has an assessment document that was used to assess the needs of people who use the service, prior to admission into the home. A number of completed assessments were looked at and they contained basic information about the needs of the individuals. Staff said the information was used as a base to establish a care plan. The operational manager told us that there had been no recent admission into the home as they had entered into a voluntary agreement with social services to not admit people into the home. The agreement has now been lifted following a case conference. Relatives confirmed that they had been involved in the admission of their relative and Care Homes for Older People Page 11 of 28 Evidence: they told us that they had looked at other homes before making a decision about Hunningly Grange. They said staff were very helpful during the admission and this had helped their relative settle. Information about the home was available to people prior to their admission, although some of the information requires updating to reflect the management arrangements and the contact details for Care Quality Commission. 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans do not provide sufficient information to ensure peoples health and welfare needs are met. Medication procedures were generally well managed, however regular monitoring is not taking place to ensure staff continue to follow procedures safely. Evidence: The operations manager told us that social services had recently undertaken care reviews on all people living the home. They raised concerns about the lack of detail and how the care plans had been evaluated. They told us they were working with staff and have provided training to improve writing and communication skills. We looked at four care plans and the details were in the process of being updated. However, it was clear that the care plans had not been regularly evaluated and where they had been reviewed, the detail was very basic. There was no evidence to confirm risk assessments had been reviewed and some assessments (nutrition and skin care) were lacking action. One persons care plan required regular checks on their blood sugar levels, although the senior carer said the machine was broken. The person had not had the check for a considerable length of time, which could pose significant risk to the health of the person. Care Homes for Older People Page 13 of 28 Evidence: There was no care plan to support peoples needs and choices with regard to activities. The operational manager said activities were recorded on the communication sheet. these were looked at and showed very little to confirm peoples social and emotional needs were met. Medication procedures were generally followed, although one record looked at, had three days medication that had been signed for but the medication was still in the monitored dosage system. Controlled records were kept, although one persons fentanyl patches were still held and the person had been discharged from the home. The record and stock was inaccurate. The medication fridge was stored in the staff room, the room was not locked and the fridge was also not locked. The home has a quality monitoring form used to audit medication procedures. The audits had not been completed for a number of months. Senior carers said the supplying chemist did not undertake audits of the stocks and records. Therefore there was no regular monitoring of the procedures, which means mistakes and staffs competencies were not checked. Staff have been trained to safely administer medication, although there competencies were not regularly checked. One senior carer should be assessed and her training record checked as it was unclear if she had the required accredited certificate. Care Homes for Older People Page 14 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have little opportunity to join in activities, and mealtimes were organised although people could be made more comfortable. Evidence: People had limited opportunities to take part in activities, as there was no staff designated to undertake the role. Relatives said that they have not observed activities taking place although they were given information that activities would be offered on a regular basis. People said they could join in bingo although this was the only activity they joined in. Care plans looked at confirmed the lack of social stimulation, as none of the care plans looked at had a social care plan. Relatives said they were always made to feel welcome and staff were kind and caring. They said they visited at various times of the day and staff always seemed to be very busy. Relatives said that on occasions there did not appear to be sufficient staff on duty to meet peoples needs, in particular at meal times. Breakfast and lunch were observed and staff were seen supporting people during the meal. A number of people were left in their wheelchairs which made it difficult for them to get close to the table, to eat their meal comfortably. The cook said menus Care Homes for Older People Page 15 of 28 Evidence: were arranged around the likes and dislikes of the people, although the menu was not prominently displayed. People said they did not know what was on the menu for lunch, although staff said they offer two choices of main course. People said they enjoyed the lunch which was pork steak and vegetables followed by spotted dick and custard. One relative said she tried to visit at lunch time to assist with feeding their relative. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints and safeguarding procedures were generally followed although staff require training to recognise signs of abuse. Evidence: The home has a complaints procedure although it requires updating to include changes to the management arrangements and the contact details of the Care Quality Commission. The complaints are currently recorded in a book which should be reviewed so that it is in accordance with the Data Protection Act 1998. People should be able to raise concerns anonymously, therefore complaints leaflets should be reviewed as the current leaflet belongs to another home in the group. The home follows safeguarding procedures, although only some of the staff have received training to recognise signs of abuse. Recent safeguarding referrals had led to a voluntary block on new admissions into the home, the ban was lifted a few days before writing this report. The operations manager said they were working with social services to improve record keeping, which was identified when social services visited the home. They have agreed to implement audits and improve training of staff to make the required improvements to the service provided to people. Care Homes for Older People Page 17 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment needs considerable investment to improve health and hygiene outcomes for people who use the service. Evidence: The environment was looking rather tired, some of the carpets were stained and bedrooms require decorating and the bathrooms and laundry needs refurbishment. The washers were out of order and there was no lock on the laundry door, this could pose a significant risk to people, as the laundry houses substances which could damage peoples health. The operations manager arranged for the maintenance person to fit the lock before the end of the inspection. The washer was also repaired although staff said it often broke down. There is no sluicing facilities at the home and the operations manager said commodes are washed in the baths used by people who live at the home. Bathrooms were generally untidy with commode bowls and drying racks stored in the room. The kitchen needs refurbishment as it lacks ventilation, this was identified during the last environment health report, there was no dishwasher or sterilising sink. Staff have not had training in infection control and the issues identified in the previous paragraphs reflects our decision to judge this outcome area as poor. Care Homes for Older People Page 18 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff had the skills and knowledge to fulfill their roles within the home, although some essential training was required. There was a stable staff group. Recruitment policies were followed, to ensure the right people were employed to work with vulnerable adults. Evidence: Staff were employed in sufficient numbers to meet the current needs of people who use the service. Senior staff have added responsibility to organise the shift and ensure medication was administered safely. The home has robust recruitment procedures and most of the staff have worked at the home for a good period of time. Four recruitment files were looked at and they contained the required two references and Criminal Record Bureau check and there was evidence that they had checked gaps in employment. Induction and training records were looked at. The induction programme was dated and fails to meet the Skills for Care standards. The operations manager told us that new staff had been identified to improve the senior team and give direction to staff. New staff are generally supported by a more senior staff member until they can demonstrate they have the right skills and competencies. Training record were extremely poor, they contained little evidence to confirm any Care Homes for Older People Page 19 of 28 Evidence: refresher training had taken place. Social services undertaking safeguarding investigations required the home to make improvements in the training provided. The operations manager confirmed that training to recognise the signs of abuse had taken place for half of the staff team. A further date has been set for early September. Training in effective communication and dementia awareness has also taken place, however most of the mandatory training is required. The home continues to support staff to undertake National Vocational Qualifications (NVQ). The numbers of staff trained to NVQ Level 2/3 in care exceeds 50 . Care Homes for Older People Page 20 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and safety procedures do not ensure people who use the service are kept safe. The financial interest of people are safeguarded. The home has a quality assurance system although peoples views had not been obtained. Evidence: The registered manager has worked a the home for a considerable period of time, although she has been on long term sick leave for a number of months. A temporary manager has been appointed although she was unavailable during this inspection. The changes to management and recent safeguarding referrals have affected the homes ability to deliver a good service. There was a lack of leadership or direction which has resulted in staff morale being extremely low. The home has quality assurance systems although audits have not been completed over recent months. The home has surveys which were used to gain the views of people although the operations manager told us that they had not been completed. The operations manager has responsibility to undertake monthly quality audits on Care Homes for Older People Page 21 of 28 Evidence: behalf of the organisation (regulation 26), although they had not been completed over recent months. An audit of peoples personal monies confirmed accurate recording takes place, however records showed that all transactions only had the signature of one person. Staff have not received health and safety training or training in infection control. Fire safety checks had not been undertaken at regular intervals, and staff had not received any formal training in the last 2 years. This means staff may not understand action to be taken in emergency. Care Homes for Older People Page 22 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 23 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must contain sufficient detail to enable staff to deliver appropriate care. Risk assessments and evaluation of care plans must be underatken at regular intervals. To ensure peoples needs are met. 02/11/2009 2 8 12 People must have the required healthcare checks. This must include checks undertaken at the required frequency. To ensure their needs are met. 05/10/2009 3 9 13 Medication must be recorded, administered, and discharged from the home. This helps to confirm that medication is being given as prescribed and facilities are suitable for storage. 28/09/2009 Care Homes for Older People Page 24 of 28 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 To ensure people receive their medication safely. 4 18 13 All staff must receive training to recognise the signs of abuse. To ensure people who use the service are safe and protected. 5 26 13 Suitable arrangements must 05/10/2009 be made to ensure good hygiene practises take place. This includes approprite sluicing facilities, laundry facilities in good working order and suitable ventilation in the kitchen. To control the risk of infection and maintaining a clean, hygienic environment. 6 30 18 Staff must receive refresher training to ensure they have the required skills and competencies. To ensure they can meet the needs of people who use the service. 7 31 26 The registered provider must undertake monthly quality audits (Regulation 26) and the reports must be made available for inspection. 05/10/2009 02/11/2009 05/10/2009 Care Homes for Older People Page 25 of 28 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 So that we can assess the quality and leadership of the service provided. 8 38 13 Health and safety checks must be undertaken. To ensure people are safe and protected. This includes fire safety training and regular audits of fire safety equipment, and health and safety training for staff. 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 05/10/2009 1 1 Information provided to people who use the service should be updated to reflect to changes to the management arrangements. The complaints details should also be updated to reflect the contact details of the Care Quality Commission. Care plans should reflect the social and emotional needs, so that staff can support them to follow their interests. The temperature of the medication fridge should be taken at regular intervals and it should be kept locked and stored in a room suitable for storage of medicines. Staffs competencies and regular audits of medication should be undertaken to ensure medication procedures are followed. Social activities should be improved to ensure people can engage in activities of their choice. A care plan should be implemented for all people who use the service to identify the support people need to take part in activities. The home should review the seating arrangements in the 2 3 7 9 4 9 5 12 6 15 Care Homes for Older People Page 26 of 28 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 dining area to ensure people can sit in dining chairs rather than wheelchairs. This will ensure people can eat their meal comfortably. Menus should be clearly displayed so that people can make an informed choice of the food offered. 7 16 The complaints procedure should be updated to reflect the changes to the management arrangements and contact details of Care Quality Commission. Forms to enable them to raise their concerns anonymously should be developed to ensure they meet Data Protection Act 1998. The home should continue to refurbish the environment, by redecorating areas and replacing furnishings where needed. Quality assurance systems should be implemented to ensure people have the opportunity to give their views on the service. Peoples financial records should be regularly audited and should include two signatures for all transactions. 8 9 19 33 10 35 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC 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. 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