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Inspection on 22/01/09 for Hyne Town House

Also see our care home review for Hyne Town House for more information

This inspection was carried out on 22nd January 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides people with a comfortable and safe place in which to live. Everyone living at the home has a care plan. Health care needs are well met and the arrangements for administering medication are satisfactory. There is a variety of activities and outings on offer and visitors are made welcome at any time. There is a simple complaints procedure and people feel that their concerns are listened to and acted on. Good procedures are in place to ensure only people suitable to work with vulnerable adults are employed, and there is a high emphasis placed on staff receiving suitable training to enable them to meet people`s needs. Staffing levels are generally good and the manager and owner promote an open and honest atmosphere. One member of staff told us that they felt everything was good at the home and that all staff worked together as a team. Another said they `treat people as people` and communicate with the person at their level.

What has improved since the last inspection?

There is on ongoing programme of refurbishment. The home has made arrangements for the safe storage of toiletry items and now ensures that all hazardous chemicals are stored in a locked cupboard. Staff sickness levels have been reduced.

What the care home could do better:

The home needs to write to people who are thinking of moving into the home to confirm their needs can be met. More detail on daily recordings would evidence that identified care needs had been met. All handwritten entries on MAR (Medication Administration Records) sheets should be double signed to ensure correct details are entered. The details of the new Care Quality Commission should be entered onto the home`s complaints procedure so that people have the correct details if they need to contact us.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hyne Town House Hyne Town House Strete Dartmouth Devon TQ6 0RU     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: Sue Dewis     Date: 2 2 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 26 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 26 Information about the care home Name of care home: Address: Hyne Town House Hyne Town House Strete Dartmouth Devon TQ6 0RU 01803770011 01803770307 info@hynetownhouse.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Yvonne Margaret Mould,Mr Stephen Anthony Mould Name of registered manager (if applicable) Mrs Jean Gloria White Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Hyne Town House is a privately owned care home registered to provide care for up to thirty-three people within the categories of Dementia - over 65 years of age (33), Old age, not falling within any other category (33), Physical disability over 65 years of age (33). It does not provide intermediate care and it is not registered to provide nursing care. Hyne Town house is a Georgian period-detached building with a purpose-built wing. It is situated in the small coastal village of Strete, approximately 15 minutes drive from the town of Dartmouth. It is on a bus route (Kingsbridge/Dartmouth), and local Care Homes for Older People Page 4 of 26 care home 33 Over 65 33 33 33 0 0 0 Brief description of the care home amenities including a post office/small shop are situated nearby in the village. Car parking is available within the grounds of the home or opposite in the village car park. The home provides accommodation for people over three floors, with a passenger lift to access the upper floors. Following an extensive refurbishment programme the home has been upgraded to a high standard. This includes a quiet lounge, assisted bathing facilities, a commercial kitchen, and a large garden room with patio doors allowing access to the garden and terraced areas. There are 27 single rooms and 3 double rooms, with the majority being en-suite and many with far reaching views of the surrounding countryside and out to sea. The fees at Hyne Town House range from 550 to 720 ponds per week. Additional extras are hairdressing, chiropody, newspapers, special interest journals and magazines, and any sundry items, all at commercial rates. This information was given to the Commission by the Registered Provider in January 2009. A copy of the Commissions report on the home is available from the office. Care Homes for Older People Page 5 of 26 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: This unannounced visit took place over 7 hours at the end of January 2009. The last Key Inspection of this service took place on 25 January 2007. The home had been notified that a review of the home was due and had been asked to complete and return an AQAA (Annual Quality Assurance Assessment). This shows us how the home has managed the quality of the service provided over the previous year. It also confirms the dates of maintenance of equipment and what policies and procedures are in place. Information from this document was used to write this report. During the visit 3 people were case tracked. This involves looking at peoples individual plans of care, and, where possible speaking with the person and staff who care for Care Homes for Older People Page 6 of 26 them. This enables the Commission to better understand the experience of everyone living at the home. Although only one inspector undertook this inspection, throughout the report there will be reference to what we found and what we were told. This is because the report is written on behalf of the Care Quality Commission. During the inspection 3 people living at the home were spoken with individually and 6 others in a group setting. The interaction between the people living at the home and those who care for them was also closely observed. We also spoke with 3 staff the manager and the owner. A tour of the building was made and a sample of records was looked at, including medications, care plans and staff files. An Annual Service Review was completed on the home in May 2008. This review concluded that we did not need to do a Key Inspection of the home at that time in order to ensure a good service was still being provided to people who live at the home. Since the last visit to the home the Commission received a complaint relating to fees and some staff members. The complaint was passed to the provider to investigate using their complaints procedure. Evidence was seen that showed the home had appropriately investigated the matter when we had asked them to and had informed the complainant of their investigation. 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.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 8 of 26 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 9 of 26 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. The admission procedure ensures that there is a proper assessment prior to people moving into the home, and that individuals can be assured that their care needs can be met. Evidence: There is a Statement of Purpose, Service User Guide and Brochure available to people thinking of moving into the home. These are given to people and their representatives and discussed with them before they decide whether to move into the home. People are usually asked to come and try the home to see if they like it. The files of three people living in the home were looked at, and all contained preadmission information. The Manager told us the procedure that is followed when people have been referred for possible admission to the home. We were told that wherever possible this included visiting the person whether they were at home or in Care Homes for Older People Page 10 of 26 Evidence: hospital to complete a pre-admission assessment. We were told that although people are always invited to visit the home, it is often their family that looks at the home on their behalf. Prior to people moving into the home some details are transferred to a care plan so that staff have basic information on how best to meet their needs. The care plan is completed more fully when they have been at the home for some time. The home must write to people to confirm their needs can be met, prior to them moving into the home. This is so that people can be assured the home can meet their needs. The home does not provide intermediate care. Care Homes for Older People Page 11 of 26 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. Everyone who lives at the home has a care plan which provides staff with information to enable them to meet peoples health and social care needs on a day to day basis. The management of medication is good and helps ensure people are protected from the risk of not receiving their prescribed medication. Evidence: A computerised care planning system is used. The care plans of three people living at the home were looked at. They contained detailed assessments of peoples health and social care needs. They gave some indication of how these needs were to be met and there is detailed advice on general routines kept in peoples bedrooms. There was evidence that detailed risk assessments have been completed where necessary and in particular there were risk assessments relating to pressure area care and moving and handling needs. There was some evidence that care plans had been reviewed, but one care plan had Care Homes for Older People Page 12 of 26 Evidence: not been reviewed since 2007. There was evidence that the individual or their representative had been included in the care planning process and we were told that the manager was continually encouraging more involvement. It was clear through discussions with staff that they knew the people they care for very well and knew how best to meet to meet there needs. There were some good daily recordings that gave an indication of how the individual had spent their day and what care had been given. However, the recordings need to be more specifically related to the care plans, and rather than record appears well indicate how the identified needs had been met. We discussed with the manager and owner varying ways in which the care planning process could be further improved, and the manager was going to look into this. There was evidence on file that peoples health care needs were being met, and that a range of health care professionals visited the home, including GPs and District Nurses. There is a policy and procedure for the administration of medicines and evidence was seen to show that people are supported to look after their own medicines if they wish to. All medicines were seen to be stored correctly and staff were seen administering them appropriately and signing the MAR (Medication Administration Record) as needed. We were told that medicines are checked and counted when they come into the home. However, hand written entries onto MAR (Medication Administration Record) sheets are not double signed, which is good practice to ensure the correct information is recorded. There is a list of sample signatures and initials to help identify who has administered a particular dose of medication. All people we saw during this visit looked well cared for, were treated with respect by the staff and their right to privacy was upheld. Personal care was seen to be offered in a discreet manner. Staff told us how they respect peoples privacy when helping them with personal care and we heard staff speaking with people in a kindly, friendly way. There was an obvious affection between staff and the people they care for. Care Homes for Older People Page 13 of 26 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. Social interaction and activities are available, and there is daily variation and social interaction for people living in the home. Evidence: An activities co-ordinator is employed for 4 days each week. Activities that are available include skittles and quizzes. There is also regular entertainment and a pianist visits regularly. Concerts are organised regularly as well as buffet evenings when there is music and sherry and chocolates on offer. We were told that the activities vary depending on what people want to do. On the afternoon of the visit several residents were enjoying gentle exercises in the lounge. Staff told us that they had time to sit and chat with people and that not all their interaction was centered around care giving. We were told that some people attend various clubs in the community and there are regular trips to the pub. There are monthly church services held at the home. People living at the home told us that their family and friends can visit them at any Care Homes for Older People Page 14 of 26 Evidence: time and that they are always made welcome. The owner told us that relatives often stay for lunch. Staff were able to tell us how they offered choices to people though out the day, including what time they get up and what they wear. We were told that people were encouraged to remain independent and that as few restrictions as possible were put on their daily lives. People told us that the food was generally very good at the home and that there was always an alternative if they didnt want what was on the menu. We ate lunch with people in the dining room. The meal was tasty, well presented and nutritious and people said that they enjoyed it. We saw people being helped with their meals in a discreet manner. There was much friendly banter between staff and people living at the home. Care Homes for Older People Page 15 of 26 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. There is a good complaints procedure and people can be confident that their concerns will be listened to. Adequate procedures are in place to ensure that people are protected from abuse. Evidence: There is a clear and simple complaints procedure in place to help people who wish to raise concerns. There is a copy of the procedure displayed in the hallway and contained in the welcome pack for the home. A complaints book is kept so there is an easy read summary of any complaints. The details of any complaints that have been dealt with are kept in a separate file. Some people living at the home who were spoken with during this visit were unable to tell us whether they knew about the homes complaint procedure or whether they would feel comfortable making a complaint. However, those who were spoken with were able to tell us who they would speak with if they were unhappy about anything. A complaint was made to the Commission by someone who had spent a short while at the home. The complaint was about fees and some of the staff at the home. The complaint was passed to the provider to investigate using their complaints procedure. Evidence was seen that showed the home had appropriately investigated the matter Care Homes for Older People Page 16 of 26 Evidence: when we had asked them to, and that they had passed their findings on to the complainant. Records show, and staff told us that they had received training in Protection Of Vulnerable Adults (POVA) issues. All staff were able to discuss different forms of abuse and said that they would report any suspicions they had to the manager. They were also clear about who they would report any concerns to, outside of the home. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a pleasant, comfortable and safe environment for those living in, working at and visiting the home. Evidence: A full tour of the communal areas of the home was made and some of the bedrooms were looked at. The communal areas of the home were light and airy with a comfortable homely feel. They are nicely decorated and comfortably furnished in a domestic style. There is a lovely garden room where many people choose to sit during the day enjoying the views of the garden. The house was clean and free from unpleasant smells. The manager has done some research into how the environment can impact on people with dementia. There is level access throughout the home and the upper floors are accessed by a passenger lift. People can enjoy a beautiful sensory garden that has excellent views down to the sea. Peoples bedrooms contained many individual items and reflected the personality of the occupant. People told us that they had been able to bring things from their home Care Homes for Older People Page 18 of 26 Evidence: when they had first moved in. Locks have been fitted to bedroom doors where people have requested them. Radiators throughout the home are covered, which helps reduce the risk of people suffering burns from falling against them. Some areas of the home have underfloor heating. Windows above ground floor level are fitted with restrictors which minimizes the risk that people may fall from them. Thermostatic valves are fitted to taps in all but 6 rooms to ensure people are protected from burns from water that may be too hot. There is a range of aids and adaptations around the home to help staff meet the needs of people who have limited mobility. These include mobile hoists, bath hoists, sliding sheets and a standing turntable. Staff told us that they had received training in moving and handling and people have moving and handling risk assessments in their care plans. Staff said that they had received training in infection control matters and were seen following good infection control procedures. Disposable gloves and aprons were readily available around the home. The laundry area small but practicable and was clean and tidy. It has an impervious floor covering to help prevent cross contamination from soiled articles and washing machines have the ability to meet disinfection standards. Good work systems were in place. Care Homes for Older People Page 19 of 26 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. A wide range of training is provided and the numbers and skill mix of staff on duty are sufficient to meet the needs of people currently living at the home. People are protected by recruitment procedures that ensure people who may be unsuitable to work with vulnerable people are not employed at the home. Evidence: On the morning of the visit there were 33 people living at the home. There were 5 care staff on duty plus the manager and 5 ancillary staff. People that were spoken with felt that there were enough staff at the home to meet their needs. Concerns were raised at the last visit that staffing levels were sometimes compromised due to sickness at the home. The owner and manager told us that this has improved, though there was a problem over Christmas when agency staff were used to cover some shifts. Staff told us that they felt there were generally enough staff on duty although there were times when they were a bit rushed because of sickness. Three staff files were looked at. One file contained all the required information including satisfactory CRB (Criminal Records Bureau) checks, two written references and proof of identity. However, the file of a member of staff who had been employed for many years did not show evidence of any references being obtained. The manager Care Homes for Older People Page 20 of 26 Evidence: assured us that references would have been obtained. The file of a recently employed staff member did not contain a satisfactory CRB check. However, we were told by the manager that this person was undertaking their induction and did not have unsupervised access to anyone living at the home. Training has a high priority at the home. Records show and staff confirmed that they receive a wide variety of training, including a comprehensive induction for all new staff. Other training includes Fire procedures, Moving and Handling, Food Hygiene, First Aid and Infection Control. Staff are also encouraged to work for NVQs (National Vocational Qualifications) and the owner told us that they will not employ anyone who is not prepared to work towards an NVQ. Staff were praised by people living at the home when we spoke with them and one person told us that although they didnt need much help, staff were always there to help if they did. Care Homes for Older People Page 21 of 26 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. The home is well managed resulting in practices that promote and safeguard the health, safety and welfare of people who live and work in the home. Evidence: Mr Stephen Mould, the Registered Provider, is actively involved in the day-to-day running of the home. However, Mrs Jean White, the Registered Manager, has overall responsibility for staffing and overseeing the provision of care. They said that they work well together and work hard to ensure there is an open and transparent atmosphere within the home. Staff that we spoke with during the visit told us that they felt supported by the manager and owner to do a good job. There is a formal quality assurance system in place at the home. Questionnaires are sent out to everyone connected with the home and any suggestions implemented. A Care Homes for Older People Page 22 of 26 Evidence: report of the findings is drawn up and made available to interested parties. There are regular meetings for people who live at the home, to enable them to express their views of the home. A newsletter is produced to keep people informed of what is going on in the home. People living at Hyne Town House are encouraged to either handle their own financial affairs or to make alternative arrangements. The AQAA (Annual Quality Assurance Assessment) submitted prior to the visit, provided evidence that Hyne Town House complies with health and safety legislation in relation to maintenance of equipment, storage of hazardous substances, fire precautions, health and safety checks and risk assessments. Policies and procedures are not always inspected during the visit but the information provided on the AQAA helps us form a judgement as to whether the home has the correct policies to keep people living and working at the home safe. Information provided by the home, evidenced that policies and procedures are in place and along with risk assessments are reviewed regularly and updated where necessary, to ensure they remain appropriate and reduce risks to people living and working at the home. So that the risk of burning from hot surfaces is minimised, radiators within the home have been covered, or there is underfloor heating. So that the risk of burning from hot water is minimised temperature controls are fitted to taps in all but 6 rooms. Restrictors are fitted to windows above ground floor level to minimise the risk of anyone falling from these windows. Care Homes for Older People Page 23 of 26 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 24 of 26 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 3 14 The home must write to 07/05/2009 people to confirm their needs can be met, prior to them moving into the home. This is so that people can be assured the home can meet their needs. 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 9 You are recommended to ensure that daily recordings evidence where peoples assessed needs have been met. You are recommended to ensure that all hand written entries on MAR sheets are double signed. Care Homes for Older People Page 25 of 26 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 26 of 26 - 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!