Inspection on 16/12/08 for Inwood House

This inspection was carried out on 16th December 2008.

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

Inwood House 11/01/07

Inwood House 25/11/05

Inwood House 29/06/05

Inwood House 17/02/05

Inwood House 10/06/04

Similar services:

Abbey The

Snydale Care Home

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 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Inwood House 142 Wakefield Road Benton Hill Horbury West Yorks WF4 5HG     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: David White     Date: 1 6 1 2 2 0 0 8 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. the things that people have said are important to them: They reflect 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Inwood House 142 Wakefield Road Benton Hill Horbury West Yorks WF4 5HG 01924272159 01924266564 richard@inwoodhouse.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Deborah Nightingale Type of registration: Number of places registered: Mr Richard J Barraclough,Wendy Patricia Barraclough care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Inwood House is situated on the main road close to the centre of Horbury approximately two miles from Wakefield. Set back in its own grounds the large Victorian house provides personal care for 35 older people who may also have dementia, mental health needs or physical disabilities. The home provides mostly single accommodation, however there are some shared facilities available. There are 6 lounges including a large television lounge and smaller quiet lounges. There are Care Homes for Older People Page 4 of 26 Over 65 35 35 35 35 0 0 0 0 Brief description of the care home handrails throughout the building. There is also a passenger lift and a number of assisted baths for the use of people who have difficulties with mobility. The home is on a main bus route and there are shops a few minutes walk from the home. The centre of Horbury is close by with easy access to all local facilities and amenities. The service provider makes sure that information about the service is available to people who are thinking about moving into the home, people already living there and their relatives and representatives. This information can be found in the homes statement of purpose and service user guide and through CSCI (Commission for Social Care Inspection) reports. 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: We went to the home without telling them we were going to visit. This report follows the visit that took place on 16th December 2008. The visit lasted from 09:00 until 15:00. The purpose of the visit was to make sure that the home is operating and being managed in the best interests of people living there. Information has been used from different sources for this report. These sources include reviewing information that has been received about the home since the last inspection visit. Prior to this visit information was provided by the provider on an Annual Quality Assurance Assessment (AQAA) questionnaire. Surveys were returned by people living in the home, staff who work there and by social care professionals who visit the home. Care Homes for Older People Page 6 of 26 During the visit time was spent talking to people who live at the home, relatives, care staff, an housekeeper, the manager and owners of the home. There was observation of how staff interacted with people. Various documents and records were looked at and some areas of the home used by people living there were visited. The manager and owners of the home were available throughout the visit and the findings were discussed with them at the end of the inspection. At the time of the visit on 16th December 2008, the fees ranged from 435 pounds per week upwards. The previous inspection visit took place on 11th January 2007. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? The home has introduced a new assessment tool to look at whether people may be at risk from malnutrition and dehydration. This means that any risk can be identified at an early stage and acted on to maintain the persons nutritional needs. The home has had new carpets fitted, some windows have been replaced and an enclosed patio area has been built so that people can sit outside. This has made the environment more comfortable, pleasant and safer for people at the home. Staffing levels have been adapted and improved so that more social activities can be provided. An uneven carpet that could have caused people to trip up has been replaced so that people are at less risk from injury. Care Homes for Older People Page 8 of 26 Staff fire training records are now all up to date. This helps to confirm the fire training that staff have undertaken and helps to identify when further training is needed. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 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 10 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. Proper pre-admission procedures are in place and followed so that people who are thinking about moving into the home can feel confident that their needs will be met. Written information is also available to help people with their decision-making about whether the home can meet their needs. Evidence: A written statement of purpose and service user guide are available to people who are living in the home and those who are considering a move to the home. These provide information about the care and services on offer. The service user guide is in large print format to help people with visual impairment to read the information in the document. People living in the home who were spoken to and those who returned surveys to us all said that they received a contract on moving into the home. This explained the terms and conditions of their stay at the home. One person said, staff were very helpful when I moved into the home. Another person said, everything was Care Homes for Older People Page 11 of 26 Evidence: fully explained before I signed the contract. Pre-admission procedures were in place to make sure that only suitable people are admitted into the home. Information about the persons care needs was collected from all available sources such as the persons social worker and relatives. This helped to support the home in their decision-making about whether they have the skills and resources to meet the persons needs. One of the management would then visit the person in their own home or hospital to carry out an assessment of the persons needs before deciding on the persons suitability to live at the home. People who are considering moving into the home and their relatives were invited for a visit before any decision was made about whether they move into the home for a trial period. A survey returned by someone living at the home said, before moving in I had a tour of the premises and had a long discussion with one of the owners. I am highly satisfied with my choice. Completed pre-admission assessments were seen in the personal files checked. These showed that admission procedures were being followed. The assessment information included individual information about people such as their dietary preferences. The home does not provide intermediate care. Care Homes for Older People Page 12 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. Peoples personal and health care needs were well met in a way that respected their privacy and dignity. Overall medicines are managed safely although one aspect of the medication procedures needs addressing. Evidence: Each person had an individual plan of care detailing peoples needs and the actions that staff were to take to meet these. There was some evidence that relatives had been involved in the drawing up of the care plans. The care plans were easy to understand and were specific in providing information about how people were to be supported. Where people needed support with bathing for example, the care plan specified how this was to be given, who by and the type of equipment to be used. The care plans also included information about peoples social needs and their interests. One person liked to read a local newspaper every week and a staff member confirmed that this was happening. One person living in the home said, I cant imagine having better support elsewhere, another said, staff are extremely helpful. A relative had assisted one person to complete a survey. The relative commented I would Care Homes for Older People Page 13 of 26 Evidence: recommend Inwood House if people required such services. Risk assessments had been undertaken in order to maintain peoples independence and safety. These included assessments of risks to people from falls, pressure ulcers and moving and handling. The home had recently introduced the MUST (Malnutrition Universal Screening Tool) to assess peoples risk of malnutrition and/or dehydration. This meant that any assessed risk could be identified at an early stage so that appropriate action could be taken to address any areas of need. Peoples care was regularly monitored and formal care reviews take place regularly. One relative said, It is a very nice home, the care is good. I am involved in discussions about my relatives care. Another relative commented I attend meetings about my relatives care. Daily records were up to date and reflected how people had spent their day. Discussion was had with the manager and the owners about how one incident had been inaccurately recorded. This was being dealt with through the supervision process with the member of staff concerned. Surveys returned by staff indicated that they were always kept up to date with information about individuals needs and handover periods took place between shifts to make sure that information was passed on. Each person had a GP (General Practitioner) and access to dental, optical and chiropody services. Referrals were made to specialist services as and when required. Health care information was recorded in the care plans about why people were attending appointments and outcomes from these. This helped in making sure that everyone was aware of the persons health needs and how these were to be met. A relative spoken to said, what I particularly like is that if my relative becomes ill staff act straight away to seek medical attention. Staff who handle medications on behalf of people were trained to do so. The medication was appropriately stored. Systems were in place to record medications received and disposed of by the home. The medication records corresponded with the drugs held. One person was prescribed additional medication to be taken on a when needed basis. Whilst the staff had recorded the dosage of medication given, they had not recorded what time it had been administered. This needed addressing so that accurate records could be maintained about when the person had received the medication in order to make sure the persons health needs were being met and to reduce any potential risk to the person from medication errors. Care Homes for Older People Page 14 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have opportunity to take part in a good range of activities and have access to the local community. Evidence: People said that they were happy with the choices of activity that were on offer. Some people spoken to said that they preferred to stay in and were supported to do this and not pressurised to go out. Activities were organised in-house and there was opportunity for people to enjoy trips out in the local community. Staffing numbers had been increased so that more activities could be provided. In-house people enjoyed activities such as arts, crafts and bingo. There were also individual activities for people and a beauty therapist visited the home on a weekly basis at no extra cost to people living in the home. Church services from different religious denominations were held at the home and some people liked to visit the pub. There was also a weekly trip to a local fish and chip shop. Recently some people had enjoyed a concert at a local school and entertainers visit the home on a regular basis. Personal achievements such as birthdays and anniversaries were celebrated by the home. Photographs of recent events were on display throughout the home. A letter had been sent to the home by a member of the public paying compliment to the way staff had supported people from Care Homes for Older People Page 15 of 26 Evidence: the home during an outing. The home kept a record of activities undertaken by individuals and their level of enjoyment from these. This helped in making sure that activities were planned to suit individual needs. People are encouraged to maintain links with their family and friends. One person uses the homes internet to e-mail family and friends in America. Relatives could be seen visiting the home at the time of the visit. One relative spoken to said, I am always made to feel very welcome. Throughout the day of the visit people were supported by staff in a respectful and dignified manner. Those people who required support with personal care said this was done in a sensitive way. One person said, I dont feel embarrassed at all when staff need to help me. People said they could do what they wanted at all times and could get up and go to bed when it suited them. All the surveys returned by people living in the home commented that they always enjoy the meals. People were asked in advance what they would like to eat and the menus were on display to remind people about the meals on offer. A mealtime was observed and staff could be seen offering choices to people. People could have second helpings of food if they so wished. The cook said that fresh produce is purchased from the local butchers and there were plentiful supplies of food available to people in the home. People ate in different parts of the home and the mealtime was observed to be relaxed and unhurried. Staff supported people who needed help with eating. Care Homes for Older People Page 16 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. Peoples concerns were listened to and acted on. Systems were in place and procedures were followed to safeguard people from abuse. Evidence: The home had a complaints procedures and copies of this were given to people living in the home and their relatives. Surveys returned by people living in the home all said that staff listened to what they said and acted on any concerns. Those people living in the home who were spoken to at the time of the visit knew who to speak to if they had any concerns. All commented that they would feel very confident that any concerns would be properly dealt with. The home had received four complaints that had been logged and investigated. The complaints records showed that the complainants were satisfied with the outcomes from these investigations. Staff received training on how to safeguard people from abuse. Staff spoken to knew their responsibilities in reporting such matters to the management without delay in all instances. Since the previous inspection visit there had been two incidents that had required safeguarding procedures to be followed. In both cases referrals had been made to the appropriate agencies to keep people safe. 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 environment was clean, homely, comfortable and safe for people living there. Evidence: The accommodation was over two floors. There was level access to the home and there was a passenger lift that enabled people to access both floors of the home. This meant that the home was suitable for people with mobility problems. The home was bright and spacious and had six communal lounges, one that was designated as a smoking area for people who chose to smoke. There were toilets and bathrooms on both floors with showers on the first floor. Handrails, hoists and other adaptations were available to support people with their mobility. Most bedrooms were single. Where bedrooms were shared there were screens to maintain peoples privacy and dignity. Bedrooms were lockable and people had their own bedroom key if on assessment they were identified as being able to do this safely. To maintain peoples safety the main door had a keypad and all the other external doors were fitted with alarms to alert staff when someone was leaving the building. Some improvements had been made to the environment to make it more pleasant and safer for people. A carpet that had been identified at the previous inspection visit as a possible tripping hazard had been replaced. Other parts of the home also had new carpets including peoples bedrooms that had been carpeted to suit their personal Care Homes for Older People Page 18 of 26 Evidence: tastes. Some windows had been replaced to offer more comfort to people and an enclosed decked patio area had been built to enable people to sit outside if they chose to do so. Surveys returned by people living in the home said that the home was always fresh and clean and this was the case on the day of the inspection visit. The home employed housekeeping staff to help maintain standards of hygiene and cleanliness. There were plentiful supplies of gloves and aprons and hand sanitisers were available in different parts of the home. One relative said, the home has a clean and welcoming environment. A survey returned by a social care professional who visited the home commented Inwood House provides an exceptional, well maintained, clean and safe environment which feels homely. 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. People received good care from a settled staff team who were well supported in developing their skills and knowledge to meet peoples needs. Evidence: The home had an experienced staff team and staff turnover was low so that people received consistent care from staff who knew them well. The team consisted of management, care staff, housekeepers, a cook and a handyman. Staffing levels had been adapted so that there were more staff on duty at busy times. A member of staff spoken to said, staffing levels are very good. Surveys returned by people living in the home commented that staff were always available and people spoken to at the time of the visit said that call bell requests were answered promptly. A number of them also described the staff team as very helpful. One person spoken to said, the staff cant do enough for you, they give us everything we need, another person said, the staff are brilliant. The home had a good atmosphere and staff said they all worked well together. A survey returned by one member of staff commented this is the best job I have ever had. This is due to the friendly atmosphere. Communication is really good between staff. The home had an ongoing programme of NVQ (National Vocational Qualification) training. The majority of care staff had either completed or were enrolled on the Care Homes for Older People Page 20 of 26 Evidence: training. Two staff recruitment files were looked at. These showed that all the necessary checks had been undertaken before people started working at the home. This helped to make sure that only suitable people were employed to work at the home. Staff said that they received good training to support them in meeting peoples needs. One staff member said, staff are always out on training courses at every opportunity. New staff have a full induction before they are expected to carry out any tasks they are unsure of. One staff survey commented when I started working here I sat down with the manager and went through every detail. She was very helpful. Staff received training on specialist subjects such as dementia awareness and managing challenging behaviour to develop their knowledge and skills. 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 in the best interests of the people who live there and provides a safe place for people to live and work. Evidence: The registered manager is experienced in running the home. People living in the home said they would go to her with any concerns and staff described the manager as helpful, approachable and supportive. A survey returned by one staff member commented the manager is very friendly and easy to approach. She sorts things out in a professional way. Throughout the visit the manager showed a commitment towards providing a good quality service for people. She received support from the owners who are involved with the home on a daily basis. The home had a comprehensive quality assurance system in place. Annual detailed questionnaires were sent out to people living at the home, relatives and professionals who have involvement with the home. The findings from the questionnaires are Care Homes for Older People Page 22 of 26 Evidence: published in the service user guide. An annual quality improvement plan is developed to address areas which need improvement. Meetings are held with people living at the home and staff so they can have an opportunity to be involved in the running of the home. The home still holds the Quality Registration Standard (BS EN ISO 9001:2000) for the quality of the care and accommodation they provide to people who use the service. Staff said that the home holds small amounts of spending monies for people in the home. Records were made of all transactions and these were signed by two people. The self-assessment form completed by the home prior to the inspection visit indicated that all the required maintenance and servicing of equipment was up to date and a sample of records looked at supported this. Staff receive a range of health and safety training including fire safety and this was recorded. A fire risk assessment was in place to minimise risk of fire and fire drills were carried out at periodic intervals. All incidents were recorded and these were audited to identify whether there were any patterns to the the incidents so that improvements could be made. 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 9 13 Medication records must 31/01/2009 clearly state what time medication that is prescribed on a PRN (when needed) basis has been administered. This will help to make sure that peoples health care records are accurate and up to date and will reduce potential risk from medication errors. 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 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 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!