Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Kingsley Nursing Home 4 Trafalgar Road Southport Merseyside PR8 2EA 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: Claire Lee
Date: 2 6 0 5 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 31 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 31 Information about the care home
Name of care home: Address: Kingsley Nursing Home 4 Trafalgar Road Southport Merseyside PR8 2EA 01704566386 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) : kingsleyhomesltd@yahoo.co.uk Kingsley Nursing Homes Ltd care home 25 Number of places (if applicable): Under 65 Over 65 25 old age, not falling within any other category Additional conditions: 0 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 25 Date of last inspection Brief description of the care home Kingsley is a privately run home providing twenty five places for older people who need nursing care. It is situated in a residential area of Southport with easy access to local shops, the town centre and public transport. The registered provider/owner is Kingsley Nursing Homes Ltd and the manager is Mrs Barbara Evans. The premises are detached and comprise of two buildings over four floors. The home has twenty one single bedrooms (four ensuite) and two double bedrooms both ensuite. The accommodation is on the ground, first and second floor and a passenger lift provides access to all areas. Residents have the use of a call system with an alarm facility. Recreational space consists of a lounge and conservatory overlooking the front. The conservatory is used as a dining room and quiet area. Both rooms are pleasantly Care Homes for Older People
Page 4 of 31 Brief description of the care home decorated. Bathrooms although domestic in style have aids to assist those who are less independent. The home has well established gardens to the front and rear and there is also some car parking space. A ramp leads to the front door. The weekly fee rate for accommodation ranges from 510 to 554 pounds. The higher rate is charged for a single room with an ensuite facility. Copies of the most recent CQC inspection report are available with the statement of purpose and the service user guide from the manager or home administrator Care Homes for Older People Page 5 of 31 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: As part of the inspection process we sent Kingsley Nursing Home an Annual Quality Assurance Assessment (AQAA) document, which was completed prior to our visit to the home. This document was to provide information about the service at Kingsley and to tell us where they felt they had made improvements to the way they support service users and the staff team. As part of the inspection process surveys were sent to four service users and seven members of the staff team, a total of seven responses were received. The last inspection on this service was completed on Care Homes for Older People
Page 6 of 31 We visited Kingsley Nursing Home to enable us to look at records and to discuss how the home supports service users in all aspects of their lives. Part of this process involved speaking with the manager, members of the staff team and spending time with service users to find out their views on living at the home. We spent approximately seven hours at Kingsley Nursing Home. What the care home does well: What has improved since the last inspection? Care Homes for Older People Page 8 of 31 Kingsley Nursing Home provides a comfortable environment for service users to live in. The following information was gained from the AQAA dataset completed by the manager prior to our visit to the home indicating items purchased and work carried out in the last twelve months: New garden furniture has been purchased so that when the weather permits residents can have afternoon tea in the garden. New mattresses have bee purchased. New chairs purchased for lounge and conservatory. New bedroom furniture has been purchased. Refurbishment of bedrooms. New hospital beds have been purchased. Opened up fireplace in the lounge. New larger wall mounted TV in the lounge. The manager and the owner continue to support the staff team to undertake training to enable them to offer service users appropriate and safe support resulting in positive outcomes. Members of the staff team spoken with and comments made in returned surveys provided the following information: The home is very good at giving people choice and maintaining their independence. The service provides a high level of care to all service users and caters to all service users needs. As I have worked in the same place for over 10 years I think that speaks for itself. The care given to the residents is to a high standard and they look happy. Barbara is very supportive and fair. We support and try and meet all the needs of our residents. They give very good training for new employees. They treat residents as individuals they dont generalise them. We get on well as a team What they could do better: We looked at a number of risk assessments and discussed with the manager the need to review them more frequently and to clearly document information received or sought from other healthcare professionals. This is to ensure service users healthcare needs are being fully met in a proactive manner. We discussed the information currently recorded when a risk assessment has identified that bedrails are needed to maintain a service users safety. We advised the manager to keep detailed records as to how often the bedrails and bumpers are checked to ensure they are in the correct position to safeguard service users from injury. The manager told us she would ensure detailed records are kept including attempts made to contact specialist services for advice and support. All members of the staff team have received safeguarding adults training. However we discussed with the manager the need to have a copy of the local adult social services departments safeguarding vulnerable adults policy and procedure easily available for the staff team to access. Care Homes for Older People
Page 9 of 31 The home does not have a designated dining room, which limits the options service users have to eat meals together as a group allowing them to use mealtimes as a social activity. The AQAA dataset completed by the manager acknowledges this issues as an area they would like to improve. 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 10 of 31 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 11 of 31 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. Prospective service users can be confident the home can meet their identified care needs and personal aspirations in a safe and supportive environment. Evidence: The statement of purpose and service user guide provides basic information about the services and facilities available. We discussed with the manager the need to review the formats used in these documents to ensure they are easily understood and are in formats that are meaningful to service users and people who may wish to move into Kingsley Nursing Home. Before a person moves in to the home the manager or one of her deputies make arrangements to carry out a full assessment of the persons needs and lifestyle choices. The assessment process involves talking and spending time with the person who wishes to move into the home and talking to their relatives and other
Care Homes for Older People Page 12 of 31 Evidence: professionals involved in their care. Admissions to the home only take place if the manager or deputies are confident they can meet the prospective service users identified needs. This approach ensures service users can be confident they are moving into a home that can meet their medical, physical, emotional and psychological needs. Care Homes for Older People Page 13 of 31 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. Service users personal and health care needs are met by a staff team who are skilled, respectful and sensitive to their needs. This results in them receiving a person centred service which respects and promotes their individual needs and wishes. Evidence: Service users receive personal and health care support using a person centred approach with support provided being based upon the rights of service users to be treated with dignity, equality and respect. This ensures service users receive individualised care and support based on their needs and lifestyle choices. Care plans provide information regarding service users health, social, emotional and psychological needs. We discussed with the manager the need to increase the information held about service users past life experiences, which will support the staff team to get to know them in a more individualised and personal way. Care plans are regularly reviewed to ensure the care support provided meets the changing needs and wishes of service users. Enabling service users to have confidence that the home can
Care Homes for Older People Page 14 of 31 Evidence: continue to meet their needs in a sensitive and professional manner. The manager was advised to review the way in which the staff team record information following visits from other healthcare professionals. This is to ensure there is clear guidance and information for the staff team to follow resulting in service users receiving consistent and safe care. Service users spoken with provided the following information: I only need to ask for help and the girls are there. The girls are very good and help me when I need it. Records show the home acts proactively to ensure service users are supported to access health care services when required including GP, hospital appointments, podiatry, tissue viability services and optical services. Service users spoken with during our visit confirmed this information. We looked at a number of risk assessments and discussed with the manager the need to review them more frequently and to clearly document information received or sought from other healthcare professionals. This is to ensure service users healthcare needs are being fully met in a proactive manner. We discussed the information currently recorded when a risk assessment has identified that bedrails are needed to maintain a service users safety. We advised the manager to keep detailed records as to how often the bedrails and bumpers are checked to ensure they are in the correct position to safeguard service users from injury. The manager told us she would ensure detailed records are kept including attempts made to contact specialist services for advice and support. If I feel unwell Barbara or will ring the doctor. The home has a detailed medication policy and a procedure that is clear and easily understood for the staff team to follow. Qualified nurses administer service users medication. A sample of service users medication and the accompanying records were examined and the following issues were raised with the manager: On some Medication Administration Record sheets it was unclear when medications should be administered. The manager acknowledged this and told us she would contact the dispensing pharmacist to make sure this information was added. The use of PRN medication for one service user should be reviewed with the GP to ensure there is clear guidance for the staff team. Food supplements prescribed for individual service users should be stored separately
Care Homes for Older People Page 15 of 31 Evidence: to ensure they use can be effectively monitored. Following the site visit the manager confirmed by email the above issues had been resolved. The AQAA document tells us service users have access to a public telephone in the entrance hall, however they are also supported to have a telephone line fitted in their bedrooms for easy access and privacy. Service users spoken with felt their relatives and friends are made to feel welcome when they visit. We observed members of the staff team supporting service users in a respectful and affectionate manner. Care Homes for Older People Page 16 of 31 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. Service users views and wishes are sought and form the basis of social and leisure activities provided by the home. Evidence: The manager and the staff team support service users to develop friendships within the home and to maintain important personal and family relationships. Enabling service users to remain connected to their lives prior to moving into Kingsley Nursing Home. Service users are supported to continue to take part in activities they enjoyed doing prior to moving into the home and to become part of the home community through shared activities and experiences. This could be further improved by widening the variety of activities provided supporting service users to be involved in meaningful activities and to engage in decision- making regarding how they spend their days. During the site visit we were told a number of service users were going on a trip to Blackpool to enjoy a cabaret style afternoon. Service users spoken with provided the following information:
Care Homes for Older People Page 17 of 31 Evidence: I would rather be living in my own home but Im not well enough living here is quite nice The girls are lovely and very helpful when my family visit they are made to feel very welcome. There are things to do if you want to sometime I join in other times I like to be on my own. There is no formal dining room with service users supported to eat their meals in their rooms or the lounge and conservatory if they wish. The lack of space reduces the ability for service users to be able to eat together as a group and to use meal times as a communal social event. The AQAA dataset completed by the manager prior to our visited raised this issue as an area they would like to improve. There are set menus with alternative meal options available for service users to view. Discussions with service users provided the following comments: They will change any food I do not like. They are happy to serve me in my room if I want If I dont want the meal on offer they will always make me something else. Special dietary needs such as soft foods, low sugar, salt and fat diets are catered for. We discussed with the manager the need to keep detailed records about food supplements being given to service users to ensure a clear audit trail can be maintained. Care Homes for Older People Page 18 of 31 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. Service users views and opinions are sought and acted upon. This results in a service that proactively promotes service users rights as citizens to be protected from discrimination and abuse. Evidence: The home has an open culture that allows service users to express their views and concerns in a safe and understanding environment, resulting in service users feeling valued and respected. Service users spoken with told us they are happy with the level of service provided, feel safe and supported by the manager and the staff team who promote their protection and safety. Service users spoken with provided the following comments: It very nice here if I was worried I would talk to my daughter who would speak to one of the nurses in charge The girls are very good if I was unhappy about anything I would talk to them or Barbara. All members of the staff team have received safeguarding adults training with refresher training taking place at regular intervals. Members of the staff team spoken
Care Homes for Older People Page 19 of 31 Evidence: with demonstrated a good understanding of their roles and responsibilities regarding protecting service users from all forms of abuse and neglect. Resulting in service users living in an environment, which respects and supports their lifestyle choices and promotes their wellbeing. We discussed with the manager the need to have a copy of the local adult social services departments safeguarding vulnerable adults policy and procedure easily available for the staff team to access. Care Homes for Older People Page 20 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The current environment adequately meets the needs of service users and offers them a homely and comfortable place to live. Evidence: Kingsley Nursing Home provides a comfortable environment for service users to live in. The following information was gained from the AQAA dataset completed by the manager prior to our visit to the home indicating items purchased and work carried out in the last twelve months: New garden furniture has been purchased so that when the weather permits residents can have afternoon tea in the garden. New mattresses have bee purchased. New chairs purchased for lounge and conservatory. New bedroom furniture has been purchased. Refurbishment of bedrooms. New hospital beds have been purchased. Opened up fireplace in the lounge. New larger wall mounted TV in the lounge. We noted a number of window frames appeared worn with paint peeling off the wood. This issue should be addressed through the homes general maintenance programme. The home does not have a designated dining room, which limits the options service
Care Homes for Older People Page 21 of 31 Evidence: users have to eat meals together as a group allowing them to use mealtimes as a social activity. The AQAA dataset completed by the manager acknowledges this issues as an area they would like to improve. The gardens to the front and rear of the home are well maintained and accessible for service users to use. Service users spoken with told us they felt comfortable living at Kingsley and had no complaints about the facilities provided. At the time of our visit the home did not have an infection control policy in place however hygiene and nursing practices indicated the staff team promote good practice to minimise the risk of cross infection to service users. The manager told us she would produce a detailed policy to ensure service users safety and wellbeing. Care Homes for Older People Page 22 of 31 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. Service users are supported by a well trained and skilled workforce resulting in their individual needs and lifestyle choices being met in a person centred way. Evidence: Rotas show Kingsley is staffed efficiently and in a way that supports service users daily routines enabling them to feel in control. Service users and members of their families spoken with during the visit provided the following information: The girls are lovely and very helpful. Since my mother moved in her health has improved and she is much happier. I like living here the nurses and the rest of the staff look after me very well. Barbara and A keep me up to date about how mum is nothing is too much trouble for them. The manager supports the staff team to undertake training courses to enable them to
Care Homes for Older People Page 23 of 31 Evidence: gain the skills, knowledge and expertise to support service users needs and lifestyle choices effectively and safely. Members of the staff team spoken with and comments made in returned surveys provided the following information: The home is very good at giving people choice and maintaining their independence. The service provides a high level of care to all service users and caters to all service users needs. As I have worked in the same place for over 10 years I think that speaks for itself. The care given to the residents is to a high standard and they look happy. Barbara is very supportive and fair. We support and try and meet all the needs of our residents. They give very good training for new employees. They treat residents as individuals they dont generalise them. We get on well as a team Care Homes for Older People Page 24 of 31 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 management and administration systems within the home promote the health, safety and welfare of service users. Evidence: The registered manager, Ms Barbara Evans has over twenty years experience as a qualified nurse and has been managing Kingsley Nursing Home for approximately four years. There are management systems in place to support the running of the home including policies and procedures and clear financial planning with a commitment to continue to improve the service. Leading to an increased quality of life for service users with a focus on promoting equality, dignity, respect and fairness. The manager is open and transparent and is supportive of both service users and the staff team.
Care Homes for Older People Page 25 of 31 Evidence: The home works to health and safety policies, with the staff team being supported to undertake training at regular intervals. Regular supervision takes place including observational supervision to ensure staff members adhere to health and safety procedures. An administrator is employed to manage the financial processes within the home with the manager providing management support. A selection of health and safety records were examined they demonstrated the manager and the staff team work hard to ensure service users live in a safe and healthy environment. We discussed with the manager the need to look at the in house quality assurance systems in place and ensure they are service user focused. Care Homes for Older People Page 26 of 31 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 27 of 31 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 The times medications are to be administered must be documented on all Medication Administration Record sheets. This is to ensure service users receive their medication at the appropriate times to supoprt them to maintain their physical and mental health wellbeing. 23/06/2009 2 12 13 Detailed records must be 22/06/2009 maintained with regard to the administration of prescribed food supplement. This is to ensure servcie user nutritional needs are being met appropriately and safely. 3 26 13 An infection control policy must be produced. 13/07/2009 Care Homes for Older People Page 28 of 31 This is to ensure service users and and welfare is promoted and protected from the risk of infection. 4 33 24 A review must take place 14/09/2009 with regard to the current in house quality assurance systems being used. This is to ensure the views and opinions of service users, their relatives and other stakeholders are sought to enable the home to feel confident the services they are providing meet with the needs and expectations of service users. 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 1 The statement of purpose and service user guide should be reviewed to ensure they are in formats that support prospective service users to make an informed decision as to whether Kingsley Nursing Home can meet their needs and wishes. When bedrails and bumpers are being used detailed records should be kept regarding the observations df the staff to their position and condition. This is to safeguard service users from injury. The use of PRN medication for one service user should be reviewed with their GP to ensure the medication is being administered in line with their instructions. Food supplements prescribed for individual service users should be stored separately to ensure a clear audit trail can be maintained. A review take place as to whether there is a possibilty to use the conservatory as a formal dining room for service 2 8 3 9 4 9 5 15 Care Homes for Older People Page 29 of 31 users. 6 18 A copy of the local adult social service departments safeguarding vulnerable adults policy and procedure should be available for the staff team to access. Painted window frames which are damaged and worn should be repaired. 7 19 Care Homes for Older People Page 30 of 31 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 31 of 31 - 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!
