Inspection on 19/11/08 for Kingswood Park

This inspection was carried out on 19th November 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kingswood Park 24/11/06

Kingswood Park 21/10/05

Kingswood Park 08/06/05

Kingswood Park 18/01/05

Kingswood Park 28/04/04

Kingswood Park 11/03/04

Similar services:

Claremont House

Oak Ridge

Coopers Mill Ltd

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Paradise Lodge

Bilney Hall

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Kingswood Park Kingswood Road March Cambridgeshire PE15 9RT     The quality rating for this care home is:   one star adequate 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: Don Traylen     Date: 1 9 1 1 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 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) 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 29 Information about the care home Name of care home: Address: Kingswood Park Kingswood Road March Cambridgeshire PE15 9RT 01354652381 01354660304 home.mar@mha.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Sumiyo Berkeley Type of registration: Number of places registered: Methodist Homes for the Aged care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability old age, not falling within any other category Additional conditions: Staffing levels must not fall below 7 care staff from 7.30am - 10pm and 3 waking night staff throughout the night. Date of last inspection Brief description of the care home Kingswood Park is a spacious care home situated in a quiet residential area of the town of March in the Fenland area of North Cambridgeshire. The care is provided by Methodist Care Homes, who entered into a partnership agreement with Hereward Housing Association, after Cambridgeshire County Council sold the home in November 2001. Methodist Homes lease the property from Sanctuary Hereward Housing. The home is registered to provide for 44 elderly people. Included in that number are people with a formal diagnosis of dementia and 2 people who have a learning disability. The home is divided into 5 units: Cherry, Redwood, Rowan, Maple and Willow. Each unit Care Homes for Older People Page 4 of 29 0 0 0 Over 65 18 2 44 Brief description of the care home has 8 or 10 bedrooms, a dining room, a lounge and a kitchen. All bedrooms and the deputy managers office are on the ground floor. The managers office, the administration office, a staff meeting/training room and staff facilities are situated on the first floor. The home provides a Day Centre that is staffed as an independent provision and is separate from the homes staffing arrangements. Fees charged by the home at the time of inspection ranged between £354 per week, to £530 per week. The lower amount being the lowest funding provided by Cambridgeshire County Council and the higher rate being the fee charged for people who privately fund their care. Care Homes for Older People Page 5 of 29 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was carried out on 19th November 2008 and lasted 7.5 hours. The manager and two deputy managers were present at various parts of the inspection. Peoples records of their admission to the home, their written care plans and medication records were assessed. The homes training arangements for staff, their recruitment process for two new care workers and various policies and fire safety arangements were assessed. The home completed an Annual Quality Assurance Assessment (AQAA) prior to this inspection and people living at the home and their relatives completed 22 survey forms. A tour of the building was conducted. Fifteen people were spoken to at random during the inspection and eight people were spoken to about their care. Four visiting relatives were also spoken to. Two care staff were asked about the care they provide, their training and knowledge of safeguarding Care Homes for Older People Page 6 of 29 people. What the care home does well: What has improved since the last inspection? What they could do better: Information written in the Annual Quality Assurance Assessment infered that the home may not always have adequate assessment detail of peoples needs. When any person is admitted for respite, or on a permanent basis, the home is reminded they have to be certain they have adequate detail to determine wether they can meet that persons needs. Care plans must reflect the most current and appropriate care needs of all people living at the home. Care plans must include the precise detail of the plan to prevent, or relieve pressure sores when this has been identified as a need. The plans should include the daily intake of how much fluid and food has been consumed when at risk of poor nutrition or considered to need adeqate fluids and are confined to long periods of lying or sitting in bed or chair. Care plans could be improved by use of an index system. The home should be prepared to request Health Services for urgent responses if they Care Homes for Older People Page 8 of 29 consider any person in their care to be in urgent need of specific, or emergency health care. The carpet in the passageway from the kitchen to the lounged should be cleaned or replaced. All part of the home where there are hazardous materials, such as cleaning liquids, must be kept locked if unattended and areas where equipment is stored must not prevent access to doorways. 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 29 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 29 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. People are assured the home has details of their assessed needs before they move into the home. Evidence: The home has sufficient information to inform people who are interested in living at the home. Two peoples files revealed they had been assessed by PCT Care Managers prior to moving into the home. One other person who was privately funding their care had been assessed by the home. It was not recorded if the home had referred the person to Cambridgseshire Primary Care Trust for their needs to be assessed under the 1990 Community Care Act 1990 (section 47). The home completed an Annual Quality Assurance Assessment in which they stated that occasionally they had not received adequate information from the the PCT/Local Authority. The manager said these related mostly to respite care arrangements. Care Homes for Older People Page 11 of 29 Evidence: Peoples experiences revealed that some placements are made quickly. One person wrote about her choice about living at the home was, last minute changed to Kingswood, no options. One person who had been in the home for two days told us that she did not know the layout of the home and that she had not been shown this and did not go anywhere apart from her room and the dining room. This is an aspect of admission that could be changed to improve peoples experiences. Intermediate care is not provided and therefore standard 6 was not assessed. Care Homes for Older People Page 12 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not assured all of their care is reviewed and their care plan has been updated to reflect their needs. People are not assured their medication is always safely managed. Evidence: The AQAA that the home completed stated that regular reviews of care plans are carried out and that contain action to be taken for tissue viability. The AQAA also stated the home has focused on end-of-life care. Three peoples care plans included risk assessments for falls. In the care of two people, the home were giving care that was meeting both persons needs, but had not fully recorded this and had not shown how they should meet certain needs. One person had a greatly reduced appetite, was confined to sitting in a chair or her bed and had been seen by a Community Nurse and her GP. When she was spoken to it was clear she was weak and had severe difficulties ingesting food. There was a chart showing she could consume only very small amounts of food and very small amounts Care Homes for Older People Page 13 of 29 Evidence: of water. She had been prescribed anti-nausea medication. Records of her fluid and food intake dated from 14th-19th November 2008. She had been provided with an special air pressure mattress as a preventative measure and did not have a pressure sore. However, there was no chart to show that she had been assisted to change her position whilst in bed to ensure the risk of developing a sore was reduced. There was a concern that she needed further medical investigation and this appeared to be urgent. The home knew that a hospital outpatient appointment had already been arranged for the near future by her GP, but it was considered this should not be waited for. The home was asked to contact the GP and request a hospital admission. This was immediately arranged. A second persons care plan was read. There were plans for her personal care and mobility and other elements of care. There were some omissions of care planning in her care plan: there was no clear plan for her pressure relief, no charts to record any body turns, no continence plan and no plan to ensure she was consuming or being offered sufficient fluids. However, the home knew this person had a good appetite and drank plenty of fluids and this she confirmed when she was spoken to in her room whilst on her bed. All nursing and GP visits and contacts had been recorded in each of the above persons care plans. The home keeps daily records in each care plan that are recorded for different topics of care needs but this format does not show a daily record to show a chronological sequence of events and this was not helpful when establishing the daily pattern of care for the above two people. A third persons care plan was read after she was spoken to. She had lived at the home for 2.5 years and had been assessed by the home because she was privately funding her care. Her major care needs related to her immobility and permanently needing chair and bed care. She was dependent on assistance to feed and drink. There were also needs related to her method of communication. The part of her care plan that related to her food and nutritional care was poorly recorded in that it did not adequately state how the home were meeting her needs. When questioned, one care worker offered a clear description of how she was helped to be fed and what food she had and that her weight had been maintained although her care plan did not reflect this care. Her weight had not been recorded and there was no measurement of her food and fluid intake. There was not a risk assessment for these associated needs. One person regularly visits his wife and wrote in his survey that he felt it necessary to ask her GP to assess his wifes hearing and legs because he was concerned. Medication administration records (MAR) were accurately completed for two items of medication for one person. Records of another item of medication were assessed and discussed with the manager and the assistant manager when it was discovered that it Care Homes for Older People Page 14 of 29 Evidence: could not be established if the amounts of medication were correct. The home had not carried forward a numerical amount of previous medication and had not added an additional amount of new medication to the Medication Administration Record sheet when this had been used. Staff were observed to be respectful and spoke to people in a manner that showed they were treated attentively and with dignity. One person spoke to us and said the carers are wonderful and they have kept her daughter informed. Another person replied in the survey forms that her requests have, all been heeded. Another person wrote , I do wish for ailments check each day.... carers could ask each person they are in charge of. Then things would not get overlooked. Care Homes for Older People Page 15 of 29 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. People are provided with choices about their meals, although they could be better assured of their preferences being heard. Evidence: The AQAA completed by the home stated that the home has introduced a broader range of activities and therapies and that a therapy room has been created. The AQAA also stated that Kingswood Park have improved the quality of their catering by offering more choice and well presented meals and a better mealtime experience. The AQAA states the home has strong links to Age Concern and Alzheimers Society. Comments made by people and their relatives about the food were varied. Some people said they experienced good food, whilst others said they did not like certain foods such as curry and burgers. One relative commented she was not sure what food her mother ate, as she was unable to tell her and there was no record kept that informed her. Visitor to the home are welcomed and during the inspection at least seven people visited. Three people stated they were frequent and regular visitors. One person stated Care Homes for Older People Page 16 of 29 Evidence: that he or his family visits his wife every day. He stated that, I think her and other residents need much more stimulation and encouragement after he had stated that, the only activity I know of is a visit to the Raptor Centre near St Ives and a couple of church services in the main room. When asked if staff listen to them, one person stated, certain members of staff do. But I have to mention things on a regular basis. Care Homes for Older People Page 17 of 29 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. People are assured the home will protect them from abuse, although the home does not assure people they have consistently heard their complaints. Evidence: The homes AQAA stated they have robust policy and procedures for dealing with any allegations or suspicions of abuse. They have provided two telephone links to an external agency to facilitate any staff or visitor to whistle blow. The home has consistently reported suspicions of abuse in the correct and appropriate manner and have co-operated fully with the Local Authority when they have investigated these allegations. They have also provided information in leaflets about abuse and reporting abuse and these are available within the home. Two staff who were asked where they would report abuse did not know who would deal with abuse and did not know where the contact telephone numbers were written. However, they were adamant they would report any concern to the manager and felt certain they could find the contact numbers in the managers office if they needed them. The home keep a record of complaints made to them. One person replied in the survey forms that, the complaint protocol is not clear and another person wrote that he did not know how to make a complaint. Another person wrote that staff, dont always get my kylie and my alarm and they dont always cut my dinner. A relative commented that the laundering of her fathers clothes is mismanaged and she has to Care Homes for Older People Page 18 of 29 Evidence: resort to taking some of his clothes home to clean. Care Homes for Older People Page 19 of 29 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. People are assured the home is reasonably well maintained, comfortable and has adequate facilities. Evidence: The surveys returned by people and relatives indicated they had some concerns about odours within the home and commented on the use of carpets rather than non-slip flooring. These include the following comments: I wonder if non slip flooring could be kept any cleaner; rooms could do with updating, sinks very ropey. I take air fresheners and urine smells bad in the summer. The home was clean and tidy and clear of hazards and was warm. There were no inoffensive odours. There was adequate natural daylight and ventilation. New no-slip flooring had been laid in the dining room. The blue carpet in the corridor outside the kitchen was stained. Although no rooms have en suite facilities, there are adequate bathrooms and toilets. Doors to two rooms where the cleaning materials and chemicals were stored were not locked. These were pointed out to the manager and were attended to. The maintenance employee was asked my a member of staff to deal with this as an emergency, but this was not immediately responded to by him. However, the manager Care Homes for Older People Page 20 of 29 Evidence: ensured this had been satisfactorily attended to by the end of the inspection. Care Homes for Older People Page 21 of 29 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 are assured care staff are safely recruited, although they would be better assured if all staff were trained in further key topics. Evidence: The report for the last key inspection on the 24/11/2006 required that staff be trained in falls prevention. This has been achieved. One person told us during the inspection that there were, not enough carers for the whole place. There were six care staff working in the morning plus the assistant manager and six staff in the afternoon and three staff working during the night time between 10pm and 8am. The manager works Monday to Friday 9am to 5pm. An activities co-coordinator is employed between Mondays and Fridays. A condition of their registration is that there must be seven care staff between 7:30 and 10pm. The organisation provides most of the training for staff. Records showed that all staff had received falls prevention training and safeguarding vulnerable adults. The AQAA states that end of life care is planned although not all staff have received this training. The AQAA stated that staff are trained in Mental Capacity Act. Most staff had received training in care planning; moving and handling; dementia care; infection control and fire procedures and evacuation. The records showed that only a small percentage of Care Homes for Older People Page 22 of 29 Evidence: staff had received training in Nutrition & the Elderly. The AQAA also stated that 70 of staff are NVQ level 2 qualified in care, although this was shown as closer to 50 in the records given to us during the inspection. The home provides induction training for new staff. There is no reference in this programme that it is based on Skills for Care Induction Standards, as expected by the Skills for Care Council. and no reference that names and details of staffs satisfactory complete ion of their induction are submitted to the Skills for Care Council. Recruitment records for two care workers showed they had been recruited safely and had not commenced employment before references and a satisfactory Criminal Records Bureau check had been disclosed. Care Homes for Older People Page 23 of 29 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. People are assured the home promotes their best interests. People are not totally assured their views are always heard. Evidence: The manager has been in post for some 5 years and has achieved the Registered Managers Award. She has always led by good example and practise. The management team of the home consists of the manager, a deputy manager and an administrative assistant. The AQAA completed by the home stated they had introduced a staff communication process so that staff are more involved in local and national decision making. They operate an internal quality assurance called Standards and Values Assessment to raise the level of service. However, this report has shown some evidence that care plans and medication management and written policies about induction could be improved. The homes recruitment policy had been adhered to when the details of the Care Homes for Older People Page 24 of 29 Evidence: two members of staff were assessed. The home did not have a policy for induction when this was asked for. The home has a written fire risk assessment. Fire safety training has been undertaken by all staff. Weekly fire equipment checks and alarm testing were recorded. The home has an evacuation plan that ensures people are evacuated and has an extensive emergency arrangements in place for a major incident and arrangements for local temporary accommodation should it be required. Doors to rooms with hazardous substances have already been referred to in this report as matters requiring management attention. Records of Regulation 37 and Regulation 26 reports and records of recruitment have always been completed and maintained when necessary. Record for food including meals and temperatures of food served, cleaning of the kitchens were kept. Hot water temperatures were safe and had been tested regularly and recorded. Water Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plan must be kept under review and must reflect peoples current needs so that people are assured they will be given the correct care they need. 01/01/2009 2 9 13 The home must ensure that medication records are accurately maintained So that people are safe and are not at risk of incorrect records being kept of their medication. medication are not at risk of being given All staff must be trained in nutritional and dietary care for elderly people so that people are safe and are assured that all staff are able to provide and recognise the appropriate care that is needed for people who have needs 01/12/2008 3 27 18 01/01/2009 Care Homes for Older People Page 27 of 29 associated with nutrition and diet. 4 38 13 All hazardous substances, such as cleaning liquids, must be stored safely so that people are not at risk from these hazards 17/12/2008 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 5 The home should ensure that people moving into the home either for respite or permanently should be shown around the building as part of their admission process. The home should promote peoples health by being prepared to request urgent Health Service, when this appears to be needed by any person living at the home. The home should ensure people are eating the food of their choice and that relatives are assured the know what and how much food people have eaten. The home should review their procedures for how people can make their views and complaints known. The home should promote staff awareness of how to report an allegation or suspicion of abuse. The carpet area outside of the kitchen should be cleaned or replaced. Induction training should be based on the Skills for Care Common Induction Standards. The home should write and induction policy. 2 8 3 15 4 5 6 7 8 16 18 19 30 33 Care Homes for Older People Page 28 of 29 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 © (2008) 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 29 of 29 - 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!