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Inspection on 30/10/08 for Larchwood Nursing & Residential Home

Also see our care home review for Larchwood Nursing & Residential Home for more information

This inspection was carried out on 30th October 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

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

What the care home does well

The service carries out good assessments prior to admission to the home to make sure that the service can meet the needs of the prospective residents. The residents speak highly of the staff group and their hard work. Relatives praise the care shown to residents, comments reflected that they consider the staff to be "most caring" and "always friendly and helpful". The residents made positive comments about the food such as "food is lovely" and "we get to choose what we want to eat". Activities for the residents are well organised and one commented that "there is always something going on and things for us to do" The service maintains good records for all complaints received and how they have been dealt with.

What has improved since the last inspection?

The service has improved its procedures for the vetting of new staff before employment. A new breakfast room has been established and decorated. Some curtains have been replaced and some rooms re carpeted.

What the care home could do better:

The care plans do not always reflect the current support needs of the residents with prompt revision following changes identified. Staffing levels are a concern especially during the weekends and the use of agency staff remains high. The process for supervision of staff needs to be improved so that it becomes a more formal and a continual process. The staff training programme covers all mandatory training but this needs to be extended to include training in relation to meeting specific needs of the individuals who use the service. The carers need also to be given more opportunities to complete NVQ training. The manager needs to have a better system for maintaining records. The service must ensure that the Commission is always advised of all incidents that occur in the home. All matters highlighted in this report suggest that a more robust monitoring and oversight of the management of the home is required for its safe management.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Larchwood Nursing & Residential Home 133 Yarmouth Road Thorpe St. Andrew Norwich Norfolk NR7 0RF     The quality rating for this care home is:   zero star poor 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: Marilyn Fellingham     Date: 0 4 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. 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 29 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 29 Information about the care home Name of care home: Address: Larchwood Nursing & Residential Home 133 Yarmouth Road Thorpe St. Andrew Norwich Norfolk NR7 0RF 01603437358 01603702046 larchwood@bondcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Bondcare (Larchwood) Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 48 Number of places (if applicable): Under 65 Over 65 48 0 old age, not falling within any other category physical disability Additional conditions: 0 48 No more than 48 Service Users may be accommodated. One person with dementia whose name is held on CSCI records may be accommodated. Once this person is no longer resident, the registration reverts to 48 older people. Up to forty-eight (48) Older People may be accommodated in the category OP. Up to forty-eight (48) Service Users who have a physical disability may be accommodated in the category PD, who are aged 55 years or over. Date of last inspection Brief description of the care home Larchwood Nursing and Residential Home is owned by Bondcare Ltd and is situated on the outskirts of Norwich, within Thorpe St Andrew. The home lies within easy access of Care Homes for Older People Page 4 of 29 Brief description of the care home a large supermarket, post office and small local shops. It is a two-storey building with access to the first floor by shaft lift and stairs. The home can accommodate up to 48 older people, 25 with nursing needs and 23 with residential needs. The service has 36 single and 6 shared bedrooms. All the bedrooms have en-suite toilets and washbasins. There is an enclosed patio area with seating and with raised flowerbeds that are accessible to wheelchair users. The home has car-parking facilities at the rear of the premises. The home informed CSCI of its charges in March 2007 and charges the following for care provision: from £358 to £650 per week. Residents are expected to pay extra for hairdressing, chiropody, newspapers and personal items. 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: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit that took place over twelve hours. The key inspection for this service has been carried out using information from previous inspections, information from some residents, relatives, visitors to the home and people who work in the home. The main method of inspection used was case tracking. This involved selecting individual care plans and information available about people who live in the home and tracking their experience as a result of the support provided. During out visit a tour of the premises was undertaken and residents records and staff Care Homes for Older People Page 6 of 29 files were looked at. What the care home does well: What has improved since the last inspection? What they could do better: The care plans do not always reflect the current support needs of the residents with prompt revision following changes identified. Staffing levels are a concern especially during the weekends and the use of agency staff remains high. The process for supervision of staff needs to be improved so that it becomes a more formal and a continual process. The staff training programme covers all mandatory training but this needs to be extended to include training in relation to meeting specific needs of the individuals who use the service. The carers need also to be given more opportunities to complete NVQ training. The manager needs to have a better system for maintaining records. The service must ensure that the Commission is always advised of all incidents that occur in the home. All matters highlighted in this report suggest that a more robust monitoring and oversight of the management of the home is required for its safe management. Care Homes for Older People Page 8 of 29 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 who use the service have good information about the home prior to making a decision about whether it is right for them The needs assessment means that peoples needs are identified and planned for before admission. Evidence: We looked at the assessments records for prior to admission for two recently admitted residents; the initial assessments were good with sufficient information to ascertain if their needs could be met. We spoke with one of these residents to find out if they had been given enough information about the home so that they could make a decision about if they wanted to live there. They told us that they had Bent given enough information about the home and that they were happy with the arrangements for admission to the home. Prospective residents and their relatives are given the opportunity to visit the home in order to establish if they like it; whilst we were visiting the home we noted two lots of Care Homes for Older People Page 11 of 29 Evidence: relatives visiting and we were aware that they were coming back the next day in order to show their relative the home and gain their approval. Each resident is given a contract and we saw a copy of one for one of the newly admitted residents. 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. The practice regarding the planning and delivery of care could be improved with more detail related to wound care, to ensure that that the residents assessed care needs are fully met. Evidence: We looked at six care plans which included two related to the newly admitted residents. We noted that there was no evidence of resident involvement in the care planning system for any resident. All six resident records had life histories in place. It was noted that for some of the care plans there were detailed instructions for care needs; nutritional and skin integrity assessments had been carried out and weight monitoring had also been recorded. However we did note on the care notes for one resident that they had not been weighed since 28/07/08 although it was noted previously they had been losing weight. Risk assessments were in place for manual handling for this resident as also were relevant details for the preventative care in relation to the risk of developing pressure sores. We also noted that there was evidence of continual review of the care. The care notes for another resident, as for Care Homes for Older People Page 13 of 29 Evidence: the previous resident were relevant to his assessed needs, however they did have a pressure sore with very little evidence of instructions for care that just stated on the care plan regular dressing. Another residents records we looked at had good care plans in place for all assessed needs with evidence of risk assessments for manual handling and dealing with MRSA: they did not however have a detailed plan in place for a wound dressing. We also noted that another resident had no care plan in place at all for a sacral sore. The other care plans we looked at had good notes in place for GP visits and contact with other agencies. We did note that those residents that had been prescribed p.r.n. medicines (as required), had care plans in place to justify use of the medicine; there were also records in place for the protocol to follow to deal with residents pain. We did note that the plans of care did not record any information about the residents mental capacity. We undertook a random check of medicines, which revealed a few anomalies, two residents had not received their medication on one morning with no reason in place for it not having been given. We questioned the manager and sister about this and the discrepancy was due to an agency nurse that had been working in the home. The manager stated that they had spoken to the agency involved and that they were asking the nurse why the medication had been withheld. We observed a carer who was administering medicines to the residential residents in the home, we observed him signing for a medication to say he had given it before it had been given to the resident. We spoke with a number of residents and visitors to the home; we discussed aspects of care with all of them. One resident told us said I am mostly well cared for and I get pain relief when I need it they did go on to tell us that they did not like the foreign workers talking over them in their own language but added that they were all very kind and caring. Another resident said I have not been here very long but the staff are very good, and another resident told us I am treated nicely and I choose what I want to do. One daughter who was visiting told us that she was so far pleased with the care her relative was receiving. One gentleman visiting his wife said my wife is always very clean, the staff are extremely helpful and kind in every way from the bottom to the top. Another visitor was concerned that their relative was not always dressed properly and that some of the care staff talk in their own language. During our visit we observed that the communication between staff and the residents was dignified, courteous and sensitive. Care Homes for Older People Page 14 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. A wide range of activities within the home means that the residents have many opportunities to participate in stimulating and meaningful activities. Mealtimes appear to be unrushed and enjoyable. Evidence: We discussed with a number of residents and visitors about activities within the home and the wider community. We did note that all resident involvement with activities is recorded in their care notes, these were informative with notes about their engagement in the activities. We looked at the records of activities that have taken place over the past months, these included entertainment, baking, flower arranging, a film club, and quizzes. We spoke with the member of staff responsible for the activities who showed us some records and photos of residents enjoying some of the activities. This staff member told us that they also like to try and continue some of the pastimes with the residents of things they used to like doing. One resident we spoke with told us that there is usually something going on every afternoon, they went on to tell us that they enjoyed the baking and that once a week they try each others recipes. Another resident told us that they often join in the activities. Care Homes for Older People Page 15 of 29 Evidence: We observed lunch being served and the residents appeared to enjoy what they were given, a number of them were being assisted with their lunch which was being carried out in an empathetic manner. We discussed the food with some residents and relatives who made complimentary comments about the meals the residents were served. One relative said the choices on the menus are good, a resident commented the food is very good, whilst another told us food is average but we do get a choice and another said the food is lovely. The residents choose where they wish to eat their meals some were in the dining room whilst others were in their own rooms. We noted that about ten residents were requiring assistance with feeding and because of this a number of them were receiving their lunch quite late in comparison to the other residents. The menus we looked at were varied and nutritious. Care Homes for Older People Page 16 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. Residents feel safe and listened to. The staff have been given the knowledge to recognise all aspects of abuse, this means that every effort is made to protect the residents. Evidence: We noted on arrival that the information in the reception area stating how persons can make a complaint needed up dating as it did not have the relevant and recent information We looked at records for complaints and noted how they had been dealt with; we noticed that no records were kept of small concerns expressed by residents and relatives and how they have been actioned. We spoke with some residents and relatives who all stated that they knew how to air their concerns. One relative told us so far every concern has been dealt with sympathetically. A resident said I go to the manager if I have a concern and another resident told us they did not have any concerns. The staff we spoke with were aware of the complaints procedure. We spoke with seven members of staff and all were aware of issues relating to safeguarding adults and had received training in this; this was confirmed by looking at training records for this. We looked at minutes of meetings that took place with relatives and residents, however they did not record any concerns that had been raised or how they had been dealt with although the manager informed us that concerns are raised at these meetings. Care Homes for Older People Page 17 of 29 Care Homes for Older People Page 18 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. The continual maintenance and risk assessments of the environment means that people live in an adequate and safe environment. Evidence: We toured the premises and found them to be clean and well maintained; we did not detect any unpleasant odours. As residents rooms have been vacated so they have been re carpeted and some rooms have had new curtains. The manager told us that the ground floor and top floor had been priced for re carpeting. One room has been made into a very pleasant breakfast room, this was a very bright room and well furnished. We gained permission from a number of residents to view their rooms; they were suitable and and some had personal belongings in them. Those residents we spoke with said that they were satisfied with their accommodation and told us that generally they were kept clean. There were good records in place for the maintenance and servicing of all equipment in the home, including those for the hoists, passenger lift, and the boiler. PAT tests have been carried out and risk assessments for the environment; the rooms are risk assessed on a regular basis. We also saw records for the maintenance of bed rails and wheelchairs and the fire risk assessments for the whole building. Care Homes for Older People Page 19 of 29 Care Homes for Older People Page 20 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels and training could be improved which would result in much better outcomes for those people using the service. Evidence: We looked at the duty rosters and although the home has taken on some new staff there were periods when agency staff had been used especially at the weekends. Those staff we spoke with felt that it was difficult to maintain continuity of care for the residents when agency staff are used. We noted that on our arrival at the home there was only one Registered nurse on duty who was doing the medicine round; the manager should have been on sick leave although came into the home for the duration of our visit. No other trained nurse had been arranged to cover and the one nurse on duty was not only managing the home but also carrying out other duties such as wound care. We noted in the afternoon that one gentleman had been waiting for his wound to be dressed since the morning and was sitting with one leg unprotected and exposesd to the elements: this could have been avoided if other staff had been added to the staffing ratios for that day. The manager herself told us that the recruitment process takes too long and that the use of agency staff was too much. We talked with seven members of the staff team during our visit; they were knowledgeable about the residents they were caring for and understood their roles. Care Homes for Older People Page 21 of 29 Evidence: However they told us that they have not received much training recently and would like more skills to help them care for the residents more adequately. We were unable to check training records as none were available. Most of the staff have done fire training and new recruits have completed induction training, but some staff have not had relevant training in safeguarding adults and neither has the manager. Two of the kitchen asssitants have not had training in food hygiene. Some of the staff told us that they were having a problem meeting up with their NVQ assessors as the staffing levels did not permit them to do this. We looked at the records for newly appointed staff, these reflected a rubust system for recruitment with all the required checks being in place. Care Homes for Older People Page 22 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are management shortcomings that potentially compromise the health, safety and welfare of people using the service. Evidence: We had numerous concerns expressed to us by staff about the management of the home; they felt that the manager did not listen to their concerns and that she not not treat some of their personal concerns confidentially. They also expressed their concerns about the manager often shouting at them and mood swings. The management of records is not entirely satisfactory and the manager at times had difficulty in locating the paperwork and records that were necessary for the inspection process. A number of incidents have occurred in the home that the Commission had not received notification about. We looked at accident records but the manager confirmed that they had not been audited so a pattern of accidents and frequency had not been established. Care Homes for Older People Page 23 of 29 Evidence: A sample of health and safety related information was checked, these records were in good order and had been maintained by the maintenance person. Formal supervision has not been taking place this was confirmed by the staff we spoke with and the manager. Care Homes for Older People Page 24 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 9 13. 2 The person responsible for administrating medicines must not be interrupted in the course of their duties so that medicines are administered safely and in good time. A policy and procedure for the recruitment and vetting of staff must be written and adhered to so that all staff employed in the home are thoroughly vetted and checked prior to employment. 30/11/2007 2 29 19 30/11/2007 Care Homes for Older People Page 25 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 20 All people using the service must have an up to date, detailed care plan. This will ensure that all people using the service receive person centred support that meets their needs. 27/02/2009 2 30 18 It is required that all staff receive training appropriate to the work they are to perform. The improvement in training should result in better outcomes for people using the service. 28/02/2009 3 36 18 The manager must ensure that all staff are appropriately supervised. This will ensure that the residents have sufficient protection and staff are given the opportunity to express concerns and devlop professionally. 27/02/2009 Care Homes for Older People Page 26 of 29 4 37 17 The manager must ensure that records must be available at all times for inspection in the care home by the Commission. This will ensure that the home is being well run and that the quality of care can be monitored. 27/02/2009 5 38 17 The manager must inform the Commission of any incidents that occurr in the home. This will ensure that the service is complying with the Care Home Regulations. 27/02/2009 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 7 It is recommended that all staff understand the procedure for giving medicines this will ensure that the residents receive the correct treatment in a safe way. If possible all residents if able, or their representatives should be encouraged to participate in the care planning activity and records put in place to acknowledge this. It is recommended that all residents are assessed to establish their mental capacity and that this information is recorded on care plans and reviewed at appropriate intervals. This will help to ensure the safety of the residents and their mental well being. It is recommended that all residents who have wounds have detailed care plans in place, this will ensure that the residents are receiving the appropriate care for their wounds. It is recommended that a policy and procedure be put in place for the administration of homely remedies. This will make sure that the residents are not being denied immediate treatment and can be given one off medicines Page 27 of 29 2 7 3 7 4 8 5 9 Care Homes for Older People to relieve symptoms. 6 16 Itis recommended that the manager receives training in all issues relating to the protection of vulnerable aduts. This will ensure that she understands the process for dealing with abuse issues and the local process for reporting abuse. It is recommended that records are kept of all concerns expressed by the residents or their relatives. This will ensure that the service can demonstrate how they deal with all issues that they receive and assist the service in monitoring the quality of care it offers. Consideration must be given to the ratio of staff on duty at any given time and the limited use of agency staff. This will help to achieve better outcomes for those people who use the service and ensure that there is continuity of care. It is recommmneded that better records are maintained for staff training, this will assist in the monitoring of required training needs. 7 16 8 27 9 30 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 © (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 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. 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