Inspection on 01/10/08 for Lawn Park Care Home

This inspection was carried out on 1st October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lawn Park Care Home 02/10/07

Lawn Park Care Home 14/09/06

Lawn Park Care Home 18/01/06

Lawn Park Care Home 24/05/05

Lawn Park Care Home 21/01/05

Lawn Park Care Home 06/09/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 17/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lawn Park Care Home Lucknow Drive Sutton In Ashfield Nottinghamshire NG17 4LS     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: Rose Moffatt     Date: 0 1 1 0 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 27 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 27 Information about the care home Name of care home: Address: Lawn Park Care Home Lucknow Drive Sutton In Ashfield Nottinghamshire NG17 4LS 01623515340 01623440174 lawn.park@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Keslaw Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Name of registered manager (if applicable) Mrs Rosalind Kennedy Brown Type of registration: Number of places registered: care home 49 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Service user shall be within categories OP (49) and PD (over 60 10 beds) Date of last inspection Brief description of the care home Lawn Park overlooks the park in Sutton In Ashfield near Mansfield, and is within walking distance to a bus route into the main town. The home provides personal care and nursing care for up to 49 people. The purpose built home is on two floors. All of the bedrooms have ensuite facilities. There is a large and comfortable lounge, a smaller sitting room and a dining room. There is a small conservatory used as a smoking lounge. There are pleasant and accessible gardens and a car park. Fees at the home range from £361 to £820 per week, depending on the assessed needs of the 0 10 Over 65 49 0 Care Homes for Older People Page 4 of 27 Brief description of the care home person. Information about the home, including CSCI inspection reports, is available in the main entrance area of the home or from the manager. Care Homes for Older People Page 5 of 27 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: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The last inspection of this home was on 2nd October 2007. The focus of our inspections is on outcomes for people who live in the home and their views on the service provided. The inspection process looks at the providers ability to meet regulatory requirements and national minimum standards. Our inspections also focus on aspects of the service that need further development. We looked at all the information that we have received, or asked for, since the last key Care Homes for Older People Page 6 of 27 inspection or annual service review. This included: the annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service; surveys returned to us by people using the service and from other people with an interest in the service; information we have about how the service has managed any complaints; what the service has told us about things that have happened in the service, these are called notifications and are a legal requirement; the previous key inspection and the results of any other visits that we have made to the service in the last 12 months; relevant information from other organisations; what other people have told us about the service. We carried out an unannounced inspection visit that took place over 6 hours on one day. The inspection visit focused on assessing compliance to requirements made at the previous inspection and on assessing all the key standards. There were 39 people accommodated in the home on the day of the inspection visit, including 21 people assessed as needing nursing care. People who live in the home, visitors and staff were spoken with during the visit. The manager was available and helpful throughout the inspection visit. Some people were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Case tracking was used during the inspection visit to look at the quality of care received by people living in the home. Four people were selected and the quality of the care they received was assessed by speaking to them and or their relatives, observation, reading their records, and talking to staff. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.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 8 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 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. There is a thorough assessment process so that people are confident their needs will be met at the home. Evidence: We looked at the care records for four people in the home. Each one had an assessment carried out by the home manager before admission to the home. People also had assessment information from social services, hospital staff, and Primary Care Trust (PCT) nurses as appropriate. The assessment carried out by the home was detailed and covered all areas of the persons life, needs and abilities. The home had recently collected personal history and preferences information for each person. People told us their needs were met at the home. They said, were well looked after, and,Im happy here - I dont want for anything. Staff told us they always had up to date information about people in the home, and they had appropriate training to Care Homes for Older People Page 10 of 27 Evidence: ensure they were able to meet peoples needs. The AQAA said that people are offered a day at the home before deciding if they wanted to live there,and that people had a trial period after admission. Staff have received customer care training to ensure that all enquiries about the home and any visitors to the home are treated properly. Standard 6 did not apply to this home as there were no people receiving intermediate care. Care Homes for Older People Page 11 of 27 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. There was sufficient information in care records, good staff training and awareness so that peoples needs appeared to be met. The care plans were not person centred to ensure that individual needs were fully met in the way people preferred. Evidence: Each of the four records we looked at had a care plan in place. The care plans had all been reviewed monthly up to date. There was evidence that the person or their representative had been involved in assessment and care planning. The care plans had good details of the action required by staff to meet the persons needs. There were some references to how the staff were to ensure the persons privacy and dignity were maintained, including some information about personal preferences. There were some gaps in the care plans. For example, none of the four people had a care plan about how their emotional and psychological needs should be met, even though this area had been included in the assessment information. One person had no care plan about protecting their skin even though they had been assessed as at risk of Care Homes for Older People Page 12 of 27 Evidence: developing pressure sores. One person had no care plan about their assessed need for help with eating. Gaps in care plans were noted at the previous inspection. We observed that some people were in wheelchairs without the footplates in place. This is a potentially unsafe practice as injuries can be caused. There were no relevant risk assessments in place in the care records. From discussion with people in the home, visitors and staff, and from looking at daily records and from observation, it appeared that peoples needs were met at the home. One person said their health had improved since coming to live in the home and said this was due to the excellent care I have had. Staff were knowledgeable about peoples individual needs and preferences. Staff had received appropriate training to ensure they had the skills and knowledge to meet individual needs. People told us that they saw their GP when needed, and other healthcare professionals, such as district nurse and chiropodist. The care records we saw included the input of other healthcare professionals. There was evidence that peoples health was monitored and appropriate action taken in response to any concerns or changes. The AQAA said that a weekly report was completed by the manager to monitor any pressure sores, weight variations, accidents, and any infection control issues. The manager and deputy manager carried out regular audits of care plans and medication and took action to address any shortfalls. Medication was stored securely. The registered nurses administered medication for all residents. The nurses had an annual update in the safe administration of medication and an assessment of their competence. The administration records seen had been correctly completed. One person had a topical cream prescribed that they administered themselves, but there was no care plan or risk assessment in place about this. People said the staff were friendly, kind, and patient. They told us that staff knocked on bedroom doors before entering. A visitor said that staff always treat the residents well and talk to them with respect. There were some reference to ensuring peoples privacy and dignity in the care plans. Staff induction and training included promoting privacy and dignity. Staff were able to give examples of how they ensured peoples privacy and dignity. We observed that staff treated people in an appropriate and respectful manner. Care Homes for Older People Page 13 of 27 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. The lifestyle offered in the home generally met the needs, preferences and expectations of people living there by providing a good range of activities, flexibility in routines, and well balanced meals. Evidence: People told us about things they enjoyed doing in the home, such as knitting, making cards, playing dominoes and bingo, having entertainers, and gentle exercises. They told us that routines were flexible and they could usually choose how to spend the day. One person said they enjoyed a daily walk in the grounds of the home. One person was pleased they could return to their bedroom whenever they wanted to, and were also pleased they could bring in items from home. One person was pleased with a recent manicure. One person said, I like having company - I wouldnt have that on my own at home. Another person said, I like sitting with my friends. People told us there was a regular religious service at the home, and also visitors from a local church. There were photos displayed of activities people had taken part in and information about future events. Visitors told us they could visit at any time and were always made welcome. They Care Homes for Older People Page 14 of 27 Evidence: could use the kitchenette area of the dining room to make a drink if they wished, or were offered a drink by staff. People living in the home said they could see their visitors in private if they wanted to. One person was pleased they could share a meal with a visiting relative. We observed that visitors were warmly greeted by staff. People told us staff usually listened to them and acted on what they said. Information about each persons personal history and preferences had recently been collected and was in the care records and also in the persons bedroom. Bedrooms were personalised with peoples own furniture and other belongings. One person said, My bedroom looks like it belongs to me. There was information available about a local advocacy service. The manager and deputy manager had attended training about The Mental Capacity Act 2005. The manager said further training was planned for care staff to attend. Most staff had received training about equality and diversity. People said they enjoyed the meals at the home and told us they had a choice. One person said they were pleased staff brought their breakfast each morning just the way I like it. The menu was displayed in the dining room and was also on each table. The menu appeared varied, balanced and appealing. The lunchtime meal served on the day of the inspection visit looked appetising and people said they had enjoyed it. The dining room was pleasant and bright, with cloths, flowers and condiments on each table. People who needed help with eating were assisted by staff in an appropriate and dignified manner. Water jugs and glasses, and bowls of fresh fruit were available throughout the day in the lounges. The home had recently introduced snack boxes for people so that they could have access to a snack at any time. Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are satisfactory systems in place and good staff awareness so that people are confident their complaints are taken seriously and they are protected from abuse. Evidence: People told us they knew how to make a complaint if they needed to. They said they would go to the manager with any concerns and were confident she would take appropriate action. One person who had made a complaint said they satisfied with the action taken by the home. There were detailed records of complaints made, including less formal complaints, with the action taken and the outcome. A summary of complaints was completed every month and included in the homes quality assurance audits. No complaints had been made directly to CSCI about the home. There were appropriate policies and procedures in place about safeguarding vulnerable adults. Most staff had received suitable training. Safeguarding information and procedures were included as part of the induction of new staff. Staff we spoke with were aware of safeguarding issues and the procedures to follow if abuse was alleged or suspected. The home had followed correct procedures and dealt effectively with two allegations of abuse made in 2008. Care Homes for Older People Page 16 of 27 Evidence: We observed that visitors had to ring the doorbell to be admitted by staff to ensure security. Visitors were reminded to sign in and out. We observed staff asking an unknown visitor who they were there to see, and checking with the person that the visitor was expected. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was clean, well maintained, and suitably equipped so that people enjoyed a safe, pleasant environment that met their needs, preferences and expectations. Evidence: People told us the home was always clean and free from offensive odours. People said they liked their bedrooms and were pleased they could bring in their own furniture and other belongings to personalise the room. People said the home was usually warm enough, although two people said they sometimes felt cold in their bedrooms or in the smaller lounge. Since the last inspection several improvements had been made, including refurbishment of the hairdressing salon, providing new equipment to assist manual handling, providing specialist beds to ensure peoples safety and comfort, and a new nurse call system. There was an ongoing programme of redecorating and refurbishing. The manager said that the ground floor bathroom and shower room were to be completely refurbished in the next three months to provide a fully accessible shower room . The home had a maintenance man working full-time. There was a smoking room off one of the lounges. Although this room met the relevant smoke free regulations, two people said the smoke sometimes drifted through into Care Homes for Older People Page 18 of 27 Evidence: the lounge. This was noticed on the day of the inspection visit. The manager said that sometimes people forgot to turn on the extraction system in the smoke room. The lounges and dining room were comfortably furnished. There was suitable seating to meet peoples needs, such as specially adapted wheelchairs and easy chairs, and dining chairs with sliders to enable easy manoeuvring by people and staff. The bedrooms seen were individual and personalised with ornaments, photographs and furniture. The manager said that when rooms were due to be redecorated, people could choose the colour scheme if they wanted to. The home was clean and fresh throughout on the day of the inspection visit. Most staff had received training about infection control. Staff were able to give examples of good practice to control infection, and we observed appropriate use of disposable gloves and aprons. Care Homes for Older People Page 19 of 27 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. There were sufficient staff and satisfactory recruitment, induction and training of staff so that people were protected and well supported. Evidence: People told us that staff were usually available when needed. One person said they sometimes had to wait for help to get up in the morning. We observed that there appeared to be enough staff to meet peoples needs, even at busy times. Staffing levels had recently been increased because of an increase in the number of people living in the home. People told us, the staff are lovely, theyre friendly, we have a laugh, and nothing is too much trouble. We looked at the records of four members of staff. All included the required documents and information, such as a Criminal Records Bureau (CRB) disclosure and two written references. Two application forms did not have a full employment history. New staff had an induction programme that met Skills For Care standards. Staff training records showed that all staff had received training in manual handling, and most staff had received training in safeguarding vulnerable adults, equality and Care Homes for Older People Page 20 of 27 Evidence: diversity, first aid, infection control, fire safety, coping with challenging behaviour, and customer care. Some staff had received training about the needs of people with dementia, and about peoples continence needs. Staff told us they were pleased with the training offered and found it useful in their jobs. The AQAA said that nine out of twenty-one care assistants, (approximately 43 ), had achieved National Vocational Qualification (NVQ) at Level 2 or above. The manager said that four care assistants were currently working towards NVQ Level 2, and other care assistants had recently signed up to start the qualification. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was well managed to ensure peoples views and best interests were taken into account, and to ensure health and safety was promoted. Evidence: The manager was suitably qualified and experienced to run the home. She was supported by a deputy manager and an administrator. The area manager for the providers was based at the home. The manager said she felt well supported. People told us they could go to the manager with any concerns and were confident she would take appropriate action. One person said prompt action had been taken when they raised a concern with the manager. A visitor said the manager always has time to talk. Staff said the manager was easy to talk to. The AQAA was completed by the manager and returned by the date required. The AQAA contained clear, relevant information that was supported by a wide range of Care Homes for Older People Page 22 of 27 Evidence: evidence. The AQAA gave a good picture of the current situation within the home, and details of the improvements that were planned. The data section was fully completed. The quality assurance system included annual surveys sent out to people in the home and their relatives or representatives. The results of the surveys and the action taken to meet any issues raised was displayed on the notice board in the main entrance area of the home, and was also brought to the regular meetings for people living in the home and their relatives. The latest survey results showed that the home had achieved an overall rating of 81 satisfaction. Action had been taken to improve bathrooms and to ensure visitors could make a drink for themselves after these issues were raised in the surveys. There were internal audits of all aspects of the home with an action plan of work needed to ensure compliance with National Minimum Standards, regulations, and internal policies. We looked at the records of personal money held for people living in the home. The money was securely kept with access limited to the administrator and manager. The records were up to date and all transactions had two signatures. The AQAA showed that all maintenance and servicing of systems and equipment was up to date. The maintenance person was responsible for ensuring all fire safety checks were up to date and the records seen showed this. Most staff had received appropriate training to ensure health and safety, such as fire safety, manual handling, and first aid. Accident records were satisfactory and there was a monthly audit by the manager of accidents. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 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 There must be a care plan 30/11/2008 and risk assessment in place where people choose not to use the footplates on their wheelchairs. This will help to protect people and to minimise any risks. 2 7 15 There must be a care plan 30/11/2008 and risk assessment in place for people who choose to administer their own medication. This will help to protect people and ensure medication is taken as prescribed. 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 Care plans should be written using a person centred and holistic approach, rather than focusing on perceived problems. This will ensure that people have the care they Page 25 of 27 Care Homes for Older People need in the way they prefer. 2 29 Staff application forms should include a full employment history. If there are any gaps noted, a satisfactory explanation should be given by the applicant before an offer of employment is made. This will help to ensure a robust recruitment system that protects people living in the home. Care Homes for Older People Page 26 of 27 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 27 of 27 - 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!