Inspection on 08/03/09 for Mallands Care Home

This inspection was carried out on 8th March 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Mallands Care Home 09/01/08

Mallands Care Home 12/06/07

Mallands Care Home 22/08/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Mallands Care Home Odle Hill Abbotskerswell Newton Abbot Devon TQ12 5NL     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: Brendan Hannon     Date: 0 8 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Mallands Care Home Odle Hill Abbotskerswell Newton Abbot Devon TQ12 5NL 01626366244 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mallands Care Ltd care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: A maximum of 38 service users aged over 65 years may be accommodated in the category of Dementia (DE(E)) A maximum of 38 service users aged over 65 years may be accommodated in the category of Old Age A maximum of 38 service users aged over 65 years may be accommodated in the category of Physical disability (PD(E)) Date of last inspection 0 0 0 Over 65 38 38 38 Care Homes for Older People Page 4 of 25 Brief description of the care home Mallands is registered to provide care for 38 older people who may also have a physical disability and / or dementia. It is a large detached older property with a purpose built extension and provides accommodation on the ground and first floors. The ground floor has spacious communal rooms including 2 lounges, one of which overlooks the garden, and a dining room. All bedrooms have en suite facilities or an adjacent toilet. There are two passenger lifts for people who are unable to use the stairs. The home provides aids and adaptations to meet peoples needs including grab rails, mobile hoists, adapted baths and a walk-in shower room. At the front of the house there is level access to a pleasant garden and seating areas. Mallands is located on the outskirts of the village of Abbotskerswell, Newton Abbot. There are local shops, a church and a public house within the village and a wide range of amenities in Newton Abbot. Fees currently range from 395-425 Pounds. Written information is provided for people considering going to live at Mallands and those who are resident. A copy of the most recent CSCI inspection report is available. Care Homes for Older People Page 5 of 25 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 inspection was unannounced and took place over 7 hours from 9.30am till 4.30pm on the 8th March 2009. Mr Leadbetters, [the responsible individual for Mallands Care Ltd], daughters Yvonne Berry and Marie Bird, who are also administrators for the home, were available throughout the inspection. Assistance was also provided by a senior member of staff and other staff members during the day. The homes Registered Manager was on holiday on the date of the inspection, but was subsequently spoken with on the telephone. Prior to the inspection the proprietors provided CSCI with written information about how they maintain a safe environment, train and support staff, and seek the views of the people who live at the home to improve the quality of care provided. We sent out surveys to gain the views of people living in the home, relatives, and staff. Feedback was received from 12 people who live in the home with the assistance of their relatives and 9 staff. Care Homes for Older People Page 6 of 25 There were 35 people resident in the home during the inspection of whom 2 were on respite. Staff were observed and spoken with in the course of their daily duties. The views of the people spoken with and those who replied to surveys are reflected within this report. In addition, a partial tour of the premises was made and records were inspected, including care, medication and staff records. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 25 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 25 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 receive adequate information to help them, sometimes with their representatives support, choose whether they wish to live at Mallands. The assessment of every persons needs before their admission to the home is agreed ensures that everyone admitted to the home receives an appropriate service. Evidence: People living in the home and their relatives confirmed they had received written information about the services provided. This written information is given to people considering moving to the home, and is available in peoples rooms. Records of people who have been recently admitted contained a preadmission assessment undertaken to assess the persons needs. The manager or an assistant manager undertakes thee assessments, visiting the person in hospital or in their own home. The pre admission assessments seen did not always record where and when the assessment took place. These assessments contained clear information about the persons needs and how these needs should be met. Care Homes for Older People Page 10 of 25 Evidence: A letter is sent to the person, or their representative, confirming that their needs can be met by the service, and a contract or statement of terms and conditions is issued. Care Homes for Older People Page 11 of 25 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. Care plans contain clear guidance for staff and are reviewed regularly to ensure that people living in the home receive consistent care. Evidence: People living at the home and their relatives made positive comments about the care given and many praised the staff for their kindness and attention to peoples needs. They said that care staff provided personal care sensitively and their privacy was respected. We observed staff assisting people in a friendly and attentive manner. Some of the relatives of people living at the home wrote, we cannot thank the staff enough, and they treat the residents with respect, and I praise them all. The level of care is superb. Relatives of people living at the home particularly commented on the staffs care and respect for people with dementia conditions. There are systems in place to ensure that everyone living in the home has a care plan. Care planning documentation for 3 people with significant care needs was inspected in detail. These documents demonstrated that care plans are reviewed and updated every month. The care plans and risk assessments inspected provided sufficient information to enable the persons health and personal care needs to be addressed. Care Homes for Older People Page 12 of 25 Evidence: They also contained details of the persons former life, their interests, likes and dislikes and preferred routines. Peoples dietary preferences and needs were recorded. Peoples weight is monitored on a monthly basis and appropriate action had been taken to address concerns identified. Fluid and food intake is monitored and recorded when necessary. Evidence was seen that people living in the home or their relatives are enabled to take part in the review process if they choose. The Registered Manager has introduced the Malnutrition Universal Screening Tool [MUST] to estimate the weight of people that cannot use domestic weighing scales. This effective approach helps to ensure that everyone living at the home has their weight regularly monitored so that significant weight changes are acted upon. The Registered Manager has introduced monthly monitoring of falls experienced by people living at the home. These events are analysed and action taken to try and prevent further falls. This action has more than halved the number of falls taking place each month in the home and is effectively helping to prevent people from suffering injuries. The home supports a significant number of people with dementia care needs and they continue to develop their service in this area. 17 of the 21 care staff have received dementia care training and the remaining 6 will receive this training during March 2009. The home provides dementia training as part of the basic care training regime for all care staff. The home has good quality advisory documentation to assist their planning of further developments in their dementia care practice and facilities. New larger naming plates have been placed on peoples bedroom doors, and also communal toilet, bathroom and shower doors, to assist peoples recognition of each room. A new daily board has been placed in the front hallway, which states the date, day and that days communal activities. The homes system for the administration of medicines was inspected. Medication administration records were sampled and those inspected were satisfactory. The administration of controlled drugs was sampled and those checked were recorded and stored appropriately. The storage of medication was inspected and medicines kept by the home were stored securely and tidily. All the care staff have received a level of medication administration training. All the care staff have received in house training. Care staff that administer medication have also received external training from the homes pharmacy and in some cases have taken a distance learning course. Care Homes for Older People Page 13 of 25 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 who live at Mallands have activities available and are supported to enjoy a good quality of life. Evidence: A programme of activities is provided which includes in house games such as bingo, scrabble, and target ball as well as trips out of the home. Themed events, chosen by the more able people take place both indoors and in the garden, when weather permits. The Donkey Sanctuary brings donkeys along to visit the home every 6 months which includes a donkey being brought inside the building so that all the people can be involved. A regular newsletter is produced which contains photographs of events. Photographs of various recent events and listings of daily activities were displayed in the reception area on the day of the inspection. Opportunities for people to go out on small group outings are offered. Staff spend time talking informally with people in the lounges and offer individual activities. The home is regularly visited by a beautician and an aromatherapist. The home has installed a new digital aerial so that everyone including those staying for short time have Freeview digital television access in their bedroom. Care plans examined showed that the person or their relative had been consulted Care Homes for Older People Page 14 of 25 Evidence: regarding their choice of daily routine. Relatives said that they are made welcome at all times. Some people living in the home said they enjoy seeing family and friends who live locally locally. A small number of older people visit Mallands for day care. People said that the food provided was adequate. Peoples preferences are noted and an alternative to the main meal was available. The menu is designed daily and is taken round in the morning so that people can make individual choices about their meals throughout the day. Special diets are catered for and dietary requirements were recorded in the kitchen. The Registered Manager has introduced a monthly audit of the quality of the meals being provided. The home is attempting to maintain a policy of protected mealtimes to enable the people that use the service to concentrate on their main meal of the day without interruptions. This is a national health policy which aims to help people eat more by focusing on an uninterrupted mealtime, thereby supporting peoples nutrition. At present the home has only been partially successful in implementing this policy but will continue to attempt to implement it over future months. Care Homes for Older People Page 15 of 25 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. The management and staff are aware of protection of vulnerable adults issues and procedures. The people that live in the home are protected from abuse by the awareness of staff and the services complaints and alerting procedures. Evidence: The home has a written complaints procedure, which is contained in the Service Users Guide that is given to every person, and is also on display in the main hallway. Information from surveys from people living in the home indicated that they were aware of how to complain. They would raise concerns with senior care staff or the management, or ask a relative to raise concerns on their behalf. The management have not received any complaints since the last inspection. The home has an adult protection policy and procedure. Most staff have received adult protection training from Devon County Council. This training has helped staff to understand what abuse is and the warning signs. The few who are still to receive external training have viewed a DVD on safeguarding. Care Homes for Older People Page 16 of 25 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 live in an attractive, comfortable and well maintained home. Evidence: Mallands is decorated in a homely style and has pleasant communal areas and attractive gardens for people to enjoy. There is an ongoing programme of maintenance and renewal. The home has its own maintenance worker and routine maintenance work is attended to systematically. A tour of the premises took place and some bedrooms were seen. They were found to be well decorated, clean, comfortable and personalised to the persons individual taste. People living in the home and relatives commented on the cleanliness and the quality of the accommodation. The premises were clean, hygienic and generally free from unpleasant odours. A washing machine with sluice and infection control capabilities is in the laundry. Relatives and staff commented positively on the cleanliness of the home. This is supported by the substantial number of hours provided for cleaning staff to keep the home clean and hygienic. The paperwork storage cupboards behind the main administration desk in the front hallway area of the building are secured with large padlocks. These locks should be replaced to give a more domestic appearance to these cupboards and this hallway. A fence and gates securely enclose the upper garden area. The upper garden is wheelchair accessible from the first floor of the extension. The lawned area to the Care Homes for Older People Page 17 of 25 Evidence: front of the building is accessible to wheelchair users from the main entrance of the home. A gate is fitted at the main entrance to the site, which the homes administrators said is kept closed at night. Care Homes for Older People Page 18 of 25 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. There are an adequate number of appropriately trained staff on duty to meet the needs of the people that live at the home. Evidence: Communication seen between staff and people living in the home during the inspection was friendly and courteous. People said that staff were kind and helpful, and relatives confirmed this. The homes administrators said that there are always sufficient, skilled and experienced staff on duty to meet peoples needs by day and night, and that staffing levels are reviewed to ensure that the staffing level is appropriate to meet the changing level of dependency in the home. Information from the survey of service users, relatives and staff, carried out as part of this inspection, indicated that the staffing level, though normally adequate to meet the needs of the people that live at the home, has been lower when care staff have gone sick. This was confirmed by review of the staffing record. The administrators for the home said that the home does not use external agency staff cover and relies on the staff team to provide cover at short notice should a staff member be unable to work due to sickness. Information from the returned surveys indicated that on the days when the care staffing level has been below the normal level there is a reduction in the quality of the service delivered. Care Homes for Older People Page 19 of 25 Evidence: The care home had a high turnover of staff in the year before October 2008. However since October 2008 changes in the care staff team have greatly reduced helping the home deliver a more consistent service to the people that live there. There was a clear system in place to identify and address staffs individual training needs. A clear, co-ordinated training plan was on display to ensure that staff attend and receive training. This included mandatory training in safe working practices, the care of people with dementia, and safeguarding vulnerable adults. There was a system of induction in operation for new staff based on the Skills for Care specifications. On the day of inspection 6 of the care staff, or 28 of the care staff team, held a National Vocational Qualification [NVQ] in Care at level 2 or above. The homes administrators said that the service had had difficulty with staff qualification because of the previous high staff turnover. Training plans showed that the home is continuing to support care staff to undertake NVQ 2 qualification training. A further 9 care staff were pursuing an NVQ2 in care. If these staff were to complete their qualification course then 66 of the care staff team would be qualified. Qualification training helps care staff to provide the people that live in the home with better quality care and support. A sample was taken of the recruitment process for 3 more recently employed care staff. In the main recruitment was found to be carried out appropriately. However, checks of the Protection Of Vulnerable Adults [POVA] register, and the gaining of 2 appropriate written references, were not consistently being carried out before new staff came into contact with the people that live in the home. Not carrying out the recruitment process appropriately puts the people that live in the home at increased risk. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is stable supporting the delivery of good quality, consistent care to the people that use the service. Health and Safety in the home is well managed helping to keep people safe. Evidence: The Registered Manager, Susan Watts, has been in post since the 16th June 2008. She has 23 years of experience in the provision of care and holds both the Registered Managers Award and National Vocational Award at Level 4 in the provision of care. The Registered Manager is supported by both an Assistant Manager and the Senior care staff. The services care management team is supported by Mr Leadbetter, the companys Responsible Individual, and the homes two administrators, Mr Leadbetters daughters. The Registered and Assistant Managers directly supervise the care staff in the day to day delivery of care. The present system of formal one to one supervision meetings with care staff has not been successful. The Registered Manager agreed to develop a new system of supervision that will be able to supply every care staff member with a one to one Care Homes for Older People Page 21 of 25 Evidence: supervision meeting every other month. The home has minimal involvement with peoples financial affairs. Either the person or more usually a relative or a representative manage this. Payments made by the administrator on behalf of a person are invoiced monthly to the person or their representative. The home stated through the Annual Quality Assurance Assessment [AQAA] that routine health and safety maintenance processes are managed satisfactorily. The AQAA stated that regular checks and tests are completed in respect of fire safety, electrical systems, gas and water systems, and lifts and hoists. A fire risk assessment is in place, which includes evacuation plans for people living in the home. The Registered Manager stated that all the windows openings are restricted to maintain the safety of the people that use the service. The services administrators stated that all the hot water outlets available to people that use the service, including baths and showers are restricted to a safe temperature at the point of use. They also stated that all the radiators in the home have been covered. These measures help to eliminate the risk of scalds and burns from hot surfaces and hot water temperatures. The home provides a service for people with dementia care needs. All the external doors of the building are alarmed to alert staff if someone has left the building. After discussion it was agreed that the front door alarm would remain activated at all times and that people seeking to enter the building will seek assistance to be admitted. The main gate to the site is closed and all the buildings external doors are secured after dark. The service administrators and the Registered Manager have stated that the building security together with the individual assessments of peoples needs and risks, are adequate to maintain the safety of all the people that use the service. The homes administrators and the Registered Manager stated that the service was not suitable for a person with dementia care needs where the person was not safe if outside the building unaccompanied, would actively seek to leave the building unaccompanied, and would by doing so put themselves at serious risk. A Quality Assurance procedure is regularly carried out using questionnaires. Residents that need support to complete the questionnaires are assisted by staff members to do complete these forms. The action points from the last round carried out in August 2008 were to ensure that relatives are always informed of visits by health professionals to their relatives. Also to institute a monthly laundry day to follow up clothing and ensure all items are marked and in the correct place. Care Homes for Older People Page 22 of 25 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 23 of 25 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 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 20 The padlocks on the paperworkstorage cupboards behind the main administration desk in the front hallway area should be reconsidered. The homes self assessed level of care staffing should be maintained at all times to ensure that the quality of the service received by the people that live in the home is maintained. The staff recruitment process should be carried out consistently so that POVA checks and both references are always received before new staff come into contact with the vulnerable adults that live in the home. The management of the service should implement a system of staff supervision that enables all staff to receive one to one supervision bi monthly. The security of the building should be increased during daylight hours to increase the safety of the people that live at the home. 2 27 3 29 4 36 5 38 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - 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!