Inspection on 03/11/08 for Manor Gate

This inspection was carried out on 3rd November 2008.

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

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

Other inspections for this house

Manor Gate 06/05/08

Manor Gate 23/05/07

Manor Gate 30/05/06

Manor Gate 14/12/05

Manor Gate 17/08/05

Manor Gate 10/11/04

Manor Gate 15/06/04

Similar services:

Carlton Care Home

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Manor Gate 190 Causeway Wyberton Lincs PE21 7AR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Elisabeth Pinder     Date: 0 3 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Manor Gate 190 Causeway Wyberton Lincs PE21 7AR 01205366260 Telephone number: Fax number: Email address: Provider web address: lawrence@manorgate.co.uk Name of registered provider(s): Name of registered manager (if applicable) Mr Herman V Rodrigues Type of registration: Number of places registered: Mrs Mary T Rodrigues,Mr Herman V Rodrigues care home 15 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: One PD place for age 59 . Date of last inspection Brief description of the care home Manor Gate Care Home is a converted Victorian farmhouse with a purpose-built annexe, situated in the village of Wyberton, close to local shops and approximately one and a half miles from the market town of Boston. It is registered to provide care and accommodation for up to fifteen residents over the age of 65 years, some within the category of dementia and one within the category of physical disability under 65 years, in two shared and eleven single rooms. The home also has three day-care places, however, current legislation does not regulate these. There is a garden to the side of the property and car parking space for four cars; further parking is outside the Care Homes for Older People Page 4 of 29 0 0 1 Over 65 14 14 0 Brief description of the care home frontage of the home. The current fees for the home range from £351 to £452 with additional charges made for hairdressing and chiropody. Information about these costs, as well as the day-to-day operation of the home, including a copy of the last inspection report, is available from the main office of the home. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means that people who use this service experience adequate quality outcomes. This was an unannounced visit and it formed part of a key inspection, focusing on key standards, which have the potential to affect the health, safety and welfare of people who use the service. Throughout this report the terms we and us refer to The Commission for Social Care Inspection (CSCI). The visit lasted approximately four hours and was carried out by two inspectors. We took into account previous information held by us including the previous inspection report, their service history and records of any incidents that we had been notified of since the last inspection. Care Homes for Older People Page 6 of 29 Before we made our visit the provider had returned the Annual Quality Assurance Assessment (AQAA). This gave us information about their own assessment of how well they are meeting standards and their plans to improve aspects of the service. However, the information in this document was brief and did not tell us all we needed to know about the service. We also sent out surveys to people before we visited the service and two completed surveys were returned to us. Since the last inspection the service has been visited on three occasions by Lincolnshire County Council contract and monitoring department. The purpose of the visits were to make sure the home-owner and acting manager were meeting the conditions set out in their contract with Lincolnshire County Council and to monitor progress being made since our last inspection. The main method used to carry out the inspection is called case tracking, this included following the care of a sample of three people through their records and assessing their care. We spoke to nine people who use the service and saw rooms of those people whose care was being followed and said we could. We also spoke to three staff members. The registered provider and the acting manager were present throughout the visit and the general outcomes of the visit were discussed with them. 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 Care Homes for Older People Page 8 of 29 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 coming into this service have access to information to help them make a decision about moving into the home and procedures are in place to ensure people are only admitted after a needs assessment has been carried out. Evidence: Information sent to us prior to the visit included a statement of purpose and service users guide, both documents have recently been updated and these tell people about the service. However, we saw that both documents had little information about how differing needs such as religious and cultural needs will be met or how people can be involved in the planning of their care. We spoke to the acting manager who recognised the need for further development of these documents and he told us how he would take action to develop them further. Since the last inspection the acting manager has developed a residents booklet which Care Homes for Older People Page 11 of 29 Evidence: is given to people on their admission, this tells them what they can expect from the service. It gives information about how they can raise a concern or complaint and includes a link to our internet where they can obtain our latest inspection report. During the visit the registered provider carefully explained the pre-admission procedure to a person on the telephone and it was noted that he answered questions based on the potential for changes in care needs. One person told us that two ladies had visited her at home and had taken details about her care needs prior to her admission and records showed that a basic needs assessment had been carried out and the information had been used to develop an initial care plan. Two completed surveys had been received from residents prior to our visit and both confirmed that they had received a contract. One specific comment read, I am happy at Manor Gate and I am well looked after. People spoken to all said they were happy living in the home. 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 health care needs of people living in this home are being met, however, care plans and risk assessments must continue to improve to show that peoples capacity to make decisions has been fully considered. Evidence: Information provided in the AQAA told us that people have access to the health care services to meet their assessed needs and this was evident in care records seen. Two completed resident surveys received told us people always or usually receive the medical support needed. The care plans of three people whose care was being followed were looked at and these have improved considerably since the previous inspection. These have been developed electronically and are in five sections including a personal profile and life history of each person. Risk assessments have been written and those seen gave basic information for managing immediate risk and the acting manager told us he is aware these need further development to include additional risks associated with daily living. Care Homes for Older People Page 13 of 29 Evidence: He told us he plans to develop care plans further to include religious wishes, social stimulation, dementia health needs and end of life wishes. He also told us he is making plans for staff to receive information and training on the Mental Capacity Act (MCA) and plans to include how decisions are made in care plans to give staff clearer guidance on how to meet individual needs. Information received since the visit tells us that the MCA Code of Practice has been obtained. Currently there are no male carers, therefore at the moment people are unable to choose who provides their personal care, should this change the acting manager is asked to record peoples preferences in their care plans. One person told us they had lived in the home for seven years and felt very happy and well cared for. They said staff know how they like things done and they do it properly. Staff spoken to had a good knowledge of the needs of people who use the service and how to meet them and were observed to deal appropriately with situations as they arose. Although no visitors were seen during our visit, some people told us they frequently have visitors, one person said his wife visits everyday and another person said her daughter visits each week. Information was available about advocacy services should people who use the service need it and we were told that not everyone has relatives or visitors, therefore people may benefit from having access to these services. Since the previous inspection a lot of work has been undertaken to update and rewrite policies and procedures and clear medication policies are now available. A period of observation was carried out by one of the inspectors during the lunch time period and staff were seen to treat people with kindness and respect. People chatted with each other and with staff, laughing and joking whilst they had their lunch and a good atmosphere was noted. Information available during our visit showed us that all the people who live at the home currently need support to take their medicines safely. We observed one member of staff giving people their medicines and this was generally done using safe procedures, however, medicines were handled by staff and signed for before giving to the individual and a discussion with the acting manager was held around the risks this may have. The acting manager agreed to address this issue immediately. Medicines which require refrigeration were being stored in the domestic refrigerator in the kitchen and although correct temperatures were being maintained and recorded these were not secure as no lock had been provided. This was discussed with the acting manager who told us he would take action to address this. Staff spoken to said they were in the process of completing medication training and one person showed us their training manual. The service was last visited by their Pharmacist on 28/08/08 the Care Homes for Older People Page 14 of 29 Evidence: report was available and no issues were raised. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged and supported to have control of their daily lives. Activities and leisure arrangements have improved to meet individual recreational interests and wishes of people using this service. The meals provided are well balanced and cater for peoples individual preferences and specific dietary needs. Evidence: Since the last inspection a lot of work has been undertaken to ensure people have opportunity to pursue their hobbies and join in with new activities offered. Comments from people and observation during the visit showed that people take part in a variety of activities/events. They told us that they had recently decorated cakes for Halloween and said they had really enjoyed that and were looking forward to a bonfire and fireworks later this week. Records showed that some people had been on an outing to Skegness to see the lights and have a fish and chip supper, regular events such as a sing-a-long to the organist, reminiscence, bingo, dominoes and manicures take place. Each person has a weekly activity record on their file and the acting manager told us that he plans to develop a much more person centered programme of activities. People told us they can make decisions about how they live their life and they do not feel they Care Homes for Older People Page 16 of 29 Evidence: have to join in with the activities offered if they choose not to. People told us the food was good, the cook on duty had been working in the home for a number of years and had a good knowledge of peoples likes and dislikes. Menus showed that a varied nutritious diet is offered with alternatives such as finger food being available for people with dementia should they need additional nutrition. The menu of the day was displayed on a notice board outside of the dining room and the main meal of the day was sausage, egg, beans, tomatoes and fried potatoes. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service are protected by the procedures in place for handling complaints and allegations of abuse. Evidence: Information taken from the AQAA tells us that the service has a full complaints and protection procedure in place. It tells us that within the last twelve months staff have been made more aware of the whistle blowing procedure and have undertaken training in relation to safeguarding adults. The complaints procedure was seen and this gives people detailed information about how they can raise concerns and complaints. The acting manager told us he plans to produce a simpler version and give each resident a copy. One member of staff spoken to said she had not completed safeguarding adults training but she had a good understanding of abuse and the action to take should an allegation be made. No complaints or safeguarding referrals have been received since the previous inspection. None of the people spoken to had any concerns about the home and information received prior to the visit from two residents told us they knew what to do should they wish to raise any concerns, with specific comments of, I have no complaint and I would speak to the owners or manager. Care Homes for Older People Page 18 of 29 Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from generally comfortable and safe accommodation, however some areas are in need of attention with regard to repair and décor. Evidence: Since the last inspection some carpets in the extension have been replaced, a new fire alarm system has been fitted, and bedroom doors have been replaced with fire doors. However, there are still some areas of the home showing signs of general wear and tear, for example, chipped and damaged paintwork in corridors and stained carpets. The bathroom on the first floor was untidy with items such as a suitcase, Hoover and wardrobe being stored in the room. The laundry area also remains undecorated and untidy and we were told that plans are still in place to re-site this room which will rectify this problem. The bedrooms of people whose care was being followed were viewed, these were personalised and clean. People told us they were generally happy with their rooms, one person told us its great here, couldnt be better, although another person said at times it feels cold. This was brought to the attention of the acting manager who told us he would talk to the person and resolve the issue raised. The Environmental Health Officer last visited on 17/09/08 and issued a bronze Care Homes for Older People Page 20 of 29 Evidence: certificate of hygiene, the report showed that action had been taken to resolve issues raised. Staff were observed to wear protective gloves and aprons when needed throughout the visit. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff numbers are in sufficient quantity for them to be able to care for people living in this home. The service recognises the importance of training to ensure staff are knowledgeable and equipped to meet the needs of people living here. Evidence: There are currently eleven people living at Manor Gate and two members of care staff are on duty during the day and night. The acting managers hours are in addition to these and there is also a cook on duty between 09:30 - 13:00 and a cleaner from 10:00 to 14:00 hours. Two residents surveys received prior to the visit told us that staff are always or usually available when needed and people spoken to said they couldnt wish for better staff, they are so kind, always helpful and on standby should we need them. However, one person said not all staff were nice, but did not wish to tell us any more information and the acting manager was made aware of this. The records of two staff were checked and these contained relevant documents to support that staff are now being recruited using safe procedures. Staff have commenced induction training and medication training and since the visit the acting manager has sent us a full list of training. Recent training includes, fire, lift training and protection of vulnerable adults (POVA) food hygiene and moving and handling. Staff have Care Homes for Older People Page 22 of 29 Evidence: recently started person centered care training with the acting manager looking at values and personal wishes for individuals and a discussion was held with the acting manager regarding implementing a key-worker system whereby staff have specific responsibilities for a small number of people. A discussion was also held with the acting manager about training in specific illnesses, for example Parkinsons disease to ensure staff have the required knowledge to care for people with a diagnosed illness. Copies of the General Social Care Council Codes of Practice, which sets out responsibilities as care workers looking after vulnerable adults were available for all staff and training records confirmed that approximately 39 percent of staff have achieved or are working towards a nationally recognised vocational award in care. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a registered manager and acting manager in place. However, the current management roles are unclear, therefore people living in this home may be at risk. There are some systems in place to obtain residents views in order to monitor the quality of the service and procedures are being put into place to promote the health and safety of residents. Evidence: Since the last inspection the acting manager has re-commenced working in the home having full management responsibilities. Although the current registered provider is also the manager and has overall financial control he does not wish to be responsible for the day to day running of the home. The acting manager told us he has obtained a nationally recognised award in care and is in the process of obtaining relevant documents to apply for registration. He is aware of the need to keep up to date with practice and during the visit contact was made with Lincolnshire County Council regarding accessing information about the Mental Capacity Act. Care Homes for Older People Page 24 of 29 Evidence: As previously highlighted, since the previous inspection the acting manager has worked hard updating and re-writing policies and procedures and those seen were clear and detailed. However, the acting manager is aware that he needs to monitor practice and compliance. Prior to the visit we received the AQAA and information provided in this document was limited with some gaps. This was discussed with the acting manager who agreed to provide us with more information in future documents. We were also informed that various monthly audits are now undertaken by the acting manager to monitor the quality of care provided. Yearly questionnaires are to be sent out to residents and their relatives and a discussion was held regarding expanding this to include other people with an interest in the service such as General Practitioners, district nurses and social workers. People who live at the home and staff all gave positive comments about the support the management provides, one person said she felt valued and supported by management and confirmed she had supervision with the acting manager in May of this year and when this was discussed with the acting manager he told us he is aware of the recommended frequency of supervision and plans to put this in place. Records were available of a resident meeting held on 23/08/08, ten peoples comments were recorded and these included happy with activities and enjoys daily walks. Staff meetings are held twice yearly and records were available to support this. Service records were available and those seen were up to date. In September of this year the service was visited by Lincolnshire Fire and Rescue who lifted an enforcement notice on the home as they were satisfied suitable measures had been put in place to protect residents and staff in the event of fire. The last fire alarm test was carried out on 07/10/08 and the fire risk assessment was reviewed 26/08/08. Records seen also showed residents and staff health and safety is promoted, a building risk assessment was carried out on the 27/08/08 and the acting manager is accessing training in health and safety. He told us that he then plans to use the Department of Health Essential Steps to review the infection control policy to ensure it is in line with current guidance. The finances of residents case tracked were checked and found to be in order. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Risk assessments must include all identified risks associated with daily living. To ensure residents are as far as possible protected from risk. 10/12/2008 2 9 13 Medicines requiring refrigeration must be stored securely. To ensure residents are protected from harm. 10/12/2008 3 9 13 Medicines must not be 10/12/2008 handled by staff and records must be completed after the person has taken their medication. To ensure safe procedures are followed. 4 31 8 A registered manager must be appointed, as the provider does not intend to be in full time day to day charge of the care home. 31/01/2009 Care Homes for Older People Page 27 of 29 This will ensure the service is run in the best interests of residents. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The statement of purpose and service user guide should include details of how peoples differing needs will be met such as religious and cultural and tell people how they can be involved in the planning of their care and how decisions are made about the day to day running of the home. Care plans should continue to improve, be person centered, make reference to the Mental Capacity Act and include information about religious wishes, social stimulation, dementia health needs and end of life wishes. Work should continue to ensure the environment is clean, tidy and well maintained. Staff training should continue to be prioritised and should include the Mental Capacity Act, Equality and Diversity and specific illnesses such as Parkinsons disease. 2 7 3 4 19 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 © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!