Inspection on 13/05/09 for Meadow Bank Nursing Home

This inspection was carried out on 13th May 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Meadow Bank Nursing Home 07/05/08

Meadow Bank Nursing Home 15/06/07

Meadow Bank Nursing Home 04/10/06

Meadow Bank Nursing Home 02/05/06

Meadow Bank Nursing Home 15/11/05

Meadow Bank Nursing Home 28/04/05

Meadow Bank Nursing Home 02/09/04

Meadow Bank Nursing Home 01/06/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 07/08/2009.

Key inspection report Care homes for older people Name: Address: Meadow Bank Nursing Home Curthwaite Wigton Cumbria CA7 8BG     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Margaret Drury     Date: 1 3 0 5 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 26 Information about the care home Name of care home: Address: Meadow Bank Nursing Home Curthwaite Wigton Cumbria CA7 8BG 01228710279 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr B & Mrs L Whalley care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Physical disability - Code PD (maximum number of places: 1) The maximum number of service users who can be accomodated is: 19 Date of last inspection Brief description of the care home Meadow Bank Care Home is an adapted Victorian House set in extensive grounds in a rural area approximately eight miles from Carlisle. Mr and Mrs Whalley are the Registered Providers of the home, and Mrs Whalley is the registered manager. Nursing Care is provided for a maximum of 19 people, but because double bedrooms tend to be let singly there are not usually that number living in the home. There are bedrooms on both floors with the first floor being accessible by either the stairs or the passenger lift. There are two bathrooms; one on each floor, there is also a shower room on the Care Homes for Older People Page 4 of 26 Over 65 19 0 0 1 Brief description of the care home ground floor. The lounge has big windows providing lovely rural views. There is a separate dining room. The weekly fees at the time of this inspection are in accordance with the local authority and include any free registered nursing care contribution entitlement. The care home has produced a statement of purpose and a service user guide for interested people. Care Homes for Older People Page 5 of 26 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: This site visit, which forms part of the main or key inspection took place over one day in May. Margaret Drury, the lead inspector was accompanied on the day by Jenny Donnelly a nurse inspector and we (the care Quality Commission) were in the home for six hours. During our visit we toured the building looking at the environmental standards, spoke to residents and staff and inspected the kitchen facilities. We inspected medication records and stocks, looked at care plans staff records and recruitment and training records. The registered manager had completed and returned an Annual Quality Assessment Audit, which is a document that must be completed annually by every registered provider. This document tells us about the home, what has been accomplished during the past 12 months and what the manager hopes to achieve during the next year. Before the visit we looked at any notifications sent to us by the manager and information we may have received from other agencies. Care Homes for Older People Page 6 of 26 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 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 7 of 26 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 8 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admissions process does not always ensure that peoples care needs are properly assessed, which means they cannot be sure they will receive the correct level of care. Evidence: We discussed the admissions procedure with the manager and stressed how important it was to conduct a full assessment of capabilities before any prospective resident is admitted to the home. There have been occasions when this has not happened, which could mean that Meadow Bank was not a suitable placement and couuld not meet the needs of those people wishing to live there. All those wishing to move in are invited, with familiy members if appropriate, to look around and meet the staff and others living there. We asked to see copies of the residents comtracts and the manager produced a file containing these. They were very basic and there was no information about how prople were notified about changes to the contracts or increases in fees. This information should be available at all times to all those using this service. We looked at a sample of residents files that were also very basic in content. The Care Homes for Older People Page 9 of 26 Evidence: manager should always ensure that there is as much information as possible recorded about those living in the home so that staff are able to provide the correct care and support. This home does not provide intermediate care. Care Homes for Older People Page 10 of 26 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. Peoples care needs are not always clearly documented which could mean their needs may not be met in the most appropriate way. Evidence: Each resident has an individual plan of care based on the initial assessment of needs , which should be completed before any prospective resident is offered a place in the home. We were able to look at a sample of the care plans, which are now set out in a newly introduced format. Some of the care plans contained pen pictures of the residents that were written on admission to the home. It would be good practice to to include in depth personal information in each of the care plans as this information is useful in illustrating what is important to the resident and their lifestyle before moving in to the home. Some care assessments were completed when the residents were admitted to Meadow Bank but they have not always been updated on a regular basis. Monthly reviews had not been completed and all but one of the care plans we looked at had not been updated since January of this year. It is very important that all care plans are reviewed and updated at least once a month to ensure any changes are noted and Care Homes for Older People Page 11 of 26 Evidence: dealt with as soon as possible. The manager must also ensure that every resident is fully assessed prior to admission to make sure the placement is appropriate and care needs can be fully met. Access to professional healthcare is available to all those livinhg in the home and details of visits were recorded on the care plans. We checked the managemt of medicines and the records pertaining to this. We found that, in general, the records kept were in order and up to date although there were a couple of occasions when medication had been administered but not recorded as being given. There was also no written evidence to show that a regular audit of the records by the manager took place. This good practice is beneficial to residents and staff and is recommended. It was aslo noted that medicines for three residents was still in the medication cupboard even thoguh this should have been returned to the pharmacy. We looked at the records for the administration of controlled drugs and what stock was held at the home.We found that there was a supply of this medication held in the cupboard even though it should have been returned some time ago. There was also a supply of controlled medication held that had not been recorded as being received into the home. The receipt of all such medication must be recorded in a register and the stocks regularly audited. There are currently no residents who choose to be responsible for their own medication. Care Homes for Older People Page 12 of 26 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. Social activities and meals are well managed and provide daily variation and interest for those living in Meadow Bank. Evidence: The home now employs an activities organiser and there was a plan of activities on view in the hall. There is some form of activity on most days of the week and we saw photographic evidence of some of the outings the residents had enjoyed. Staff also confirmed how much the residents enjoyed going out and that there were other outings organised for later in the year during the warm weather. Visiting entertainers also come to the home and the orgainiser also spends time with residents on an individual basis. Visitors are welcome at any time and although we were not able to speak to any during our visit we did see family members spending time with residents. Routines seem to be flexible enough although we noted that most of the residents were in the lounge, having finished their breakfast fairly early on the day of our visit. We did speak to staff about this and they told us that each resident did rise and retire at the time they wished and if they wanted a lie in that was never a problem. We noted that there was a church service every month and arrangements were in place to ensure those who wished to take Communion were able to do so. Care Homes for Older People Page 13 of 26 Evidence: Lunch was served during our visit and the residents we spoke to said they enjoyed their meals. The kitchen area, though small, was well equipped and very clean on the day of our visit. Conversations with the cook confirmed that the meals, desserts and cakes are all home cooked. Food hygiene training, levels 1 and 2 had been completed by the catering staff. Menus were varied and nutritious and showed a choice at each meal. Care Homes for Older People Page 14 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are policies and procedures in place, which help to ensure that those using this service are protected from harm. Evidence: The home has a complaints policy and procedure in place with residents and their families having a copy of the procedure. There is also a copy of this on display in the hall. We spoke to one lady who was in her room and she confirmed that she would speak to any of the staff if she needed to but had never been given cause to complain. We, the Commission, have have received one complaint since the last inspection about the bath seat not working.This was referred back to the provider for her attention. We did, however, note that the seat was operational on the day of our visit. There is an adult protection policy and procedure in place but this was more information rather than advice about what to do in such circumstances. The policy should show clearly to staff what is involved in the reporting of such incidents and the procedure to follow. Staff confirmed that they had recemtly completed training in Protection of Vulnerable Adults although there some difficulty in producing evidence to support this. It is important to be able produce written evidence of any training completed. Staff we spoke to during our visit confirmed they were familiar with what to look for and report. Care Homes for Older People Page 15 of 26 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 a suitably adapted, clean, and comfortable home that is set in pleasant surroundings. Evidence: Meadow Bank is a large Victorian building situated in a rural area about 8 miles from Carlisle City centre. It is set in large gardens and has been adapted for use as a care home. Some work has been completed in the gardens to make the space more user friendly for the residents. The manager confirmed that she hopes the remaining work will be completed this year. Communal space is made up of a large lounge and a seperate dining room. There was, however, little evidence to show that the dining room was used very often and this was confirmed when speaking to the staff. It was recommended that the dining room be used more often as this would give opportunity for residents to have a change of surroundings for some part of each day. There are also those who prefer the quietness of their own room and this is respected by the staff. The rooms we inspected were clean and we saw evidence of good cleaning regimes within the home. We spoke to one of the domestic staff and she confirmed that there was always plenty of cleaning materials and that the home was a lovely place to work. Although she had completed some training in her previous position she had not been given any training opportunities since she came to work at Meadow Bamk. The home, as a whole, was extremely clean with no unpleasant odours anywhere. Care Homes for Older People Page 16 of 26 Evidence: There is assisted bathing and shower facilities for those who may have mobility problems and a passenger lift accesses the first floor. Currently there are only limited bathing facilities within the home as only one bathroom is in use. It is recommended that the ground floor shower be repaired as soon as possible. Bedrooms were personal to the residents, most of who had brought in items from their own homes. It was good to note that all the previously damp affected areas had been treated and were still free from damp. Care Homes for Older People Page 17 of 26 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. The procedures for the recruitment and training of staff need to be more thorough to ensure suitable and well trained staff are employed to care for people using this service. Evidence: The staffing levels in this home are generally sufficient to meet the needs of the people living there, althouogh some of the residents do have complex needs and a high dependency level. There is always one qualified nurse on duty, supported by carers, catering and domestic staff. There is a qualified nurse and one carer on duty during the night. The manager is also available on most days and sometimes acts as the nurse in charge. During our visit we were able to spaek to a registered nurse, a carer and one of the cleaners. They all agreed that Meadow Bank was a warm and friendly home with everyone working as a team. The qualified nurse confirmed that she does get support from the manager and only has to ring her if she is not in the home and she will come immediateley. Residents were complementary about the staff. One lady who was sitting in her room told us that girl is lovely and so kind We observed the staff caring for the residents in a calm friendly manner and were told by the residents sitting in the lounge that all the girls were lovely and looked after them very well. There has been some improvement in the way that staff training is recorded but there Care Homes for Older People Page 18 of 26 Evidence: needs to be a full training matrix available in order that the manager knows exactly when updates are due and new training accessed. This has been a requirement made regarding this on more than one previous occasion and this work needs now to be complered. The home uses an external training provider but there are times when evidence of completed training, such as certificates of attendance are not produced in a timely manner. The manager should ensure this does not happen in the future. Although the staff had completed fire training some months ago there was no evidence available as the trainer had not provided this. Care Homes for Older People Page 19 of 26 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. The current management systems do not ensure the efficient running of this service and the ongoing improvements necessary for this home. Evidence: Mrs Whalley has been the registered manager and provider since she took over the home. She is a qualified and experienced nurse and has completed a management course run by the local council. She knows the residents well as she frequently works shifts as the nurse in charge. All the residents we spoke to knew her and said she was approachable and kind, There is a warm atmosphere in the home that is greatly appreciated by those who live there. There is however, a lack of co-ordination in the paperwork and administration procedures and this needs to be addressed as soon as possible. Staff files and documentation should to be brought up to date and a programme of care plan audits should be introduced. The manager should also ensure that all care plans are regularly reviewed and updated by those with delegated responsible for this, in order to meet the changing needs of those living in Meadow Bank. Care Homes for Older People Page 20 of 26 Evidence: Staff supervision has been restarted with one of the qualified nurses having delegated responsibilities for the care and support staff, whilst the manager is responsible for the supervision, including clinical, for the qualified staff. This must be continued as least six times a year as it is important for the personal and professional develpment of all the staff. There are suitable policies and procedures for the safeguarding of residents personal finances. Although we have asked on previous occasions for a formal internal quality audit process this has not happened. The manager did confirm that she speaks to residents each day and family members when possible. It is important to, formally, take into account the opinions of people living in Meadow Bank, their families and other professional people who visit the home. This process will ensure that the quality and level of care provided always meets the needs of the residents. We looked at health and safety within the home and found that the aids used were all maintained under annual service level agreements. All fire safety equipment, including the emergency lighting, is also serviced on a regular basis and there were records confirming this. Gas and electric certificates were produced but the electric certificate showed there was some remedial work required. This needs to be attended to as soon as possible. Care Homes for Older People Page 21 of 26 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 30 18 (1) There must be an annual 01/07/2008 training plan in place to ensure that all staff receive the specific training they need at appropriate intervals, in order to do their job well. A copy of the training plan must be forwarded to the commission by the date specified. Previous timescale of 01/10/07 and 01/04/08 not met. 2 33 24 There must be a quality 01/07/2008 assurance system in place, which is based on the views of people who live in the home and other stakeholders. This is to ensure improvements can be made to the service in line with peoples? wishes and their expectations. Evidence of this must be forwarded to the commission by the date specified. Previous timescale of 31/10/06, 14/12/06, 28/02/07, 17/04/07, 01/10/07 and 01/04/08 not met. Care Homes for Older People Page 22 of 26 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 All care plans should be generated from the initial assessment of needs completed prior to admission To ensure that all staff are aware of the correct level of care required to mmet the needs of thoose living in the home. 03/08/2009 2 7 15 All care plans must be 30/06/2009 reviewed at least monthly to take into account any changes in residents needs. To ensure all assessed needs are recorded and met 3 9 13 All controlled medication received in the home must be recorded in an appropriate register To ensure the safety of residents in receipt of controlled medication. 30/06/2009 Care Homes for Older People Page 23 of 26 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 4 9 13 All medication no longer in 30/06/2009 use must be recorded and disposed of according to the homes policy and within the correct timescale. To ensure the procedures for receipt, recording and disposal of medications is adhered to at all times. 5 18 13 An in-depth protection of 10/08/2009 vulnerable adults policy and procedure should be completed to replace the document currently in place. to ensure the safety and protection of those living in the home. 6 33 24 A formal and effective internal quality assurance monitoring system must be introduced. To gather information from residents and other people about the quality of service provided. 31/07/2009 7 37 23 The electrical work indicated 15/06/2009 on the safety certificate must be completed. To ensure the health and safety of those living and working in the home. Care Homes for Older People Page 24 of 26 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 2 3 2 3 20 Information regarding the annual inrease in feed should be made available with a copy kept on file for reference. A full assessment of needs and capabilities should be made before the offer of a placement is made. It is recommended that the dining room be used on a regular basis. this will give the residents the opportunity to move to a different part of the home . It is recommended that the shower on the ground floor be repaired so as to make shower facilities available to those resident wishing to use them. It is recommended that a training matrix is completed as soon as possible to ensure all aspects of training organised and completed are recorded. 4 21 5 30 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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!