Inspection on 13/01/09 for Methodist Homes For The Aged Group

This inspection was carried out on 13th January 2009.

CSCI found this care home to be providing an Excellent 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

Methodist Homes For The Aged... 10/01/07

Methodist Homes For The Aged... 20/03/06

Methodist Homes For The Aged... 28/09/05

Methodist Homes For The Aged... 20/09/04

Methodist Homes For The Aged... 06/04/04

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Methodist Homes For The Aged Group Epworth Grange 1 Chirmside Street Bury Lancs BL8 2BX     The quality rating for this care home is:   three star excellent 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: Grace Tarney     Date: 1 3 0 1 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 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Methodist Homes For The Aged Group 1 Chirmside Street Epworth Grange Bury Lancs BL8 2BX 01617617500 01617636630 home.bry@mna.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Methodist Homes for the Aged Name of registered manager (if applicable) Mrs Carole Hope Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following categories of service only. Care home only - code PC, to people 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. The maximum number of people who can be accommodated is: 40 Date of last inspection Brief description of the care home A national company called Methodist Homes for the Aged owns Epworth Grange. The home is situated near a main road in a residential area approximately one mile from Bury town centre and is close to bus stops and local shops. It is a detached purpose built home set in its own grounds with very pleasant gardens. There is car parking to the front of the building. The home is divided into 5 wings. Elton and Brandlesholme on the ground floor, Seedfield, Walshaw and Ainsworth wings on the first floor. All 40 single bedrooms have an adjoining toilet and sink. A passenger lift provides access to Care Homes for Older People Page 4 of 27 care home 40 Over 65 40 0 Brief description of the care home the upper floor. There is a dining room on each wing and each floor is provided with bathrooms and toilets. The home also has a large central lounge and an activities room. There is a garden and patio area to the rear of the home that can easily be reached from a ground floor conservatory. The home is registered to care for people who have residential social care needs. A copy of the latest CSCI inspection report is displayed in the reception area. The weekly charge for accommodation and services is between 401.00 pounds to 506.00 pounds. This information was received on the 13th January 2009. Additional charges are made for hairdressing, personal toiletries, private chiropody services, magazines and newspapers. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent 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 inspection visit to the home by 1 Inspector lasted 8 hours. The management and staff did not know that we (the commission) were going to visit. Several weeks before the visit to the home we asked the manager to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they did at present, what they felt they did well and what they needed to do better. This helps us to determine if the management of the home see the service they provide the same way that we do. Also several weeks before the inspection visit we sent out questionnaires (surveys) to the residents and asking them what they thought of the care and quality of the service provided. We also sent out questionnaires to the staff. 2 resident surveys and 1 staff survey were returned. The responses are detailed in different sections of this report. Care Homes for Older People Page 6 of 27 During our visit to the home we looked at care and medicine records to make sure that the staff knew how to look after the residents and that their health and care needs were being met. We also looked around most of the building to check if it was clean, warm and well decorated. We also looked at what the residents were having for their meals, to make sure that there was a choice of meals and that they were varied, good and wholesome. We also checked how many staff were provided on each shift to make sure the residents needs were being met. We then looked to see if management recruited and trained the staff properly and safely. This is so the staff can do their jobs properly and the residents are protected from being cared for by unsuitable people. In order to get further information about the home we also spent time talking to 5 residents, 2 visitors, 2 care staff, the activities organiser and the manager. What the care home does well: What has improved since the last inspection? What they could do better: To make sure that the needs of the residents are met during the night management should review the night staffing levels. Care Homes for Older People Page 8 of 27 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are properly assessed before they are admitted to the home and this gives an assurance to everybody that a person is only admitted if the staff feel they can meet their needs. Evidence: Before any person was admitted to the home we saw that a senior member of staff from the home undertook an assessment of their needs. An assessment looks at what help and support a person who may be admitted to the home needs to help them make the most of their daily life. We looked at 2 assessments that had been undertaken. They were detailed and showed clearly what the people were able to do for themselves and what they needed help with. Based on this information it was decided that the staff at the home could meet their needs and therefore their admission to the home was possible. Care Homes for Older People Page 11 of 27 Evidence: The AQAA document sent to us stated that the first 8 weeks after admission are regarded as a trial period. This is to ensure that both the staff and resident feel that the residents needs are being met and that the resident and all parties concerned are satisfied with the care and services provided. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans show what care needs the residents have and care practices ensure that their needs are met in a safe, caring and dignified way. Evidence: Individual care plans were in place for each resident. Staff call them support plans. The support plans of 2 of the residents were looked at. They contained detailed information about the residents so that staff would know how to meet their needs and how to care for them. The plans were checked regularly by the staff so that any change in the residents condition could be identified and action taken if necessary. The staff looked at whether or not there was any risk in relation to the residents developing pressure sores. They also looked at whether there was any risk of the resident falling and also if a resident was at risk due to problems with their food and fluid intake. Staff also looked at and wrote down how any resident was to be assisted with being moved around and by how many members of staff and what equipment if any, was to be used to assist in safe moving and handling. We saw that residents were weighed regularly and their weight was recorded in their care notes. The support plans Care Homes for Older People Page 13 of 27 Evidence: also contained lots of information about the positive things the residents could do. Lots of emphasis was placed on what the person used to like to do before they were admitted to the home, their spritual beliefs and what relationships they had. This helps the staff and the resident to plan for their daily activities so that they can get as much enjoyment out of their lives as possible. The AQQA document sent to us stated that the staff encourage the residents and relatives to be involved in the development of the support plan. We saw evidence of this and 1 relative told us that she had read and agreed the support plan. We saw that staff wrote in the care notes when the residents had received visits from health care professionals, such as dentists, opticians, district nurses and chiropodists. The residents that we spoke to told us that they are very well looked after and 1 resident told us that the staff are wonderful. 1 relative commented: The staff are very caring. I trust them to care. A resident said to us I have been here 10 years and would not want to be anywhere else We looked at the system for managing the medicines. Staff who have received medicine training are the only people allowed to have responsibility for managing the medicines. We looked at how medicines, including controlled drugs, were ordered, stored and recorded. A safe system was in place although it was agreed that the following needed putting right: The temperature of the fridge used for storing medicines was too high. Staff were not checking and recording the fridge temperature. To make sure that medicines that need to be stored in a fridge are stored at the correct temperature it should be checked and recorded at least daily. 1 resident was receiving blood thinning medication. The amount to be given depended on the results of her regular blood tests. Whilst there was evidence to show that she always received the correct amount of medicine, the prescription medication sheet did not show clearly just how much was to be given. It was agreed with the management that staff would keep the blood test result book that contained the dose to be given, with the medication sheet. Throughout the day we saw that the staff spoke to the residents in a very friendly and respectful way. They knocked on bedroom, toilet and bathroom doors before entering and responded to the residents needs in a very dignified way. The residents looked well groomed and well cared for. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are supported and encouraged by staff to make choices about what they do, so that they can find enjoyment and satisfaction in their daily life and with the activities available to them. Great importance is attached to making sure that, regardless of their faith, the residents spiritual needs are met. The residents are given a choice of nutritious meals. Evidence: During the morning of our visit we listened to the morning prayer service. 1 of the residents was taking the service and another resident was playing the piano for the hymn music. We were told that a service is held every morning at 10am. Sometimes the service is led by the residents and other times by members of the church that is situated next door to the home. We were told that everybody,regardless of faith, is made welcome. An activities organiser is employed by the management and works almost full time. A list of what is going on for activities is displayed in various parts of the home. As well as activities being organised in-house, the activities organiser also arranges for other people/ entertainers to visit the home. After the service the activities organiser was reading out interesting pieces of news from the daily Care Homes for Older People Page 15 of 27 Evidence: newspaper. Later the residents had a quizz and they seemed to be thoroughly enjoying themselves. The home has the benefit of an activities/hobby room and on the afternoon of the inspection visit we saw some residents having a foot-spa pampering session in this room. We spoke to one of the residents who told us that she was never bored. She told us that she normally liked to do a little bit of gardening whenever the weather allowed it. A relative told us: There is always something going on to keep people occupied. It is really very,very good. We saw visitors coming and going throughout the day and they seemed to know the staff very well. The 2 relatives that we spoke to said that they are always made welcome. We did not eat with the residents but saw what they were having for their lunch. The meal served looked appetising and nutritious. Each separate area of the home has its own dining room. The tables were very nicely set with matching tablecloths and napkins. Individual cruets and condiments were on each table. We looked at the menus and saw that the residents have a choice of meal at breakfast, lunch and the evening meal. We saw a variety of hot and cold drinks being served at lunch time and throughout the day. We were told that milky drinks and light snacks are served at supper time. The residents that we spoke to told us that the meals were very good, well cooked and there was always plenty of it. 1 resident wrote and told us: The food is good. A very good buffet is given on special occasions. Staff told us that special diets are always catered for. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are systems in place to ensure that people know how to and to whom they can complain. Staff have a good knowledge and understanding of what abuse is and know what to do if it happens. This helps reduce the possible risk of harm to the residents. Evidence: A notice is displayed in the corridor explaining to people how and to whom they can complain and how their complaint will be dealt with. It is easy to understand and tells people that complaints will be looked into and a full written response will be given within 15 working days. We saw that a record is kept of any complaint made and includes details of the investigation and any action that the management may have taken to put things right. No complaints have been made to us in the last 12 months. We spoke to some of the staff and asked them to tell us what they would do if they felt that a resident had been mistreated in anyway. They were very aware of what to do and how to report it. They told us that they had been trained so that they could, as far as possible, protect the residents from harm. We saw evidence of this training in their training files. We were also told that senior staff had recently been on some protection/safeguarding training with the Local Authority. There has been 1 safeguarding incident recently. Staff have acted appropriately by Care Homes for Older People Page 17 of 27 Evidence: informing us and the Local Authority and taking the correct action to protect the residents. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents live in clean, safe and very comfortable surroundings. Evidence: Accommodation is provided on 2 floors and can be reached either by a lift or stairs. The home is divided into 5 separate wings, each with their own dining room. In addition there is a large lounge downstairs and leading off from this a conservatory. They are very pleasant rooms, nicely decorated, warm and comfortably furnished. The corridors throughout the home are wide and well lit and have grab rails for support. Bedrooms, bathrooms and toilets are situated on the ground and first floor and each bedroom also has an ensuite toilet and handbasin. The toilets are easy to get to, as they are close by to bedrooms, lounges and dining rooms. The bathrooms and toilets have a lock on the door to ensure privacy and have suitable aids on them so that the residents can use them safely. We looked at most of the bedrooms. They were clean, warm and well furnished. Each bedroom had a safety overriding door lock and some had a lockable space to store anything that is of value or importance to the resident. The home also has an activities/ hobby room and a hairdressing salon. The radiators throughout the home were guarded and we were told that thermostatic Care Homes for Older People Page 19 of 27 Evidence: control valves were fitted to baths and showers. This reduces the risk of residents being harmed by protecting them from accidental burning or scalding. The home was clean and there were no unpleasant smells. A relative told us that it was always clean and sweet smelling. A resident wrote in the survey form that the home is always fresh and clean. Disposable hand washing equipment (liquid soap and paper towels) was in place in bathrooms and toilets and disposable gloves and aprons were provided for the staff to wear. We noted however that liquid soap and paper towels were not available in bedrooms where personal care was being delivered. We discussed this with some of the staff who told us that as far as possible the staff washed their hands in the sluice before and after attending to a residents personal care. It was accepted that this was not always practical or possible. Providing disposable handwashing equipment where personal care is being given helps to reduce the spread of infection and therefore helps to protect the residents health and wellbeing. The laundry looked well organised and there was enough equipment to provide an efficient laundry service. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents are cared for by staff that are suitably trained and safely recruited. This helps to keep them as safe as possible. Evidence: A check of the duty rotas and inspection of the training files showed that there was enough suitably trained staff on duty throughout the day to care for the residents. We saw however, that there were only 2 staff on duty during the night to care for the 37 residents who live there. We were told that the dependency levels of some of the residents was quite high and that several of the residents needed quite a lot of support and attention during the night. In view of the number of residents and their dependency and the layout of the building we felt that there was not enough staff on duty during the night time hours. To make sure that the needs of the residents are met management should review the night staffing levels. The duty rota did not show the hours that the manager worked. To ensure that the rota gives a clear indication of just who is on duty at any one time the managers hours should be included. Relatives and residents told us that the staff looked after them well and that they were very supportive, polite and approachable. The information that we looked at in the training files and the information given to us in the AQAA document showed that 50 of the staff had obtained their NVQ (National Care Homes for Older People Page 21 of 27 Evidence: Vocational Qualification) level 2 or level 3 in care. Other staff were working towards these qualifications. We looked at how the management recruit their staff. The personnel files of 2 staff members were looked at. All were in order and these staff had been properly and safely employed. This helps protect residents from being cared for by unsuitable people. The information received from the AQAA form showed that management provide a staff induction programme for all newly employed staff. This is to make sure that they understand what is expected of them and that people are cared for properly and safely. We also saw that lots of training has been provided for the staff. They have had training in 1st Aid, moving and handling, basic food hygiene, fire safety, health and safety, medicine management and other subjects connected to their jobs. We saw that the training provided to individual staff is recorded in detail in their individual training file. One staff member told us that the training they received was fabulous. Another said that the training is good and relevant to the job. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is safe and very well managed. Management continually look at the care and facilities they provide so that the residents welfare is protected. Evidence: The manager of the home is about to be registered with us. She is a qualified nurse with over 27 years experience in the NHS, mainly in the acute sector. She told us that she is about to start a management training course. Staff made the following comments about the manager: Excellent. Knows what is going on.Very approachable. 2 of the relatives that we spoke to told us that they had a lot of confidence in the manager and felt that she was very good. A resident told us :She is lovely. We saw that a great deal of work goes into providing a quality assurance system for the home. This is to check on the quality of the care and services provided. From what Care Homes for Older People Page 23 of 27 Evidence: we looked at it is obvious that the Company want to make sure that they get things right for the residents. The manager of the home has to check on lots of things that affect the health, safety and well-being of the residents. She has to record all her findings and then her manager checks the findings and then acts on anything that may need attention. Management also send out surveys to residents, relatives and other visitors asking for their views on the services provided at the home. The system in place for the management of residents money was good. We were told that they mainly handle money brought in for the residents expenses. We saw that receipts were given for any money received and receipts were kept for any money that was spent on behalf of the residents. The AQAA document sent to us showed that the homes fixtures, fittings and equipment are properly maintained and regularly serviced. We saw that regular weekly checking and testing of the fire detection system, fire exits and emergency lights was undertaken and documented. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 9 The medicine fridge temperature should be checked and recorded at least daily so that medicines that need to be stored in the fridge are kept at the correct temperature. Consideration should be given to providing disposable handwashing facilities, such as liquid soap and paper towels, in bedrooms where personal care is being delivered. To make sure that the needs of the residents are met during the night management should review the night staffing levels. 2 26 3 27 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (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 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!