Inspection on 14/10/08 for Nashley House Retirement Home

This inspection was carried out on 14th October 2008.

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

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Nashley House Retirement Home 27 Montpelier Weston-Super-Mare North Somerset BS23 2RN     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: Juanita Glass     Date: 1 4 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Nashley House Retirement Home 27 Montpelier Weston-Super-Mare North Somerset BS23 2RN 01934620070 01934614909 office@nashleyhouse.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Lisa Diane Wall Type of registration: Number of places registered: Future Care Limited care home 52 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 52. The registered person may provide the following category of service: Care home only Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Nashley House is owned by Future Care Limited, the registered manager is Lisa Wall and the responsible Individual is Mr Clive Wilson. The home is registered with The Commission For Social Care Inspection to provide personal care only for people aged 65 years and over. They can provide long term care as well as respite care but cannot provide nursing care, however they can obtain input from the Local Community Nursing Team if the need should arise. The majority of Nashley House is purpose built, designed to accomodate the elderly. The original Victorian House has been thoughtfully Care Homes for Older People Page 4 of 27 Over 65 52 0 Brief description of the care home adapted to suit the needs of people living in the home. It retains many of the original features such as ornate ceilings and carved open fire places. All the bedrooms are single and above the minimum standards for size, most have en-suite facilities. All areas are accessible with a passenger lift. There are accessible garden areas providing pleasant views from windows and with ample seating and a covered gazebo for people to sit in in warmer weather. Nashley House is conveniently placed for local bus routes making town amenities such as the shops, sports centre, bowling green, library and pubs easily accessible. The homes aim is to provide care and support to people whilst recognising their need to maintain choice and control over their lives. (A full copy of the homes aims and objectives is available from the manager on request). Current fees range from 375 pound to 447 pound per week. 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 took place over one day and a total of nine hours were spent in the home. To gather enough evidence to support our judgments for this inspection, we The Commission asked the service provider to complete an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people living in the home. It also gives us some numerical information about the service, and how they intend to maintain or improve outcomes for people using their service. We also looked at surveys returned to us by people living in the home and people with Care Homes for Older People Page 6 of 27 an interest such as relatives, social workers and GPs. We received ten surveys from people living in the home some of these had been completed by relatives on their behalf. Once we had received this information we carried out a visit to the home and spoke to people living there, the staff and relatives. Whilst in the home we also looked at documents maintained for the day-to-day running of the service. These included care plans, staff recruitment, training and supervision. Also records relevant to the administration of medication, the service records and health and safety. What the care home does well: What has improved since the last inspection? The manager has worked closely with the North Somerset Safeguarding Officer to develope the homes Safeguarding policies and procedures in line with the North Somerset protocols. An annual quality assurances process has been carried out and peoples comments and suggestions acted upon. To ensure that race, gender identity, disability, sexual orientation, age, religion and belief are promoted the home has introduced a dignity champion who keeps the home aware of current changes and needs of people in their care. They are currently seeking local support for Dignity in Care and have enrolled all their residents on the Community Transport Group. Enabling them to access the local communtiy with the same oportunities as people not living in a care home. Nashley House was awarded 5 stars by North Somerset Environment Department following their food hygiene inspection. Care Homes for Older People Page 8 of 27 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 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. Prospective residents benefit from adequate written information a chance to visit the home and a full assessment of their needs. This means they can make an informed decision before moving in and their needs are fully met. Evidence: We the Commission looked at a copy of the homes Statement of Purpose and Service User guide. They were readily available in the home and provided immediately. We saw that the Statement of Purpose was well written and contained all the information a person would need to tell them about what care the home can and cannot provide. It also states clearly the fees and what they pay for with a list of extra charges clearly mentioned. The guide also stated that there would be regular Holy Communion for those who wished to attend, however it also states that they can accommodate the religious or cultural needs of people with other beliefs or cultural backgrounds. The home also makes a statement about meeting peoples needs whilst repecting their Care Homes for Older People Page 11 of 27 Evidence: religion, culture, race, sexuality and sexual orientation. We spoke to the manager about how she would assess a person who wished to move into the home. She said she visits the person either at their home or in hospital. She talked to them, a relative or advocate and staff at the hospital or a social worker. She would also look at existing care plans for the person. We then looked at the records held in the home for two people who had not lived there very long. They both had completed pre-admission assessments and community or hospital care plans. The assessments were very concise and in-depth and included personal comments from either the person or a relative. We then spoke to people living in Nashley House most did not mention how the experience of moving in had been for them. One person stated in their survey thatLisa (the manager) visited me in hospital and told me all about Nashley House. People wanting to move into Nashley House can visit and spend some time there to meet other residents and staff. This is often done by a relative or advocate on their behalf. If the manager and staff feel they can meet the needs of the person they will offer a trial period when both the person moving in and staff can decide whether the home is really the best placement for them. 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. People living in Nashley House benefit from personal and specialist health care support that is provided in a person centred way respecting their privacy and dignity. They benefit from and are protected by the homes policies and procedures for the administration of medicine and can be supported to continue to manage their own medication if they wish. Evidence: We looked at the care plans for five people living in Nashley House. All care plans were recorded in a person centred way. They showed us that staff have understood the way to record the personal likes and dislikes of the resident in their care. All the care plans we saw reflected this approach with clear guidelines for staff about peoples personal likes and dislikes, and the way in which they prefer to receive their care. Care plans were also written in a way that emphasised the persons right to receive the care they wish. For example one resident prefers to receive homoeopathic medication and this was supported by staff in the home. Staff spoken to said they knew each individual, their preferences and when they prefered to be helped or left alone. Care Homes for Older People Page 13 of 27 Evidence: We observed staff chatting and laughing with residents in a friendly and relaxed way. People we spoke to said they were happy with the way in which they were cared for. One person said they are so kind never a sad face. Theyre very busy but never too busy to say hello and chat. Another person said I cant ask for better, good staff, a good room and good food. We also spoke to the chiropodist during his visit, he said he always found that people appeared well cared for and happy and staff were willing to help him whenever requested. He confirmed that he sees people in the privacy of their own rooms. We also spoke to a GP during the visit the GP said the standard of recording Blood Pressures, Pulses and Blood Sugar Monitoring was exceptionally high for a residential home and was better than they sometimes found on a hospital ward. All the care plans we looked at included appropriate risk assessments and showed signs of regular review. Care plan reviews also reflected the changes in peoples lives showing a continuity of care. People living in Nashley House have access to healthcare specialists and care plans showed that the district nurse could be consulted when the home felt they needed some expert advice. People were also helped to attend outpatient appointments, the dentist, optician and chiropodist. A visitor from the Woodspring Blind Association had been arranged for one resident who had recently moved into the home. Nashley House has very clear policies and procedures for the receipt and administration of medication and staff receive training before they can give medication to people. We looked at the records kept by the home for medication and the way that medication is stored. We saw that all procedures were being carried out correctly. People living in the home were protected by very clear guidelines which staff followed. If a person is assessed as able to manage their own medication and have expressed the wish to do so they are supported by staff to maintain their independence. Personal wishes are also recorded as previously mentioned, one resident is supported in their choice to take complimentary therapies. 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. People living in the home benefit from the development of meaningful activities which recognises their diverse needs, likes and dislikes enabling them to maintain some control over their lifestyle. They benefit from continued contact with family, friends and the local community. A well-balanced menu means people benefit from a healthy nutritional diet. Evidence: We discussed the provision of activities in the home with the manager, staff and some of the people living there. We saw that there was a very clear record being kept to show that people have plenty of opportunities to join in an activity. One person we spoke to said that that there was always plenty to do but they prefered to remain in their room but would came down and join in some activities. Another person said they were never bored and they were looking forward to bingo that afternoon. We saw evidence to show that people attended movement to music to encourage increased mobility, outings to local places of interest, trips to the local church tea party and newspaper groups when they discussed current affairs. A full list of activities were advertised on the noticeboard in large print and people spoken to said they were kept Care Homes for Older People Page 15 of 27 Evidence: informed of what was going on. One person spoken to was very grateful for the provision of audio books so that they could continue their hobby despite a visual impairment. The home has two areas that are set aside as quiet reading areas with an ample supply of large print books. The home is also well supported by the local church who will collect people to attend services or their regular tea parties. The manager has supported one resident in continuing to play host to the church tea party at the home. The support from the Christian Community reflects the cultural and religious backgrounds of the people currently living in the home. The manager confirmed that they would also seek support from other religious organisations for residents if they wished. People we spoke to also praised the standard of food very highly more than one person said that the meals they received were of an excellent standard. Surveys received by the Commission also commented on the healthy nutritional meals provided in the home that were well presented. One person said there was always a choice and staff would remind them what was available. The manager explained that the chef meets individual residents to find out what their personal preferences are and regularly meets with people to find out what their suggestions for improvements or a preferred dish might be. Nashley House has been awarded five stars by North Somerset Environmental Health Department following their food hygiene inspection. 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. People benefit from and are protected by the complaints and safeguarding procedures in the home. Staff are fully aware of the procedures to follow to protect people from abuse. Evidence: Nashley House has a very clear complaints policy and procedure, which is easy to read. It shows a clear timeline and action to be taken if someone wishes to raise a concern or complaint. A copy is clearly displayed in the hall, and can be provided in large print if necessary. People we spoke to said they knew who to approach and felt they could raise any issue with the manager if they so wished. The manager keeps a full record of all concerns, complaints and compliments they receive. Surveys received by the commission also stated that the manager and staff were easy to approach at any time. The manager has worked closely with the North Somerset Safeguarding Officer to develope a safeguarding policy and procedure that is in line with the North Somerset local protocols. All staff have attended training in safeguarding vulnerable adults and they are all aware of the homes Disclosure of Abuse and Bad Practices Policy. Staff spoken to said Care Homes for Older People Page 17 of 27 Evidence: they knew what procedures to follow and who to contact if they suspected that a person living in the home was at risk of harm or abuse. 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. People living in the home benefit from a comfortable, well equipped and homely environment, which is well maintained and decorated with particualar emphaisis on personal choice. They have access to well maintained garden areas and local parks. People are protected by staff awareness of appropriate infection guidelines. Evidence: We carried out a tour of the home; we looked in peoples rooms with their consent. The home is well furnished in such a way that people living there can sit in small groups if they wish. There are two lounges and three dining areas. Plus two library areas that are quiet with reading facilities. Most areas of the home are accesssible with the use of a lift. The furniture and fittings are of a good standard and communal areas are pleasantly decorated. We looked at one room where the resident had requested it was decorated to reflect their cultural background, they were very proud of the room and it was bright and cheerful. The manager said it was a very different room from the rest of the home but truly reflected the persons personality. Care Homes for Older People Page 19 of 27 Evidence: We saw rooms that were full of personal possessions reflecting the persons life and family. People we spoke to said they liked their rooms and commented on the cleanliness of the home in general. A programme of re-decoration is followed as and when rooms become available. The home showed a good standard of housekeeping and no offensive odours were apparent. The manager and staff showed a clear awareness of infection control policy and procedures and the manager confirmed that she can obtain guidance from outside agencies if required. 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. People benefit from and are protected by the staffing levels and skill mix of staff in the home. The homes recruitment procedures and staff training further protect people from the possibility of abuse. Evidence: We looked at the personnel files held by the home for some of their staff. We looked at the employment records for two recently employed members of staff. We also looked at the staffing rota and the training records for people working in the home. The staffing rota showed that there is always enough staff in the home with the right skill mix to support the diverse needs of the people living in there. They also showed that staffing is flexible so that extra staff can be bought in to cover extra busy times such as activities or trips out. People spoken to said that there where always plenty of staff and although they were busy they always answered bells quickly and always had time to spend on a one to one basis. Staffing levels also reflected the cultural backgrounds of people living in the home. The manager confirmed that staff are encouraged to obtain an NVQ Qualification in Health and Social Care. This is evident when 40 of their staff have obtained a level two or above qualification whilst others are attending training. They have also Care Homes for Older People Page 21 of 27 Evidence: encouraged non care staff to obtain NVQ Qualifications so kitchen staff have catering qualifications, and domestic staff also follow an NVQ course. Staff spoken to said they felt well supported in attending training relevant to the needs of the people in their care. Records showed that staff have all attended mandatory training as well as training that is necessary to provide a good level of care to the people living in the home. We saw evidence of training in colostomy care, diabetes care and visual impairment which were relevent to people living in the home as well as other courses attended. Nashley House has strict policies and procedures for the recruitment of new staff. The personnel files for two peole who had recently been employed showed that the manager follows these guidelines as all the relevant checks such as references and a CRB (Criminal Record Bureau) check had been completed before the person started work. This protects people from the possible harm or abuse. All new staff then follow a concise induction programme which follows the Skills for Care guidelines. 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. People benefit from living in a well run home with an appropriately qualified manager and supervised staff. The home does not manage residents finances. Both people working and living in the home are protected by robust health and safety procedures. Evidence: The registered manager is Miss Lisa Wall she has been registered at Nashley House since 1984. She has 30 years experience in the care of people in a residential setting and has completed management courses in City and Guilds 325/3 Social Care and Management Award, Royal Society of Arts Counselling and Self Development Award, an HNC in Management, BTEC Certificate in Management Studies, the NVQ4 Registered Managers Award, NVQ4 Health and Social Care and the NVQ5 Operational Management. People we spoke to said they could always talk to the manager and we observed an open and approachable rapport with people living in and visiting the home. Care Homes for Older People Page 23 of 27 Evidence: A Quality Assurance process has been carried out by the manager who sent questionaires to residents and relatives, the manager confirmed that the next step was to include other agencies involved in the provision of care. The Quality Assurance process showed a 90 response rate, which is good. Comments received were largely complimentary and suggestions for improvements were seriously followed up. It was a response from this process that identified a resident who wanted their room to reflect their cultural background. Following this process the manager also decided to introduce a Dignity in Care Champion to act as an advocate to support peoples right to equal oportunities even when living in a care home. The manager confirmed that the home currently does not directly handle residents financial affairs. People either manage their own money or have a relative or power of attorney to act on their behalf. Staff personnel files showed that regular supervision is planned and carried out. Any training and development needs are identified and followed up where possible. Staff stated that they felt well supported by the manager and could approach her at any time. We looked at records relating to the servicing of equipment in the home. All the records were up to date and available for inspection, these included the COSHH records, which are guidelines for staff to follow if they spill, drink or are splashed by chemicals used in the home. These can also be provided in an alternative language if required. The implementation of health and safety within the home was satisfactory. All residents have personal risk assessments. Generic risk assessments are in place and reviewed regularly including the hot water checks. A review of the firelog showed all tests, training and drills were being carried out to the Avon and Somerset Fire Brigade guidelines. 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 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!