Inspection on 29/10/08 for Normanton Lodge Care Home

This inspection was carried out on 29th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Normanton Lodge Care Home 03/12/09

Normanton Lodge Care Home 23/11/06

Normanton Lodge Care Home 07/12/05

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Normanton Lodge Care Home 75 Mansfield Road South Normanton Alfreton Derbyshire DE55 2EF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rose Moffatt     Date: 2 9 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 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Normanton Lodge Care Home 75 Mansfield Road South Normanton Alfreton Derbyshire DE55 2EF 01773811453 01773581754 tracey@normanton-lodge.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Frances Dring Type of registration: Number of places registered: Normanton Lodge Limited care home 43 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Normanton Lodge Care Home is registered to provide personal care and accommodation for service users falling under the following categories: Older people (OP) 43 Dementia over 65 years of age (DE(E)) 43 The maximum number of service users that may be accommodated at Normanton Lodge Care Home is 43. Date of last inspection Brief description of the care home Normanton Lodge is situated in South Normanton, near to the M1 motorway at junction 28. The home is a large converted older building with several newer extensions. The home provides accommodation and personal care for up to 43 older people, including people with dementia. Most of the bedrooms are single with en-suite toilets. There are comfortable lounge and dining areas. There are accessible gardens, Care Homes for Older People Page 4 of 29 Over 65 43 43 0 0 Brief description of the care home including a newly developed sensory garden, and a car park. The fees at the home range from £345.52 to £480.00 per week, depending on the assessed needs of the person. This information was provided by the manager on 29th October 2008. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. The focus of our inspection is on outcomes for people who live in the home and their views on the service provided. The inspection process looks at the providers ability to meet regulatory requirements and national minimum standards. Our inspections also focus on aspects of the service that need further development. The last key inspection of the home was on 23rd November 2006. We looked at all the information we have received, or asked for, since the last key Care Homes for Older People Page 6 of 29 inspection or annual service review. This included: the annual quality assurance assessment (AQAA) that was sent to us by the service, (received in January 2008). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also has some numerical information about the service; surveys returned to us by people using the service and from other people with an interest in the service; information we have about how the service has managed any complaints; what the service has told us about things that have happened - these are called notifications and are a legal requirement; the previous key inspection and the results of any other visits we have made to the service in the last 12 months; relevant information from other organisations; and what other people have told us about the service. We carried out an annual service review (ASR) of the home in January 2008. The ASR looked at all the above information. The ASR showed us the home continued to provide good outcomes for people living there. For this key inspection, we carried out an unannounced inspection visit that took place over seven hours on one day. The inspection visit focused on assessing compliance with requirements made at the previous inspection and assessing all the key standards. We sent out ten surveys to people living in the home and received five completed responses. We sent out ten surveys to the relatives or representatives of people living in the home and received five completed responses. We sent out ten surveys to staff employed at the home and received three completed responses. There were 36 people accommodated in the home on the day of the inspection visit. People who live in the home, visitors and staff were spoken with during the visit. The manager was available and helpful throughout the inspection visit. Some people were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Case tracking was used during the inspection visit to look at the quality of care received by people living in the home. Four people were selected and the quality of the care they received was assessed by speaking to them and / or their relatives, observation, reading their records, and talking to staff. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 Care Homes for Older People Page 8 of 29 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was sufficient information available and a good assessment process so that people were confident their needs could be met at the home. Evidence: Five people who returned our surveys said that they had received enough information about the home before deciding to live there. Four relatives of people living in the home who returned our surveys said they always had enough information about the home, one said they usually did. People we spoke with said they had been given information about the home. The Statement of Purpose and Service User Guide were available in the reception area of the home. Two people who returned our surveys said they always had the care and support they need, two people said they usually did, and one said they sometimes did. People we spoke with told us their needs, or the needs of their relative, were met at the home. Care Homes for Older People Page 11 of 29 Evidence: People said, I have been very satisfied with the help I have received, and, her every need is catered for. We looked at the care records for four people in the home. Each included an assessment carried out by social services or hospital staff prior to the admission of the person. For three of the people there was an assessment carried out by the home before a place was offered to the person. The fourth record was for a person admitted in an emergency and so there was no opportunity for the home to carry out a preadmission assessment. The social services assessment for this person was made available to the home before admission. Staff who returned our surveys and who we spoke with told us they had sufficient information about the needs of each person. They said they had appropriate training to ensure they could meet peoples needs, including training about caring for people with dementia. Standard 6 did not apply as there was no-one receiving intermediate care at the home. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was a focus on providing individual personal care so that people received the care they needed in the way they preferred, and their dignity was promoted. Evidence: Two people who returned our surveys said they always received the care and support they needed, two said they usually did, and one said they sometimes did. Four people said they always had the medical support they needed, one said they sometimes did. Four relatives who returned our surveys said the home always met the needs of the person, and one said they usually did. People we spoke with said the home met their needs, or those of their relative. They said, were very well looked after. We looked at the care records for four people in the home. Each had assessments of their nutritional needs, tissue viability, manual handling needs, mobility and risk of falls. Those assessed as at risk of falls had an alert card in their bedrooms to remind staff. Some assessments were not dated and some were not signed by the person carrying out the assessment. Assessments were not consistently reviewed - some had Care Homes for Older People Page 13 of 29 Evidence: been reviewed regularly, some had never been reviewed. Each person had a care plan that included all of their assessed needs. The care plans included good details of the persons preferences regarding routines and personal care. The care plans had clear details for staff of the action required to meet the persons needs. There was information on how to ensure the persons privacy and dignity were maintained. The care plans had been reviewed monthly. Relatives had been involved in reviews and had signed to indicate their agreement with the care plan. Relatives told us the home kept them up to date with any changes in the persons condition. There were records of the input of other healthcare professionals, such as GP, District Nurse, Community Psychiatric Nurse, chiropodist and optician. People told us the GP was called in promptly when needed. The manager said that the GP came to the home routinely every two weeks to see people, but would visit any time in between if necessary. People told us the staff were helpful and kind, very caring, and they attend to all Mums needs in a very caring and professional way. A relative said that they had never heard staff raise their voices in the home and that staff talk properly to people. They said staff were always prepared to go the extra mile to ensure people had the care they needed. We observed that staff spoke to people in an appropriate and respectful way. We observed some good examples of positive interaction between people in the home and staff, including the ancillary staff. Staff told us they always had enough information about people, and appropriate training to ensure they were able to meet peoples needs. Staff spoken with were knowledgeable about individual needs and preferences. Medication was stored securely in the home. One person living in the home managed their own medication and had suitable storage in their room. Medication was administered by the senior care assistants who had all received appropriate training. The medication administration records (MARs) were mostly fully and correctly completed. One MAR had handwritten instructions for one medication. These instructions did not include all the required detail and were not signed by the person who had written them. When brought to the attention of a senior care assistant, this was immediately put right. Where topical creams were prescribed, there were no signatures on the MARs to show the creams had been administered. Care Homes for Older People Page 14 of 29 Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities offered and the respect shown for individual choices meant that the lifestyle in the home generally met the preferences and expectations of people living there. Evidence: One of the people who returned our surveys said there were always activities they could take part in and two people said there usually were. One person said there never were any activities they could take part in, but commented that this was by personal choice as they preferred not to join in. One person said they would like to have some physiotherapy to help with walking. A relative said Great efforts are made to make the residents smile and feel happy. There was information in the reception area of the home about recent and forthcoming activities and events. The home also produced a newsletter every season. There were individual records of activities that people had taken part in, though these were not up to date. On the day of the inspection visit, people were enjoying singing along to music, and playing dominoes. There was a weekly Brunch Club in the local community centre that was regularly attended by people in the home. Every two weeks there was Care Homes for Older People Page 16 of 29 Evidence: a gentle exercise session run by a visiting company. People from a local church visited regularly. There were regular visits from entertainers. People told us that they could get up and go to bed when they wanted to, and that they could come and go to their bedrooms as they wished during the day. Staff were clear that peoples choices and preferred routines should be respected. Visitors said they were always made welcome and offered refreshment. They said they could see people in private if they wanted to, or take people out of the home. There were several visitors in the home on the day of the inspection visit. There was information available about local advocacy services and also independent advice about care homes. The manager was aware of the implications of the Mental Capacity Act 2005 and had received some training. She said that further training was planned for herself and for other staff. Four people who returned our surveys said they usually liked the meals at the home, one person did not respond to this question. People told us the meals were very good and good quality. There were four dining areas in the home and some people chose to eat in their bedrooms. Dining tables were laid with cloths and cloth napkins. People were asked by care staff each day for their choices of breakfast, lunch and tea. A cooked breakfast was available every day. There were two main choices at lunch time. People could have an alternative if they did not want anything on the menu, for example, one person had soup instead of the main meal at lunchtime on the day of the inspection visit. There was a large choice at tea time, including sandwiches, soup, salad, and omelets. People were offered a light supper during the evening and there was food available during the night if needed. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were satisfactory policies in place and good staff awareness so that people were protected and their concerns effectively dealt with. Evidence: Five people who returned our surveys said they knew how to make a complaint and who to speak to if they were unhappy. Five relatives who returned out surveys said they knew how to make a complaint. Three said the home had responded appropriately when concerns had been raised, two did not respond to this question one of these commented that they had no concerns. People we spoke with were aware of the complaints procedure. They said that any problems raised with staff had been sorted out very quickly and had not reoccurred. The complaints procedure was displayed in the reception area of the home and in each bedroom. Staff spoken with and those who returned our surveys all knew what to do if anyone had concerns about the home. There were satisfactory records of complaints with details of the action taken and the outcome. We received a complaint about the home from an anonymous source in June 2008. We asked the provider to investigate the complaint and report back to us with their findings. We received a prompt and detailed response from the manager that addressed all the issues raised and gave details of action to be taken. Care Homes for Older People Page 18 of 29 Evidence: The home had suitable policies and procedures in place about safeguarding vulnerable adults. Staff had received appropriate training. Staff were aware of types of abuse and of the correct procedures to follow if abuse was alleged or suspected. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was clean, suitably equipped and generally well maintained so that people lived in a pleasant and comfortable environment appropriate to their needs. Evidence: Three people who returned our surveys said the home was always fresh and clean, two people said it usually was. People we spoke with told us they liked the homely environment. Some people said that some areas of the homes decor and carpets were dated and ready for a makeover. Some bedrooms had been redecorated. The decor of the communal areas generally appeared tired and dated. The decor of a corridor on the ground floor appeared quite shabby with scuffs and marks to the walls. There was choice of lounges and dining areas for people to use and these were spacious and comfortably furnished. Two bathrooms had been refurbished to provide a choice of bathing and showering facilities. The bathrooms had been refurbished in a contemporary style and looked clean and bright. Another bathroom was currently being used for storage and it was not clear that there was adequate fire protection in place. People were able to bring items of furniture and other possessions into the home to personalise their bedrooms. Care Homes for Older People Page 20 of 29 Evidence: A sensory garden had been created, reached through patio doors from the central area of the home. This garden was clearly popular with people living in the home and with visitors. Some people had helped with the creation of the garden and the manager said people would be encouraged to continue helping with planting and looking after the garden. The garden was used as the smoking area for people living in the home who smoked. The home was equipped with handrails, grab rails and frames in toilets, specialist beds for people who were more dependent, and manual handling equipment. There were suitable laundry and sluice facilities. Staff had received training about the control of infection and were aware of the correct procedures to follow. There were no offensive odours noticed on the day of the inspection visit, except for one bedroom. The manager took action to ensure the problem was dealt with straightaway. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were sufficient staff with appropriate training to ensure that peoples needs were properly met. Evidence: Two people who returned our surveys said the staff were always available when needed, two said they usually were, and one said they sometimes were. Five relatives who returned our surveys said staff always had the right skills and experience to look after people properly. Staff we spoke with and those who returned our surveys said there were always enough staff on duty to ensure peoples needs were properly met. People told us, the staff are very caring, The staff always are extremely friendly and attentive, and, I have always found the staff very helpful and kind. People said, the staff always come when I need them, and, we can buzz for staff and they come straightaway. We looked at the records of three members of staff, all recruited since the previous inspection. The records had nearly all of the required information and documents, except for a full employment history. It was agreed with the provider and manager Care Homes for Older People Page 22 of 29 Evidence: that full employment histories would be obtained for all staff recruited since the provider took over the home in November 2005. We saw records of the Skills For Care induction programme for new staff. There were individual training records that showed required training was up to date, such as manual handling, fire safety, and first aid. Staff had also received training about the care of people with dementia. Staff spoken with confirmed the induction and training they had received and said the training was useful. Out of 23 care staff, 18 had already achieved National Vocational Qualification (NVQ) at Level 2 or above, (approximately 80 ), and another 2 were working towards the qualification. This exceeded the National Minimum Standard of 50 of care staff with NVQ at Level 2 or above. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was well managed with effective systems in place to ensure that people were protected and their health and welfare promoted. Evidence: The manager was suitably qualified and experienced to run the home. People told us they felt they could go to the manager with any concerns and they were confident that she would take appropriate action. The quality assurance system had been developed since the last inspection. There were meetings for people living in the home every six months where they could discuss any concerns or ideas for improvements. Relatives were invited to these meetings, but did not often attend as the manager said they preferred to talk to her individually. There were regular surveys completed by people living in the home, their relatives, and staff. The results of the surveys were analysed and the results made available. There was a quarterly newsletter produced by the manager. Care Homes for Older People Page 24 of 29 Evidence: The personal money of people living in the home was held securely and there were satisfactory records of all transactions. There were satisfactory records of accidents in the home. The records of the maintenance of fire safety equipment and systems was up to date. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Full and accurate records of medicines must be maintained against which medicines can be safely selected for administration. Records for the administration of medicines, (including external medicines), must be completed at all times. This will ensure that people are protected and are given medication as prescribed. 30/11/2008 2 29 19 There must be a full employment history in place for all staff recruited since November 2005, and for all future staff employed at the home. This will help to ensure a more robust recruitment procedure that protects people living in the home. 31/01/2009 Recommendations Care Homes for Older People Page 27 of 29 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 7 All documents relating to personal care, such as assessments and care plans, should be signed and dated by the person completing them. This will help to ensure that the most up to date information is used to provide care and support for people. Assessments, such as nutritional needs, tissue viability and manual handling, should be regularly and consistently reviewed. This will help to monitor and plan for peoples changing needs to ensure they receive the care and support they require. Any handwritten instructions on medication administration records should be signed by the member of staff who writes them and countersigned by another member of staff who has checked the instructions are correct. This will help to protect people and ensure medication is given as prescribed. The local fire and rescue service should be consulted about the fire protection necessary in the bathroom currently used for storage. Areas of the home where decor is dated and shabby should be redecorated to ensure a pleasant environment for people. 2 7 3 9 4 19 5 19 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!